title: Combined approach for gynecomastia.
abstract: BACKGROUND
  Gynecomastia is a deformity of male chest. Treatment of gynecomastia varied from direct surgical excision to other techniques (mainly liposuction) to a combination of both. Skin excision is done according to the grade. In this study, experience of using liposuction adjuvant to surgical excision was described.
  
  
  METHODS
  Between September 2012 and April 2015, a total of 14 patients were treated with liposuction and surgical excision through a periareolar incision. Preoperative evaluation was done in all cases to exclude any underlying cause of gynecomastia.
  
  
  RESULTS
  All fourteen patients were treated bilaterally (28 breast tissues). Their ages ranged between 13 and 33 years. Two patients were classified as grade I, and four as grade IIa, IIb or III, respectively. The first 3 patients showed seroma. Partial superficial epidermolysis of areola occurred in 2 cases. Superficial infection of incision occurred in one case and was treated conservatively.
  
  
  CONCLUSIONS
  All grades of gynecomastia were managed by the same approach. Skin excision was added to a patient that had severe skin excess with limited activity and bad skin complexion. No cases required another setting or asked for 2(nd) opinion.
authors.affiliation: Plastic Surgery Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed Hassan
authors.initials: AH
authors.lastname: El-Sabbagh
keywords: gynecomastia; liposuction; periareolar incision; surgical excision