Gynecomastia is the too much breast enlargement in guys, mimicking that of women. The term derives from two Greek words, γυνε (female) and μαστος (breast). The incidence, as documented by different authors, runs from 32% to 36% among adult males and even while high as 60 per cent in adolescent boys. In accordance to the etiology, gynecomastia can be classified as physiological, pathological, pharmacological, and idiopathic, the latter being the most common.
About three histological patterns have been identified, depending on different degrees of stromal and ductal proliferation: the florid pattern, the fibrous design, and the intermediate one. The three types stand for the stages of advancement of the pathology: in the majority of situations, after a duration greater than 1 year, hypertrophic breast growth becomes irreversibly fibrotic. For this reason medical treatment usually has limited success.
Dependent on morphology and volume level, gynecomastia is classified according to Simon (1973) in four different groups (1):
I—Minor breast enlargement without skin redundancy,
IIa—Moderate breast enlargement without skin redundancy,
IIb—Moderate breast enlargement with minor skin redundancy, and
III—Gross breast enhancement with epidermis redundancy that mimics woman breast ptosis.
Simon's category supplies a simple guideline for diagnosis and management: the several amount of adipose cells, parenchyma, and skin redundancy are paramount in selecting patients and different medical strategies. Actually, surgical static correction is the accepted standard of treatment.
Many different techniques have been explained and proposed and tumble into three main groupings:
Excisional techniques adopting different approaches and incisions,
Suction-assisted lipectomy, and
Ultrasound-assisted large volume liposuction atlanta.
In our opinion, the main issue is to obtain a pleasurable chest wall condition, limiting scar extension, especially in the areolar area. The technique, first explained in 1996 and called the pull-through technique, includes liposuction and parenchymal opération. Ten years after its publication, we reviewed our series, to obtain an exact assessment based on a larger patient population and a longer follow-up.
The surgical treatment is always performed under basic anesthesia. Markings are done with the patient in an upright position and include:
Boundaries of liposuction, and
Pores and skin incisions, 8–12 mm long and set one right behind the anterior axillary pillar and the other at the lateral extremity of the inframammary fold, because of to the need for crossing liposuction tunnels and achieving the glandular tissue in the periareolar area.
A new hypotonic solution and local anesthetic with epinephrine just one: 400, 000 is utilized for subcutaneous infiltration. This step is now performed in a different way than before: the solution is injected through the two skin incisions utilizing a 2-mm multi-hole smooth cannula.
Twenty minutes following the solution has been injected, large volume liposuction atlanta is performed. This is a wide and accurate liposuction with various aims:
Fat tissue removal,
Breast contours remodeling, and
Glandular tissue isolation.
Fat tissue removal and contour reshaping are performed routinely in large volume liposuction atlanta of the pectoral region. Isolation of the glandular tissue, yet , is a specific step with this technique: the aim is to split up glandular tissue from the cutaneous and fascial attachments, to be able to facilitate the following extraction in small pieces through the short skin incisions. In order to achieve that, large volume liposuction atlanta is performed in a very meticulous way together two different planes; on the deeper one, a 4-mm preformatted “fingertip” (2) cannula is employed above the pectoral structures with the purpose of mobilizing glandular tissue. Dealing with the superficial plane, we use a thinner cannula (2–3 mm) to independent the parenchyma from the subcutaneous tissue, freeing the superficial layer skin parts.
The two layers must be meticulously created bearing in mind that the goal of the procedure is to detach glandular tissue almost completely both from the inferior plane and the superficial one. Once the parenchyma has been free of their lower and superficial parts, it can be broken up: at this point of the treatment, the parenchyma mimics an octopus with its head related to the areola. From the ending of large volume liposuction atlanta, the residual glandular tissues, located mostly in the subareolar area, can be pinched in order to localize and evaluate their condition and amount. The parenchyma to be excised is pinched between the thumb and the catalog, then it is clamped using a surgical forceps approved through the skin sillon.
The instrument is then pulled out through the skin incision used for liposuction, the glandular cells is exposed, and the parenchyma is excised by using a scalpel or the electrocautery. The piecemeal resection requires accurate inspection and palpatory sign on order to reduce bleeding and steer clear of excessive removing with consequent skin problems. All the pieces of removed mammary tissue are accumulated and sent, as separated specimens from the right and left breast, for histological examination.
After glandular tissue removal has already been completed, consistency and order, regularity of the mammary area are checked by pinching the skin: additional large volume liposuction atlanta, utilizing a thin cannula can eventually be performed to smooth out contour unevenness, especially at the margins of the pectoral area and along the anterior axillary pillar. A suction drain is inserted on each side and maintained for 24–48 h. Skin incisions are sutured in layers, and stitches are removed on the eighth postoperative day. A compressive dressing is applied at the end of surgery and removed during the time of stitches' removal; after that, an elastic garment should be worn until the end of the first postoperative month.
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