PURPOSE:

A novel surgical technique for severe gynecomastia that removes excess breast tissue as well skin with the additional benefit of areola reduction and relocation via an inconspicuous scar is described.  To accomplish this several cases using this technique are presented.

METHOD:

The surgical technique involves formation of an inferior dermal pedicle to support the NAC and a superior chest wall flap utilizing an inframammary and periareolar incisions.  Excess glandular and adipose breast parenchyma is then removed by excision. The NAC is subsequently reduced and relocated via a circular incision in the superiorly based chest wall flap.  Four patients with severe gynecomastia treated with this surgical approach are presented. 

RESULTS:

Thus far, there has been a high degree of satisfaction with the results by both the authors and patients encouraging future use of the technique.  No major wound or long term complications have been occurred.  A seroma was experienced in one patient that resolved with serial aspiration.  Temporary decrease in nipple sensation was also observed in one patient that resolved over six months. 

CONCLUSION:

Numerous techniques have been described to address gynecomastia including several minimally invasive techniques.  While less invasive techniques provide excellent results with mild to moderate gynecomastia they fail to address some of the issues in more severe gynecomastia; namely skin redundancy, nipple ptosis and areola enlargement.  More traditional techniques do address some these issues but often at the expense of one of them or overall cosmesis.  We have presented a technique capable of reducing both glandular and skin excess while relocated the NAC through two relatively inconspicuous incisions.  Overall results have been quite satisfactory without major complication or morbidity.

	Pre Op		Post Op