title: Gynecomastia: evolving paradigm of management and comparison of techniques.
abstract: BACKGROUND
  Since 1997, the authors have used a minimally invasive technique for the management of gynecomastia using ultrasound-assisted liposuction and the arthroscopic shaver to remove breast tissue through a remote incision. This technique has allowed for a consistent, refined, "unoperated" postoperative appearance in this patient population. This study analyzes the outcomes of this procedure and compares the procedure against established techniques.
  
  
  METHODS
  A retrospective study was performed on all patients who underwent surgery for gynecomastia at the authors' institution between January of 1988 and October of 2007. A total of 227 patients were divided into four groups: group 1, open excision only (n = 45); group 2, open excision plus liposuction (n = 56); group 3, liposuction only (n = 50); and group 4, liposuction plus arthroscopic shaver (n = 76). Medical records and photographs were used to compare groups for complications and results.
  
  
  RESULTS
  Complications using the liposuction plus arthroscopic shaver technique included seroma (n = 2), hematoma (n = 1), scar revision (n = 1), and skin buttonhole from the arthroscopic shaver (n = 1). There was no difference between groups in the overall incidence of complications (p < 0.20) or the need for reoperation (p < 0.325). Results were scored on a scale of 1 (poor) to 5 (excellent). Group 4 (liposuction plus arthroscopic shaver) had the overall highest mean score, with statistical significance between group 2 (open excision plus liposuction) and group 4 (p < 0.0001).
  
  
  CONCLUSIONS
  Arthroscopic mastectomy for gynecomastia is a safe and effective technique, with excellent cosmetic results and an acceptable complication rate.
authors.affiliation: Rochester, Minn.; and Winnipeg, Manitoba, Canada From the Division of Plastic Surgery, Mayo Clinic, and the Section of Plastic Surgery, University of Manitoba.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Petty
authors.forename: Matthias
authors.initials: M
authors.lastname: Solomon
authors.forename: Edward W
authors.initials: EW
authors.lastname: Buchel
authors.forename: Nho V
authors.initials: NV
authors.lastname: Tran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002648:Child; D006177:Gynecomastia / Q000601:surgery*; D006801:Humans; D015187:Lipectomy; D008297:Male; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome