Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia
Tóm tắt
Gynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on “liposuction alone”, so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia. We made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014–2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement). The patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were “satisfied” to “very satisfied”. The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) “dissatisfied” preoperatively to 4.1 (0.2) “satisfied” post-operatively. The observers’ mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7–29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650–800), operating time was 67 (65–75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481–594). Combined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers’ ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.
Tài liệu tham khảo
Nuttall FQ (1979) Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab 48(2):338–340
Gusenoff JA, Coon D, Rubin JP (2008) Pseudogynecomastia after massive weight loss: detectability of technique, patient satisfaction, and classification. Plast Reconstr Surg 122(5):1301–1311
Bailey SH, Guenther D, Constantine F, Rohrich RJ (2016) Gynecomastia management: an evolution and refinement in technique at UT Southwestern Medical Center. Plast Reconstr Surg Glob Open 4(6):e734
Kinsella C Jr., Landfair A, Rottgers SA et al (2012) The psychological burden of idiopathic adolescent gynecomastia. Plast Reconstr Surg 129(1):1–7
Nuzzi LC, Cerrato FE, Erickson CR et al (2013) Psychosocial impact of adolescent gynecomastia: a prospective case–control study. Plast Reconstr Surg 131(4):890–896
Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51(1):48–52
Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr. (2003) Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg 111(2):909–923 (discussion 924–905)
Hammond DC (2009) Surgical correction of gynecomastia. Plast Reconstr Surg 124(1 Suppl):61e–68e
Ridha H, Colville RJ, Vesely MJ (2009) How happy are patients with their gynaecomastia reduction surgery? J Plast Reconstr Aesthet Surg 62(11):1473–1478
Hodgson EL, Fruhstorfer BH, Malata CM (2005) Ultrasonic liposuction in the treatment of gynecomastia. Plast Reconstr Surg 116(2):646–653 (discussion 654–645)
Fruhstorfer BH, Malata CM (2003) A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 56(3):237–246
Lee YK, Lee JH, Kang SY (2017) Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision. J Plast Surg Hand Surg 52:117–125
Rosenberg GJ (1987) Gynecomastia: suction lipectomy as a contemporary solution. Plast Reconstr Surg 80(3):379–386
Rosenberg GJ (1994) A new cannula for suction removal of parenchymal tissue of gynecomastia. Plast Reconstr Surg 94(3):548–551
Samdal F, Kleppe G, Aabyholm F (1991) A new suction-assisted device for removing glandular gynecomastia. Plast Reconstr Surg 87(2):383–385
Anderson RC, Cunningham B, Tafesse E, Lenderking WR (2006) Validation of the breast evaluation questionnaire for use with breast surgery patients. Plast Reconstr Surg 118(3):597–602
Marozzi M (2014) Testing for concordance between several criteria. J Stat Comput Simul 84(9):1843–1850
Fruhstorfer BH, Malata CM (2003) A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 56(3):237–246
Abou Ashour H (2015) Liposuction excision of gynecomastia through an axillary liposuction opening: a novel technique. Egypt J Surg 34(3):170–176
Benito-Ruiz J, Raigosa M, Manzano M, Salvador L (2009) Assessment of a suction-assisted cartilage shaver plus liposuction for the treatment of gynecomastia. Aesthet Surg J 29(4):302–309
Schroder L, Rudlowski C, Walgenbach-Brunagel G, Leutner C, Kuhn W, Walgenbach KJ (2015) Surgical strategies in the treatment of gynecomastia grade I–II: the combination of liposuction and subcutaneous mastectomy provides excellent patient outcome and satisfaction. Breast Care (Basel) 10(3):184–188
Webster JP (1946) Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg 124(3):557–575
Letterman G, Schurter M (1969) The surgical correction of gynecomastia. Am Surg 35(5):322–325
Letterman G, Schurter M (1972) Surgical correction of massive gynecomastia. Plast Reconstr Surg 49(3):259–262
Wray RC Jr., Hoopes JE, Davis GM (1974) Correction of extreme gynaecomastia. Br J Plast Surg 27(1):39–41
Balch CR (1978) A transaxillary incision for gynecomastia. Plast Reconstr Surg 61(1):13–16
Morselli PG (1996) “Pull-through”: a new technique for breast reduction in gynecomastia. Plast Reconstr Surg 97(2):450–454
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
Teimourian B, Perlman R (1983) Surgery for gynecomastia. Aesthetic Plast Surg 7(3):155–157
Luckey RC (1992) Modified technique for correction of gynecomastia. Plast Reconstr Surg 89(4):767
Zocchi M (1992) Ultrasonic liposculpturing. Aesthet Plast Surg 16(4):287–298
Zukowski ML, Ash K (1998) Ultrasound-assisted lipoplasty learning curve. Aesthet Surg J. 18(2):104–110
Scuderi N, Paolini G, Grippaudo FR, Tenna S (2000) Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: analysis of local and systemic effects, efficacy, and costs of these methods. Aesthet Plast Surg 24(6):395–400
Illouz YG (2006) Complications of liposuction. Clin Plast Surg 33(1):129–163