Surgical Management For Gynecomastia— Incision Types

Male breasts or man boobs referred as gynecomastia, is a condition where there is a breast formation in males. Abnormal enlargement of the breast tissues may occur due to increased level of estrogen hormones in some men. It may be bilateral or unilateral depending on the skin redundancy and the breast volume involved. Nevertheless, such condition can be a major reason of poor body image for the bearer. Surgery is the best resort for a perment male breast removal.

This unfortunate morphostructural impairment of the mammary region in men is caused by the cutaneous distortion of the breast skin or parenchymal hypertrophy. It is mainly found occurring in about 32%-36% of adult males and around 60% of adolescent boys. There are three main types of patterns being identified depending on the varied degrees of ductal and stromal proliferation: the intermediate one, fibrous pattern and the florid pattern.

The sole objective behind the surgical management for gynecomastia are as follows:

  1. Restore the normal male chest contour
  2. Correct the deformity of the nipple, areola or the breast

The best surgical options for a seeking patient of gynecomastia is liposuction-assisted mastectomy or simple mastectomy or a combination of both the approaches. It is noticed that most patients receive the maximum benefit from the combined approach than the direct one.

Surgical Resection (Sub- Cutaneous Mastectomy)

The choice of the surgical technique depends upon the skin redundancy after the surgery. The skin normally shrinkage is more common in younger individuals as compared to the older individuals. There are many incisions techniques, but the most common is the intra areolar one. Also known as Webster incision extends through the circumference of the areola (in the pigmented portion). The glandular breast tissue has a greater density than the adipose tissue which is why the glandular tissue is not amenable to the liposuction.

The trans axillary incision is preferred due to its advantage of the less scars on the chest wall  and the disadvantages being the glandular resection In the case of severe gynecomastia the nipple transposition and the skin resection may be necessary.

Two Stage Breast Reduction For Severe Gynecomastia

This is suited for the moderate-sever gynecomastia. The first stage is followed by the Webster type perioral incision, followed with the removal of fat, gland and fibrous tissue for achieving a better contour. Perfumed after 4-6 months, the blood supply allows a per areolar donut mastectomy. The best part about this type of incision is the limited incision just around the nipple areola which is hardly noticeable later on.

Liposuction- Assisted Mastectomy

Liposuction was first introduced with the surgical resection in the year of 1980.  But the recent advent of ultrasound liposuction has improved the outcome and solved issues of nipple distortion, saucer deformity, and areola slough.

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