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Glandular Gynecomastia Excision Through Axillary Incision Following Ultra-Sound Assisted Liposuction (UAL) of the Breast

Background: Gynaecomastia is a medical term meaning benign enlargement of the male breast due to a physiological or pathological factor. With a reported prevalence of up to 36%. Male gynaecomastia can be pure, fatty, or mixed. Simon in 1973 grouped the patients into categories according to the size of the gynaecomastia and classified gynecomastia into grades. Rohrich classified gynecomastia according to the degree of hypertrophy and put different treatment options and in cases with more than 500gm hypertrophy he suggested excision and liposuction. The use of ultrasound for cosmetic surgery has been introduced since the late 1980. UAL delivers ultrasonic energy directly to deep fat deposits through very tiny incisions in the skin. This technique enhances the current procedure in liposuction. Following the liposuction excision can be done via different approaches to remove the remaining glandular component of the breast. Material and Methods: 28 male patients with gynecomastia were presented in this study, through the period from February 2012 to October 2016, in Fayoum university hospital. First full detailed history and lab examination was done. The surgery was done either under local anaesthesia with sedation or under general anaesthesia .Liposuction was done using UAL first through anterior axillary incision, and then dissection of the gland was done using the Laparoscopic Scissors. Excision of gland was done through the same incision of liposuction at the axilla. Pressure garments were applied for 4 weeks following the surgery. Results: 26 patients (92.8%) showed good satisfactory results in follow-up period ranging from 6 months to at least up to 2 years. 20 patients (71.4%) had been operated under general anaesthesia and 8 patients (28.6%) under local anaesthesia. The operative time ranged from 1 hour and 15 minutes to 2 hours with mean operative time 1 hour and 35 minutes. All the cases were done as a day cases. None of the patients showed hematomas or seromas or wound infection, one patient had areola injury healed spontaneously and one patient had depressed saucer dish deformity. Conclusion: The UAL and axillary excision of gynecomastia has excellent results with few complications and safe procedure and aids to decreasing the skin laxity following the surgery.