Comparative Study Using Different Techniques in Treatment of Severe Gynecomastia after Massive Weight Loss: Analysis of Long-Term Outcomes with Italian Version of Body-Q

Introduction

The aims of this study are: 1) analysis of long-term outcomes of correction of severe gynecomastia with different technique; 2) Apply the italian version of BODY-Q; 3) Present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia.

Materials and Methods

The study population consisted of men who had undergone correction of severe gynecomastia. Between January 2008 and March 2018, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q post-operative satisfaction chest module. We administered the questionnaire electronically almost 1 year after surgery for each procedure. Patients were divided into three groups: 1) Adenomammectomy with circumareolar scar, 2) Adenomammectomy with inframammary fold scar, 3) Adenomammectomy with inframammary fold scar using ICAP flaps.

All patients had experienced substantial weight loss (> 30 kg) and presented with bilateral severe tissue ptosis of the breast, follow up almost of 2 years,had a good understanding of the Italian language, and signed consent were included in the study. We excluded all patients with weight loss less than 30 kg, patients with unstable weight, heavy smokers, drug-addicted patients, and those without severe gynecomastia or breast severe ptosis. The sample was studied about age, BMI, comorbidity, bariatric surgical procedures, follow up, type of surgical procedure, complications and secondary procedures.

Results

We performed 487 severe gynecomastia correction from 2008 to 2018; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts in which 52 with circumareolar scar, 18 with inframammary fold scar, 10 with inframammary fold scar using ICAP flaps. Secondary procedures in group one were 16, in group two were 2, in group three was 1. We compared the secondary procedures of group 1 with the other groups and we obtained a significance difference with a P=0,04. The average time between the surgical procedure and completing the questionnaires was 12 months. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m² at the time of surgical correction of gynecomastia. In all patients, severe breast ptosis was associated with significant skin laxity in the upper abdominal wall. Sleeve gastrectomy had been performed in 32 patients, biliopancreatic diversion in 16 patients, and gastric bypass in 32 patients. The average weight loss was 48 kg. From the BODY-Q analysis, the group of patients undergoing Adenomammectomy with inframammary fold scar using ICAP flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image.

Conclusions

This is the first study which used BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction.