Open Tangential Excision of Gynecomastia. A Surgical Option for Revision Gynecomastia Surgery.

Abstract

Background: Gynecomastia is a common aesthetic surgical procedure carried out by Plastic Surgeons and various approaches and procedures have been described. Revision surgery following gynecomastia is not uncommon, however there is a paucity of surgical approaches described to correct this known complication. Open tangential excision is a new technique to correct residual gynecomastia following under corrected procedures.
Methods: A ten years retrospective chart analysis was performed, a total of 41 patients (39 primary and 2 secondary) were treated for gynecomastia by the author. Simon’s classification was used and 19 patients had type I,
11 type IIa, 5 type IIb and 4 type III. 2 patients were secondary gynecomastia belonging to Type I and IIb and
had their surgery elsewhere. Of the 39 primary surgeries, 37 were treated using suction assisted lipectomy alone
without gland resection and 2 patients, with type III grade gynecomastia, had vertical scar bipedicle flap along
with suction lipectomy and glandular resection.
Two secondary revisions had tangential excision of residual parenchymal tissue along with suction assisted
lipectomy. Of the two secondary cases, one patient had lower hemiareolar approach and other had periareolar
markings for skin resection with a medially based flap.
Results: Of the 39 primary gynecomastia, four patient required revision surgery. Of the four revisions, one belonged to type IIa and required complete excision of parenchymal tissue, one patient belonging to group IIb, was
treated with further suction assisted lipectomy and two patients, belonging to group type III, required excision of
dog-ears with out further parenchymal resection. Both secondary revisions were treated with tangential excision
of residual gland with suction lipectomy.
Conclusion: Revision surgery following gynecomastia is not uncommon and true prevalence rate is not known.
Revision surgery may be required to remove residual parenchymal tissue or redundant skin envelope, or both,
depending on the degree of the problem at the time of presentation, surgical approach and patient’s preference.
Tangential excision is a new technique to treat such under corrections.
Key Words: Gynaecomastia, medially based flap, double pedicle flap, periareolar approach, vertical scar approach.