title: Gynecomastia associated with herniated nipples: an optimal surgical approach.
abstract: BACKGROUND
  Gynecomastia is a common disorder observed in male plastic surgery patients. Treatment options may include observation, surgical excision, or liposuction techniques. Congenital herniated nipple is a more rare condition, especially in male patients. We present the case of a 12-year-old boy with bilateral gynecomastia and herniated nipple-areolar complexes.
  
  
  METHODS
  A staged repair was undertaken in this patient with grade 2 gynecomastia. The first operation was ultrasonic liposuction bilaterally, yielding 200 mL of aspirate from the left and 400 mL on the right, to correct the gynecomastia. The second procedure, performed 6 months later, was a bilateral periareolar mastopexy to repair the herniated nipple-areolar complexes.
  
  
  RESULTS
  The result of the first procedure was flattened and symmetrical breast tissue bilaterally, essentially a correction of the gynecomastia. The herniated nipples were still present, however. Bilateral periareolar mastopexies were then performed with resulting reduction of the herniations. There were no complications with either procedure, and a good cosmetic result was achieved.
  
  
  CONCLUSIONS
  A staged surgical approach was successful in correcting both conditions with an excellent aesthetic result and the advantage of decreased risk for nipple complications.
authors.affiliation: Division of Plastic Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Jaiswal
authors.forename: Lee L Q
authors.initials: LL
authors.lastname: Pu
mesh_terms: D002648:Child; D003131:Combined Modality Therapy; D004954:Esthetics; D006177:Gynecomastia / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples / Q000002:abnormalities / Q000601:surgery*; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology