Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 15  |  Issue : 2  |  Page : 48-51

Liposuction: a veritable option in management of gynecomastia case report


Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Date of Submission20-Jun-2019
Date of Acceptance03-Nov-2019
Date of Web Publication17-Jul-2020

Correspondence Address:
Dr Ugochukwu Uzodimma Nnadozie
Department of Surgery, Ebonyi State University, Abakaliki, Ebonyi State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njps.njps_6_19

Rights and Permissions
  Abstract 

Introduction: Gynaecomastia is the commonest aesthetic problem in men. Treatment in our environment is mainly by open surgical excision. The practice of liposuction is still developing in our region. We present our experience in the use of liposuction in the management of bilateral gynaecomastia in Alex Ekwueme Federal University Teaching Hospital Abakaliki with a satisfactory outcome. Method: We report a case of 33-year old male with idiopathic bilateral gynaecomastia (Simon grade IIb) and resultant aesthetic concern. Treatment was by suction-assisted liposuction with satisfactory outcome. Results: The lipoaspirate from the left breast was 900 mls and 600 mls from the right breast. Male chest contour was regained several weeks post-surgery with good patient satisfaction. Conclusion: Liposuction alone offered a satisfactory outcome in the management in this case.

Keywords: Gynaecomastia, liposuction


How to cite this article:
Nnadozie UU, Enyanwuma EI, Okorie GM, Maduba CC, Ewah LR. Liposuction: a veritable option in management of gynecomastia case report. Nigerian J Plast Surg 2019;15:48-51

How to cite this URL:
Nnadozie UU, Enyanwuma EI, Okorie GM, Maduba CC, Ewah LR. Liposuction: a veritable option in management of gynecomastia case report. Nigerian J Plast Surg [serial online] 2019 [cited 2020 Oct 1];15:48-51. Available from: http://www.njps.org/text.asp?2019/15/2/48/290021


  Introduction Top


Gynaecomastia is a benign enlargement of the male breast which results from increase in glands, stroma, and/or fat.[1]

It often results from increased estrogen activity or decreased testosterone activity.[2] Gynaecomastia must be differentiated from pseudogynaecomastia which involves enlargement of breast fat without glandular enlargement.[3]

Gynaecomastia could be unilateral or bilateral, symmetrical or asymmetrical, symptomatic or asymptomatic. Gynaecomastia passes through three phases namely, florid, intermediate, and fibrous phases.[4]

Numerous techniques for the treatment of gynaecomastia have been described and these include medical therapy, surgical excision, and liposuction procedures.[5]

In our environment, the practice of liposuction is still not common.[6] Gynaecomastia is commonly treated by surgical excision alone; hence we report the use of liposuction as a single modality in the management of gynaecomastia with satisfactory outcome.


  Case report Top


A 33-year old engineer was presented with 16 year history of bilateral breast enlargement of insidious onset and gradual progression. There was no history of breast pain, discharge, or palpable lump. He has normal size testes. He is not a known diabetic or hypertensive patient and has no history suggesting substance abuse or chronic liver disease.

The patient’s concern was essentially cosmetic [Figure 1] and [Figure 2]. Physical examination showed a healthy-looking young man with depressed affect. His vital signs were within normal ranges. He had bilateral, non-tender breast enlargements with no palpable lump. There was slight skin redundancy and ptosis were seen on both breasts. Both testes were normal in size, position, and consistency.
Figure 1 Preoperative marking

Click here to view
Figure 2 Preoperative lateral view

Click here to view


A diagnosis of idiopathic bilateral gynaecomastia, Simon’s grade 2b (fibrous type) was made.

The patient weighed 105 kg with a height of 1. 69 m (BMI is 36.7).

Patient’s investigation results are summarized in [Table 1].
Table 1 Pre operative investigation results

Click here to view


The patient was admitted and informed consent for clinical photographs, surgery, and anesthesia was obtained. Pre-operative markings were done.

General anesthesia with endotracheal intubation was administered.

A 3 mm midclavicular stab incision was made at inframammary line bilaterally and Klein tumescent fluid (1 L of normal saline + 50 ml 1% Lidocaine + 1 ml 1:1000 epinephrine + 20 ml of 8.4% sodium bicarbonate) − 500 ml was infused into each breast after pretunneling. Suction-assisted liposuction (SAL) was carried out with liposuction cannulas (2.5 mm) including Mercedes Benz cannulas (3.0 mm) to break up the fibrous part was done. 900 mls of lipoaspirate was aspirated from the left breast and 600 ml from the right breast after decanting the tumescent fluid.

Stab wounds were closed with nylon 4/0 and compressive elastoplast was applied.

Post-operative complications include ecchymosis around the axillae seen on day 2 post op as well as bullae on both breasts which resulted from reaction to plaster. This was managed as superficial dermal burn injuries with re-epithelialization within eight days.

The patient was discharged on day 3 post-operation with achievement of masculine chest wall contour and patient’s satisfaction after few weeks.


  Discussion Top


Gynaecomastia is the commonest male benign breast disease in our environment with incidence of 3.9–4% of the total benign breast disease in the population. [7],[8]In the male population, gynaecomastia has an incidence of 32–65% with a prevalence in young patient as high as 38%.[9] Two treatment options for gynaecomastia are medical therapy and surgical excision.[10] Gynaecomastia persisting for more than two years will likely not regress spontaneously nor respond to medical treatment because the breast tissue is now fibrotic thus requires surgical treatment.[10] Indications for surgical treatment include failure of spontaneous regression or of regression with medical therapy, gynaecomastia causing psychological distress, or considerable discomfort.[11] Different techniques have been advocated for treatment of gynaecomastia but no technique has universal acceptance.[1] Illouz in the late 1970s introduced the SAL (conventional liposuction).[12] Teimourian and Perlman[13] introduced the use of conventional liposuction in the treatment of gynaecomastia. The common treatment protocol is to do liposuction alone for Simon grade 1, grade 2a (fat dominant type), grade 2b with good quality skin, liposuction with gland excision, and skin excision for some cases of grade 2b and grade 3.[14] We therefore recommend that SAL alone should be used in treatment of selected Simon grade 2b cases of gynaecomastia with good quality skin as observed in our case in addition to Simon grade 1 and 2a.Conventional liposuction (SAL) done via inframammary incisions in Simon grade 2b allows good suction of all the areas of the breast with resultant good sculpturing of the chest wall. Pinch method was used to assess extent of residual breast tissue. Use of specialized tiger-tipped cannulas (Mercedes Benz cannulas) to break up the fibroglandular tissues around the areolar area has reduced the need for open excision of the fibroglandular tissue with minimal complications.[15],[16] Redundant skin was not big enough to require excision and was managed with pressure garment. Good aesthetic outcome and high patient’s satisfaction were seen [Figure 3] and [Figure 4]. Post-operative complication, ecchymosis, has been minimal despite the use of Mercedes Benz cannula. No residual breast lump was seen.
Figure 3 Postoperative lateral view

Click here to view
Figure 4 Postoperative anterioposterior view

Click here to view



  Conclusion Top


The use of liposuction in the treatment of gynaecomastia in this case had improved aesthetic outcome, patient’s satisfaction, and minimal post-operative complications.

We recommend increase in the use of liposuction in the treatment of well-selected cases of gynaecomastia in our environment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Arvind A, Khan MA, Srinivasan K, Robert J. Gynaecomastia correction: a review of our experience. Indian J Plastic Surg 2014;47:56-60.  Back to cited text no. 1
    
2.
Johnson RE, Murad HM. Gynaecomastia: pathophysiology, evaluation and management. Mayo Clin Proc 2009;84:1010-15.  Back to cited text no. 2
    
3.
Braunstein GD. Gynaecomastia. N Engl J Med 2007;357:1229-37.  Back to cited text no. 3
    
4.
Bannayan GA, Hadju SI. Gynaecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol 1972;27:431-7.  Back to cited text no. 4
    
5.
Fruhstorfer BH, Malata CM. A systematic approach to the surgical treatment of gynaecomastia. Br J Plast Surg 2003;56:237-46.  Back to cited text no. 5
    
6.
Onah II, Nnadozie UU, Ogbonnaya IS. Aesthetic surgery indications at National Orthopaedic hospital Enugu. Nigerian Journal of Plastic Surgery 2010;6:12-15.  Back to cited text no. 6
    
7.
Adeniji KA, Adelusola KA, Odesanmi WO. Benign disease of the breast in Ile-Ife. A 10 year experience and literature review. Cent Afr J Med 1997;43:140-3.  Back to cited text no. 7
    
8.
Uwaezuoke SC, Udoye EP. Benign breast lesions in Bayelsea State Niger Delta Nigeria: A 5 year multicentrehistopathological audit. Pan Afr Med J 2014;19:394.  Back to cited text no. 8
    
9.
Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr. Classification and management of gynaecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg 2003;111:909-23.  Back to cited text no. 9
    
10.
Khallaf AM, Mostafa H. Gynaecomastia liposuction vs surgical excision of the glandular tissue. AAMJ 2014;12: supll 148-61.  Back to cited text no. 10
    
11.
Kornstein AN, Cinelli PB. Inferior pedicle reduction technique for larger forms of gynaecomastia. Aesthetic Plastic Surgery 1992;16:331-5.  Back to cited text no. 11
    
12.
Illouz YG. Body contouring by lipolysis: a 5 yr experience with over 3000 cases. Plast Reconstr Surg 1983;72:591-7.  Back to cited text no. 12
    
13.
Teimourian B, Perlman R. Surgery for gynaecomastia, Aesthetic Plast Surg 1983;7:155-7.  Back to cited text no. 13
    
14.
Mladick AA. Gynaecomastia: liposuction and excision. Clin Plast Surg 1991;18;815-22.  Back to cited text no. 14
    
15.
Boeni R. Treatment of gynaecomastia: suction curettage with rib like projections cannula. The American Journal of Cosmetic Surgery 2011;28:67-70.  Back to cited text no. 15
    
16.
Abdelrahman I, Steinvall I, Mossaad B, Sjoberg F, Elmasry M. Evaluation of glandular liposculpture as a single treatment for grade I and II gynaecomastia. Aesth Plast Surg 2018;42:1222-30.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed467    
    Printed39    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]