Background: The difficulty of treating severe grades of
gynecomastia lies in the resection of excess skin. This resection
can result in extensive scars located in conspicuous sites. To
reach the optimum results, excess skin should be excised and
the excess fat and gland should be managed too. Managing
the excess fat, enlarged mammary gland, together with excision
of excess periareolar skin with nipple-areola transposition in
single-stage is associated with higher risk of injuring the
vascular pedicle of nipple-areola, and also associated with
excessive pleating of periareolar skin due to the sudden
reduction in the size of areola which don't allow for skin
retraction to occur. Staged-reconstruction will allow for gradual
reduction in the size of areola allowing for skin adaptation
leading to minimal pleating of periareolar skin, and also
preserve the nipple-areola vascularity.
Aim of Work: Is to compare between reconstruction of
grade III gynecomastia in single-stage versus two-stage, as
regard the complications rate.
Patients and Methods: Twelve patients with severe (grade
III) gynecomastia with enlarged ptotic nipple-areola, underwent
surgery over a 2-year period. All patients were marked preoperatively.
Under general-anesthesia, traditional liposuction
of the pei-glandular area was performed, followed by deepithelialization
of excess peri-areolar skin to elevate the
nipple-areola. The glandular tissue was delivered by “pullthrough"
technique, through a lateral trans-dermal peri-areolar
incision. Study performed on two groups, group I, surgery
was performed in single-stage, while in group II, surgery was
performed in two-stages, with liposuction of excess fat and
resection of excess peri-areolar skin with elevation of nippleareola
in the first stage then, three months later, patients
underwent minimal liposuction just to facilitate delivery of
the gland, with its delivery using the “pull-through" technique.
Results: Fellow-up period was 6 months. No hematoma,
seroma, breast skin necrosis, breast asymmetry, or nippleareola
malposition were detected post-operative in both groups.
Results were reported as “uniformly good to excellent" on a
patient satisfaction scale, as all patients were satisfied with
their breasts contour and nipple-areola position postoperative.
Transient hyposthesia of nipple-areola occurred and improved
spontaneously at 6 months post-operative. By comparing the
complications rate between both groups, results showed that
single-stage reconstruction in group I was associated with
higher complications rate as regard the nipple-areola vascularity,
and as regard the presence of excessive pleating of
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periareolar skin than in group II. One case in group I show
complete loss of nipple-areola. Another case of nipple-areola
vascular compromise and partial necrosis were also detected
in group I. While, no cases showed compromised vascularity
of nipple-areola in group II patients with two-stage reconstruction.
Conclusions: Two-stage reconstruction is considered as
safe procedure for correction of severe (grade III) gynecomastia,
which preserve nipple-areola vascularity, and permits
broad resection of excess skin and mammary tissue, while
avoiding unattractive scars on the patient's chest, with minimal
pleating of periareolar skin.