Ziegler Ulrich E, Lorenz Udo, Daigeler Adrien, Ziegler Selina N, Zeplin Philip H
Lymph-mediZin Bietigheim am Forst, Bietigheim-Bissingen.
BG Klinik Tübingen, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen, Germany.
Ann Plast Surg. 2018 Sep;81(3):290-294. doi: 10.1097/SAP.0000000000001522.
Pseudogynecomastia is the increased aggregation of fatty tissue in the area of the male breast with resultant female appearance. Two forms can appear: pseudogynecomastia after massive weight loss (pseudogynecomastia obese [PO]) and pseudogynecomastia, which is caused only by adipose tissue (pseudogynecomastia fat). For PO, only the Gusenoff classification with corresponding operative treatment options exists. However, this classification is limited by the fact that it underestimates the extensive variability of residual fat tissue and skin excess, both crucial factors for operative planning. For this reason, we propose a modification of the treatment algorithm for the Gusenoff classification based on our results to achieve more masculine results.
A total of 43 male patients with PO were included in this retrospective study (grade 1a, n = 1; grade 1b, n = 1; grade 2, n = 17; grade 3, n = 24). Forty-two mastectomies with a free nipple-areola complex (NAC) transposition (grades 2 and 3) and 1 with a subcutaneous mastectomy (grade 1a) with periareolar lifting were performed. A retrospective chart review was performed to obtain data regarding age, body mass index, body mass index loss, weight loss, reason for weight loss, comorbidities, nicotine, and additional procedures, postoperative sensitive on the NAC transplants and complications.
None of the free-nipple grafts were lost. Forty (95%) of 42 patients with mastectomy had a resensitivity on the NAC.
For pseudogynecomastia, the treatment algorithm of the Gusenoff classification should be modified and adapted according to our recommendations to achieve more optimal masculine results.
假性男性乳房发育是指男性乳房区域脂肪组织聚集增加，导致乳房外观呈女性化。可出现两种类型：大量体重减轻后的假性男性乳房发育（肥胖型假性男性乳房发育[PO]）和仅由脂肪组织引起的假性男性乳房发育（脂肪型假性男性乳房发育）。对于PO，仅存在古斯诺夫分类法及相应的手术治疗方案。然而，该分类法存在局限性，因为它低估了残余脂肪组织和皮肤多余量的广泛变异性，而这两个因素对于手术规划至关重要。因此，我们根据研究结果对古斯诺夫分类法的治疗算法提出修改建议，以获得更具男性化的效果。
本回顾性研究共纳入43例PO男性患者（1a级，n = 1；1b级，n = 1；2级，n = 17；3级，n = 24）。其中42例行游离乳头乳晕复合体（NAC）移位的乳房切除术（2级和3级），1例行乳晕周围提升的皮下乳房切除术（1a级）。通过回顾病历获取患者年龄、体重指数、体重指数下降情况、体重减轻情况、体重减轻原因、合并症、吸烟情况、额外手术、NAC移植术后敏感性及并发症等数据。
所有游离乳头移植均未丢失。42例行乳房切除术的患者中，40例（95%）NAC恢复了感觉。
对于假性男性乳房发育，应根据我们的建议修改和调整古斯诺夫分类法的治疗算法，以获得更理想的男性化效果。
