title: Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction.
abstract: BACKGROUND
  Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction.
  
  
  METHODS
  From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach.
  
  
  RESULTS
  A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%).
  
  
  CONCLUSIONS
  This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative workup is important to rule out specific diseases or malignancy causing the GM.
authors.affiliation: Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Schröder
authors.affiliation: Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rudlowski
authors.affiliation: Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Walgenbach-Brünagel
authors.affiliation: Department of Radiology and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Leutner
authors.affiliation: Department of Gynecology and Obstetrics and Center for Integrated Oncology (CIO), Cologne/Bonn, University Hospital Bonn, Germany.
authors.forename: Walther
authors.initials: W
authors.lastname: Kuhn
authors.affiliation: Division of Plastic and Aesthetic Surgery, University Hospital Bonn, Germany.
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Walgenbach
keywords: Gynecomastia; Liposuction; Periareolar mastopexy; Subcutaneous mastectomy