Breast reshaping in gynecomastia by the “pull-through technique”: considerations after 15 years
Tóm tắt
Gynecomastia corresponds to abnormal and excessive development of breast tissue in male patients. It may be unilateral or bilateral and, depending on breast volume and skin redundancy, it can be classified, according to Simon, in four different groups. Standard therapy is surgery and different techniques have been described so far, including different type of incisions in the periareolar or intrareolar skin. In 1996 in this journal we described our personal technique, called “pull-through.” Our technique combines liposuction that is performed on two planes, subcutaneous and subglandular, and sharp parenchymal excision, performed through the small liposuction incisions. These incisions are short (1–1.5 cm) and hidden in the inframammary fold and behind the anterior axillary pillar. Furthermore the operation can be performed under local anesthesia and with a short recovery period. Since then we have operated on 260 patients. We now present our 15 years experience and our review of literature, focused on authors who used and criticized our technique. Results, in terms of breast volume reduction, skin retraction, and minimal visibility of scars, were very good, even in cases more severe than in our first series (Simon's type IIb and female-to-male transsexuals). Patients' satisfaction rate was high as well and the incidence of complications was low. The results we observed in our series and the ones presented by different authors confirmed the validity and feasibility of the “pull-through” technique in terms of esthetic and functional results, patient satisfaction, and a low incidence of complications.
Tài liệu tham khảo
Simon B, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51(1):48–52
Morselli PG (2000) Temporalis muscle hypertrophy: a new plastic surgery procedure. Plast Reconstr Surg 106:1156–1161
Mladick RA (1991) Gynecomastia: liposuction and excision. Clin Plast Surg 18:815
Rohrich RJ, Ha RY, Kenkel JM, Adams WP (2003) Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg 111(2):909–923
Persichetti P, Berloco M, Muccioli Casadei R, Marangi G, Di Lella F, Nobili A (2001) Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plast Reconstr Surg 107(4):948–954
Lista F, Ahmad J (2008) Power-assisted liposuction and the pull-through technique for the treatment of gynecomastia. Plast Reconstr Surg 121(3):740–747
Ramon Y, Fodor L, Peled IJ, Eldor L, Egozi D, Ullmann Y (2005) Multimodality gynecomastia repair by cross-chest power-assisted superficial liposuction combined with endoscopic-assisted pull-through excision. Ann Plast Surg 55(6):591–594
Morselli PG (1996) “Pull-through”: a new technique for breast reduction in gynecomastia. Plast Reconstr Surg 97:450–454
Letterman G, Schurter M (1972) Surgical correction of massive gynecomastia. Plast Reconstr Surg 28:177
Dufourmentel L (1928) L'incision areolaire dans la chirurgie du sein. Bull Mem Soc Chir Paris 20:9
Webster JP (1990) Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg 12:557
Pitanguy I (1966) Transareolar incision for gynecomastia. Plast Reconstr Surg 38:414
Letterman G, Schurter M (1969) Surgical correction of gynecomastia. Am Surg 35:322
Huang TT, Hidalgo JE, Lewis SR (1982) A circumareolar approach in surgical management of gynecomastia. Plast Reconstr Surg 69:35
Rosenberg GJ (1987) Gynecomastia: suction lipectomy as a contemporary solution. Plast Reconstr Surg 80:379
Becker H (1990) The treatment of gynecomastia without sharp excision. Ann Plast Surg 24:380
Courtiss HE (1987) Gynecomastia: analysis of 159 patients and current recommendations for treatment. Plast Reconstr Surg 79:740–750
Davidson BA (1979) Concentric circle operation for massive gynecomastia to excise the redundant skin. Plast Reconstr Surg 63(3):350–354
Balch CR (1978) A transaxillary incision for gynecomastia. Plast Reconstr Surg 61(1):13–16
Bracaglia R, Fortunato R, Gentileschi S, Seccia A, Farallo E (2004) Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia. Ann Plast Surg 53(1):22–26