title: Severe Gynecomastia: New Technique Using Superior Pedicle NAC Flap Through a Circumareolar Approach.
abstract: : Gynecomastia is defined as benign proliferation of glandular breast tissue in men. Gynecomastia causes considerable emotional discomfort because of limitation of everyday activity especially in young men. Surgical treatment of gynecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in men who underwent this intervention. Various surgical techniques were suggested to treat gynecomastia, but most of them end with visible scars especially in severe degree gynecomastia. The aim of many plastic surgeons is to advocate new techniques treating severe gynecomastia (grade II B and III according to Simon et al) with less visible scars.
  
  
  OBJECTIVE
  The author proposed a new technique combining both surgery and liposuction for treating grade II B and III gynecomastia using only circumareolar approach.
  
  
  OBJECTIVE
  This study evaluates aesthetic results after surgery and assessment of the incidence of early and late postoperative complications.
  
  
  METHODS
  The patient was marked preoperatively while standing. Under general anesthesia, ultrasound-assisted liposuction of the periglandular area and de-epithelialization of excess skin were performed. A superiorly based nipple areola complex flap was created based on the subdermal plexus. The excess glandular tissue was resected through the lower half of the circle of the de-epithelialized area. Closure of the wound was done after insertion of 14-French redivac.
  
  
  RESULTS
  This treatment protocol was applied to 27 patients, 18 to 53 years of age, from February 2008 till now. Among these patients, 4 were classified as type IIB and 23 as type III. Follow-up ranged from 3 months to 4 years. Complications were the following: 1 hematoma, 1 wound dehiscence, 1 loss of nipple areola complex, 2 cases of hypertrophied scars, and 3 minor aesthetic problems near areolae.
  
  
  CONCLUSIONS
  A new periareolar approach for correction of severe-grade gynecomastia permits broad resection of excess skin and submammary tissue while avoiding unattractive scars on the patient's chest.
authors.affiliation: From the Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Saad Mohamed Saad
authors.initials: SM
authors.lastname: Ibrahiem
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006177:Gynecomastia / Q000601:surgery*; D006801:Humans; D015994:Incidence; D015187:Lipectomy; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012720:Severity of Illness Index; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult