Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Aesthetic Plast Surg. 2020 Jun;44(3):653-661. doi: 10.1007/s00266-020-01618-0. Epub 2020 Jan 27.
Gynecomastia is one of the most common disorders affecting adolescent and adult males. It is a benign disorder but has severe psychological manifestations like low self-confidence, depression, anxiety and social phobia in patients suffering from gynecomastia. Different surgical techniques have been described utilizing a variety of incisions, excisions, lipectomy and liposuction methods. Very frequently, these methods are combined for the gynecomastia treatment with variable reported results. However, there is a lack of studies comparing these techniques. The present study was planned to compare cases of gynecomastia treated by liposuction with periareolar excision (delivery technique) and liposuction with a pull-through technique.
A prospective randomized control study was conducted at a tertiary care hospital on 20 patients with gynecomastia. The patients were assigned to either liposuction with periareolar excision (delivery technique) or liposuction with pull-through technique. Anthropometric analysis and breast evaluation questionnaire (BEQ) scores were analyzed and compared before and after the surgery.
The majority of the study subjects were between 21 and 30 years of age. Low self-confidence was the main reason for surgery in most of the cases. Twelve patients had gynecomastia grade IIa and eight had grade IIb. Both groups had similar responses to BEQ scores before and after the surgery with no statistically significant difference. A statistically insignificant difference was observed between the groups on comparison of anthropometric analysis preoperatively and postoperatively. The mean lipoaspirate volume was 280 ml for the pull-through technique and 367 ml for the periareolar excision technique. No complications were observed in cases operated on by the pull-through technique, while two cases (10%) operated on by the periareolar excision had hematomas.
Both techniques provide excellent cosmetic results with low risk of complications in both small and moderate breast enlargement with skin excess. The pull-through technique combines the benefits of direct excision of glandular tissues along with the minimally invasive nature of liposuction. Thus, performing the procedure via a single incision without the use of drains is a safer alternative to traditional liposuction with the periareolar excision technique.
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男性乳房发育症是影响青少年和成年男性的最常见疾病之一。虽然它是一种良性疾病，但患有男性乳房发育症的患者会出现严重的心理表现，如自信心低下、抑郁、焦虑和社交恐惧症。已经描述了多种利用各种切口、切除、吸脂和抽脂方法的手术技术。非常频繁地，这些方法结合起来治疗男性乳房发育症，报告的结果也有所不同。然而，目前缺乏对这些技术的比较研究。本研究旨在比较经乳晕切口切除（分娩技术）和经皮穿刺抽脂术治疗的男性乳房发育症病例。
在一家三级保健医院进行了一项前瞻性随机对照研究，共纳入 20 例男性乳房发育症患者。患者被分配到乳晕切口切除（分娩技术）吸脂组或经皮穿刺抽脂术组。分析并比较术前和术后的人体测量分析和乳房评估问卷（BEQ）评分。
大多数研究对象的年龄在 21 至 30 岁之间。大多数病例中，自信心低下是手术的主要原因。12 例患者为 IIa 级男性乳房发育症，8 例为 IIb 级。两组患者的 BEQ 评分在手术前后均有相似的反应，无统计学差异。两组患者的术前和术后人体测量分析比较无统计学差异。经皮穿刺抽脂术组的平均吸脂量为 280ml，乳晕切口切除组为 367ml。经皮穿刺抽脂术组无并发症发生，而乳晕切口切除组有 2 例（10%）发生血肿。
两种技术都能提供极好的美容效果，且并发症风险低，适用于小范围和中等程度的乳房增大伴皮肤多余的情况。经皮穿刺抽脂术结合了直接切除腺体组织的优点和吸脂术的微创性。因此，通过单一切口而不使用引流管进行手术是一种替代传统乳晕切口切除技术的更安全的方法。
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