title: Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia.
abstract: BACKGROUND
  Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple-areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle.
  
  
  METHODS
  All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed.
  
  
  RESULTS
  Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m2. In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found.
  
  
  CONCLUSIONS
  We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Thiénot
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France. nbertheuil@gmail.com.|SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France. nbertheuil@gmail.com.|STROMAlab, UMR5273 CNRS/UPS/EFS - INSERM U1031, Rangueil Hospital, Toulouse, France. nbertheuil@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bertheuil
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Nicolle Hospital, University of Rouen, Rouen, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Carloni
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Méal
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Aillet
authors.affiliation: Department of Plastic and Burn Surgery, CHU of Montpellier, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200, Rennes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Watier
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D004954:Esthetics; D005602:France; D006085:Graft Survival; D006177:Gynecomastia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015187:Lipectomy / Q000379:methods; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
keywords: Gynecomastia; Liposuction; Male breast; Male mastectomy; Massive weight loss; Postero-inferior pedicle; Pseudogynecomastia; Surgery