Abstract: Gynecomastia, the benign enlargement of male breast tissue, affects a significant proportion of the male population and can lead to psychosocial distress and decreased quality of life. Surgical intervention remains a cornerstone in the management of gynecomastia, aiming to restore a masculine chest contour while minimizing complications and achieving high patient satisfaction. This article reviews the current state of gynecomastia surgery, including surgical techniques, outcomes, advancements, and considerations for patient selection and postoperative care.

Introduction: Gynecomastia is characterized by the proliferation of glandular breast tissue in males, resulting in breast enlargement. It can be caused by hormonal imbalances, medication side effects, or underlying medical conditions, impacting up to 65% of adolescent males and a substantial portion of adult men. Despite its benign nature, gynecomastia often leads to embarrassment, body image issues, and avoidance of activities such as swimming or sports. While conservative management options exist, surgical correction is frequently sought for definitive treatment.

Surgical Techniques:

1. Liposuction Techniques:
   • Tumescent Liposuction: Involves infiltration of a tumescent solution to facilitate fat removal, followed by suction through small cannulas.
   • Power-Assisted Liposuction (PAL): Uses mechanized movement of the cannula to enhance fat removal precision and minimize trauma.
   • Ultrasound-Assisted Liposuction (UAL): Utilizes ultrasound energy to disrupt fat cells, particularly effective in dense breast tissue.
2. Excision Techniques:
   • Subcutaneous Mastectomy: Direct excision of glandular tissue through periareolar or inframammary incisions, suitable for cases with significant glandular hypertrophy.
   • Combined Techniques: Often, a combination of liposuction and glandular tissue excision achieves optimal results, tailored to individual patient anatomy and severity of gynecomastia.

Advancements in Surgical Technology: Recent advancements in surgical technology have revolutionized gynecomastia treatment, enhancing precision, safety, and aesthetic outcomes:

• Vaser® Liposuction: Uses ultrasound energy to selectively target fat cells while preserving surrounding tissues.
• Endoscopic Techniques: Minimally invasive approach with smaller incisions and reduced scarring.
• 3D Imaging and Simulation: Preoperative planning tools that enhance surgical precision and patient communication.

Outcomes and Complications: Successful gynecomastia surgery aims to achieve a natural, masculine chest contour with minimal scarring and complication rates. Key outcomes include improved self-esteem, body image satisfaction, and increased social confidence. Complications, although rare, may include hematoma, seroma, infection, asymmetry, and contour irregularities. Careful patient selection, adherence to surgical principles, and meticulous postoperative care are crucial in mitigating risks and optimizing outcomes.

Patient Selection and Counseling: Patient evaluation includes a thorough medical history, hormonal assessment if indicated, and discussion of expectations and surgical options. Candidates for surgery typically exhibit stable gynecomastia, good overall health, and realistic expectations. Counseling should address surgical goals, recovery process, potential risks, and expected outcomes to ensure informed decision-making and patient satisfaction.

Postoperative Care and Rehabilitation: Postoperative care involves monitoring for complications, managing discomfort, and promoting optimal healing:

• Compression Garments: Essential for minimizing swelling and supporting tissue retraction.
• Activity Restrictions: Gradual return to normal activities under guidance to prevent strain or complications.
• Follow-up Visits: Regular monitoring of healing progress, addressing patient concerns, and evaluating aesthetic outcomes.

Gynecomastia surgery continues to evolve with advancements in surgical techniques and technology, offering effective solutions to improve the physical and psychological well-being of affected individuals. Tailored approaches combining liposuction and glandular excision, along with meticulous preoperative planning and postoperative care, contribute to achieving predictable and satisfactory outcomes. Future research should focus on further refining surgical techniques, optimizing patient selection criteria, and exploring innovative technologies to enhance long-term results and patient satisfaction.

Author: Dr. Nazmi Baycin

Plastic surgeon in Dubai