Wolter A, Scholz T, Diedrichson J, Liebau J
Klinik für Plastische und Ästhetische Chirurgie, Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf.
Handchir Mikrochir Plast Chir. 2013 Apr;45(2):73-9. doi: 10.1055/s-0033-1334910. Epub 2013 Apr 29.
Gynecomastia is a persistent benign uni- or bilateral enlargement of the male breast ranging from small to excessive findings with marked skin redundancy. In this paper we introduce an algorithm to facilitate the selection of the appropriate surgical technique according to the presented morphological aspects.
The records of 118 patients (217 breasts) with gynecomastia from 01/2009 to 08/2012 were retrospectively reviewed. The authors conducted three different surgical techniques depending on four severity grades. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and the need to re-operate were observed and related to the employed technique.
In 167 (77%) breasts with moderate breast enlargement without skin redundancy (Grade I-IIa by Simon's classification) a subcutaneous semicircular periareolar mastectomy was performed in combination with water-jet assisted liposuction. In 40 (18%) breasts with skin redundancy (Grade IIb) a circumferential mastopexy was performed additionally. An inferior pedicled mammaplasty was used in 10 (5%) severe cases (Grade III). Complication rate was 4.1%. Surgical corrections were necessary in 17 breasts (7.8%). The patient survey revealed a high satisfaction level: 88% of the patients rated the aesthetic results as "very good" or "good", nipple sensitivity was rated as "very good" or "good" by 83%.
Surgical treatment of gynecomastia should ensure minimal scarring while respecting the aesthetic unit. The selection of the appropriate surgical method depends on the severity grade, the presence of skin redundancy and the volume of the male breast glandular tissue. The presented algorithm rarely leads to complications, is simple to perform and shows a high satisfaction rate and a preservation of the nipple sensitivity.
男性乳房肥大是男性乳房持续的良性单侧或双侧增大，表现从小到明显增大不等，并伴有明显的皮肤冗余。在本文中，我们介绍一种算法，以根据呈现的形态学特征来辅助选择合适的手术技术。
回顾性分析2009年1月至2012年8月期间118例（217侧乳房）男性乳房肥大患者的病历。作者根据四种严重程度等级采用了三种不同的手术技术。观察了并发症发生率、患者对美学效果的满意度、乳头敏感度以及再次手术需求等结果参数，并将其与所采用的技术相关联。
167侧（77%）乳房为中等程度增大且无皮肤冗余（西蒙分类法的I-IIa级），采用皮下乳晕周围半圆形乳房切除术联合水刀辅助吸脂术。40侧（18%）有皮肤冗余的乳房（IIb级）另外进行了环形乳房固定术。10例（5%）严重病例（III级）采用了下蒂乳房成形术。并发症发生率为4.1%。17侧乳房（7.8%）需要进行手术矫正。患者调查显示满意度较高：88%的患者将美学效果评为“非常好”或“好”，83%的患者将乳头敏感度评为“非常好”或“好”。
男性乳房肥大的手术治疗应在尊重美学单元的同时确保瘢痕最小化。合适手术方法的选择取决于严重程度等级、皮肤冗余情况以及男性乳腺组织的体积。所介绍的算法很少导致并发症，操作简单，显示出高满意度且能保留乳头敏感度。
