Atlas of Breast Surgery by Ismail Jatoi & John Benson & Hani Sbitany

Author:Ismail Jatoi & John Benson & Hani Sbitany
Language: eng
Format: epub
ISBN: 9783030459512
Publisher: Springer International Publishing

Sometimes a combination of surgery and liposuction will yield the best results and maximize chest wall symmetry (Fig. 4.15).

Fig. 4.15(a–f) Treatment of gynecomastia with liposuction. (Indication for liposuction only in cases of fatty tissue or in addition for body contouring)

For patients with modest degrees of gynecomastia, a periareolar incision is preferred and can be extended with small wings medially and laterally. The nipple-areola complex is retracted anteriorly and the underlying breast tissue extirpated by sharp dissection or possibly liposuction depending on consistency of the tissue. It is crucial to ensure that dissection is carried out to the peripheral limits of the breast tissue, and a small disc of breast tissue should be retained underneath the nipple to avoid a sunken deformity. Note that any residual breast tissue in this context is not associated with elevated risk for breast cancer in contrast to risk-reducing nipple-sparing forms of mastectomy in women. Hemostasis is achieved using electrocautery and the wound closed in layers with a continuous subcuticular dissolvable monofilament suture (3-0 or 4-0). The surgical cavity should be irrigated copiously prior to closure and the skin suture supported with robust closure of the subcutaneous tissues to minimize adherence of the nipple to the chest wall musculature. An alternative choice of incision is one sited along the inframammary fold. However, this may hinder access to the superior limits of the breast and be cosmetically less acceptable to non-hirsute individuals (Fig. 4.16).

Fig. 4.16Treatment of gynecomastia with subcutaneous mastectomy

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