title: Treatment of severe gynecomastia (Grade III) by resection of periareolar skin.
abstract: BACKGROUND
  The difficulty of treating severe gynecomastia lies in the resection of excess skin. This resection can result in extensive scars located in conspicuous sites. Several procedures have been proposed in an attempt to solve this problem.
  
  
  OBJECTIVE
  The authors propose a new technique for treating severe gynecomastia using a periareolar approach, starting from the principle of vascularization of the nipple-areola complex (NAC) by way of the subdermal plexus.
  
  
  METHODS
  The patient was marked preoperatively. Under general anesthesia, lipoplasty of the periglandular area was performed, followed by deepithelialization of excess skin. The glandular tissue was resected through a transdermal incision in the lower portion of the deepithelialized area.
  
  
  RESULTS
  Twelve patients with severe gynecomastia underwent surgery over a 5-year period. No cases of partial or total necrosis of the NAC were observed. Complications included 1 case of unilateral hematoma, 1 case of bilateral seroma and 2 cases of decreased sensibility of the NAC.
  
  
  CONCLUSIONS
  A new periareolar approach to correction of gynecomastia permits broad resection of excess skin and submammary tissue, while avoiding unattractive scars on the patient's chest.
authors.forename: Douglas
authors.initials: D
authors.lastname: Haddad Filho
authors.forename: Rodrigo Garcia
authors.initials: RG
authors.lastname: Arruda
authors.forename: Nivaldo
authors.initials: N
authors.lastname: Alonso