Technical refinements in the surgical treatment of gynecomastia

The authors present their experience with liposuction of breast fat followe d by sharp excision of the breast gland, when needed. Liposuction is perfor med, introducing a short uterine curette through a hemicircular periareolar incision. The suction is carried out as close as possible to the glandular tissue and all around the areola in a fan shape until the boundaries of th e mammary region are reached in all directions to allow better skin redrapi ng, Because the fat layers are encased in the fibrous septi of the superfic ial fascial system, suction of the fat lobules allows shrinkage of the sept i and also enables skin retraction in patients with marked gynecomastia and considerable skin redundancy. Moreover, because liposuction causes an incr ease of coagulative factors in the treated area, it plays an important role in spontaneous hemostasis, In fact, the hypercoagulative state of the fat treated by liposuction implies minimal bleeding in additional surgery. The removal of the residual mammary gland is very easy, hemostasis is usually n ot needed, and drains are usually not used.