Frigerio G, Serre A, Engels P E, Kalbermatten D F, André-Lévigne D
Division of plastic and reconstructive surgery, University Hospital of Geneva, Geneva, Switzerland.
Regenerative medicine and reconstructive surgery research group, Department of Surgery, University of Geneva, Geneva, Switzerland.
JPRAS Open. 2024 Sep 18;42:256-267. doi: 10.1016/j.jpra.2024.09.011. eCollection 2024 Dec.
Gynecomastia and lipomastia are benign proliferations of the male breast affecting 32-65% of men. Numerous surgical procedures often result in stigmatizing scars when it comes to skin resection. The purpose of this study was to review skin-sparing techniques and to describe our skin-sparing approach to treat skin excess using transcutaneous netting.
A comprehensive review of the literature was conducted aiming at identifying available techniques to avoid skin resection in gynecomastia or lipomastia patients (Simon's grade IIb and III). Surgical techniques, patient satisfaction, time of follow-up, and complications were assessed.
Seven studies detailed skin retraction techniques, including laser-, ultrasound-, and radiofrequency-assisted liposuction (LAL, UAL, and RAL), microneedling, and nipple-areolar complex (NAC) plaster lifting. All articles provided Simon's grade classification, with most studies including patients with and without skin laxity. Complication rates were low (1.5-10%), and patient satisfaction ranged from 87.5% to 100%.While transcutaneous netting has been reported to reduce hematoma in gynecomastia surgery, no studies specifically examined its role in managing skin redundancy.
Limited data exist on scarless skin retraction techniques for gynecomastia. While LAL, UAL, and RAL show some potential, controlled studies are lacking, and skin resection is often performed for high skin redundancy. We recommend a skin-sparing approach using liposuction and transcutaneous netting for gynecomastia up to Simon's grade III, which allows for skin retraction and NAC fixation. No literature was found assessing the efficacy of transcutaneous netting in promoting skin retraction in gynecomastia.
男性乳房肥大症和脂肪性乳房肥大是男性乳房的良性增生，影响32%至65%的男性。在皮肤切除方面，众多手术操作常常会导致有明显瘢痕。本研究的目的是回顾保留皮肤技术，并描述我们使用经皮网状收紧术治疗多余皮肤的保留皮肤方法。
对文献进行全面综述，旨在确定避免男性乳房肥大症或脂肪性乳房肥大症患者（西蒙氏分级IIb和III级）皮肤切除的可用技术。评估手术技术、患者满意度、随访时间和并发症。
七项研究详细介绍了皮肤收紧技术，包括激光辅助吸脂术、超声辅助吸脂术和射频辅助吸脂术、微针疗法以及乳头乳晕复合体提拉术。所有文章均提供了西蒙氏分级，大多数研究纳入了有和没有皮肤松弛的患者。并发症发生率较低（1.5%至10%），患者满意度在87.5%至100%之间。虽然经皮网状收紧术据报道可减少男性乳房肥大症手术中的血肿，但尚无研究专门考察其在处理皮肤冗余方面的作用。
关于男性乳房肥大症的无瘢痕皮肤收紧技术的数据有限。虽然激光辅助吸脂术、超声辅助吸脂术和射频辅助吸脂术显示出一些潜力，但缺乏对照研究，对于皮肤冗余度高的情况通常仍需进行皮肤切除。我们建议对于西蒙氏分级III级以下的男性乳房肥大症采用吸脂术和经皮网状收紧术的保留皮肤方法，该方法可实现皮肤收紧和乳头乳晕复合体固定。未发现有文献评估经皮网状收紧术在促进男性乳房肥大症皮肤收紧方面的疗效。
