title: Boomerang pattern correction of gynecomastia.
abstract: BACKGROUND
  After excess skin and fat are removed, a body-lift suture advances skin and suspends ptotic breasts, the mons pubis, and buttocks. For women, the lift includes sculpturing adiposity. While some excess fat may need removal, muscular men should receive a deliberate effort to achieve generalized tight skin closure to reveal superficial muscular bulk. For skin to be tightly bound to muscle, the excess needs to be removed both horizontally and vertically. To aesthetically accomplish that goal, a series of oblique elliptical excisions have been designed.
  
  
  METHODS
  Twenty-four consecutive patients received boomerang pattern correction of gynecomastia. In the last 12 patients, a J torsoplasty extension replaced the transverse upper body lift. Indirect undermining and the opposing force of a simultaneous abdominoplasty obliterate the inframammary fold. To complete effacement of the entire torso in 11 patients, an abdominoplasty was extended by oblique excisions over bulging flanks.
  
  
  RESULTS
  Satisfactory improvement was observed in all 24 boomerang cases. A disgruntled patient was displeased with distorted nipples after revision surgery. Scar maturation in the chest is lengthy, with scars taking years to flatten and fade. Complications were limited and no major revisions were needed.
  
  
  CONCLUSIONS
  In selected patients, comprehensive body contouring surgery consists of a boomerang correction of gynecomastia. J torsoplasty with an abdominoplasty and oblique excisions of the flanks has proven to be a practical means to achieve aesthetic goals. Gender-specific body lift surgery that goes far beyond the treatment of gynecomastia best serves the muscular male patient after massive weight loss.
  
  
  METHODS
  Therapeutic, IV.
authors: Pittsburgh, Pa. From the Hurwitz Center for Plastic Surgery, University of Pittsburgh Medical Center.
authors: Dennis J
authors: DJ
authors: Hurwitz
mesh_terms: D061645:Abdominoplasty / Q000379:methods; D017439:Cicatrix, Hypertrophic / Q000473:pathology; D004954:Esthetics; D005260:Female; D006177:Gynecomastia / Q000473:pathology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology; D009558:Nipples / Q000473:pathology; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D012727:Sex Characteristics; D050151:Subcutaneous Fat / Q000473:pathology / Q000601:surgery; D013536:Suture Techniques; D015431:Weight Loss
references: Hurwitz DJ. Single-staged total body lift after massive weight loss. Ann Plast Surg. 2004;52:435–441
references: Clavijo-Alvarez JA, Hurwitz DJ. J torsoplasty: A novel approach to avoid circumferential scars of the upper body lift. Plast Reconstr Surg. 2012;130:382e–383e
references: Gusenoff JA, Coon D, Rubin JP. Pseudogynecomastia after massive weight loss: Detectability of technique, patient satisfaction, and classification. Plast Reconstr Surg. 2008;122:1301–1311
references: Letterman G, Schurter M. Surgical correction of massive gynecomastia. Plast Reconstr Surg. 1972;49:259–262