A new circumareolar approach combined with power assisted liposuction in the management of advanced gynecomastia.

[AIM] Gynecomastia is a benign proliferation of the glandular tissue of the male breast that causes considerable emotional distress due to restriction of daily activity, especially in young men. In patients with severe gynecomastia, a new approach is described with liposuction combined with circumareolar subcutaneous mastectomy with minimal periareolar scarring, including the elimination of the excess skin. Prospectively recorded data in a period of fifteen-month were evaluated retrospectively for aesthetic outcomes and early and late complications.

[MATERIAL-METHOD] A total of 18 patients (36 breasts) were treated between September 2021 and December 2022. The patient was marked preoperatively while standing up. Under general anesthesia, power assisted liposuction and deepithelialization of excess skin were performed. A superiorly based nipple areola complex (NAC) flap was created with attention to blood supply intact. The excess fibroglandular tissue was resected. The wound was approximated with pursestring suture and the NAC was positioned in its new location. The wound was closed after the insertion of a hemovac drain into the liposuction port.

[RESULTS] The ages of patients with bilateral grade 3 gynecomastia ranged from 17 to 34. Follow-ups ranged from 5 months to 1 year. The prophylactic antibiotic treatment administered to all patients. Liposuction was performed again on one patient due to an aesthetic problem. Minimal areola enlargement was observed in 2 patients.

[CONCLUSIONS] This new circumareolar approach with liposuction is a good method for wide excision of breast tissue in the surgical management of severe gynecomastia with minimal scarring and very good cosmetic results.

[KEY WORDS] Breast, Gynecomastia, Periareolar incision, Power assisted liposuction, Surgical Technique, Subcutaneous mastectomy.