|2009 Annual Meeting Abstracts
Gynecomastia, Evolving Paradigm of Management and Comparison of Techniques
Matthias Solomon, MD, FRCS, Nho V. Tran, MD, FACS, Paul M. Petty, MD.
Mayo Clinic, Rochester, MN, USA.
PURPOSE: In 1997, the senior author developed a minimally invasive technique for management of gynecomastia using a combination of ultrasound assisted liposuction, standard liposuction and an arthroscopic shaver to remove breast tissue through a small remote incision. This technique has eliminated the need for open excision of breast tissue for gynecomastia in all but one patient in the senior author’s experience for the past decade. It also has allowed for a more consistent, refined, ‘unoperated’ post-operative appearance in this patient population. The purpose of this study was to analyze the outcomes with this procedure and compare it against established surgical techniques.
METHODS: A retrospective study approved by the Institutional Review Board was performed on all patients who underwent surgery for gynecomastia between January 1988 and October 2007. A total of 227 patients were divided into four groups. Group 1(Open excision only, n=45), Group 2 (Open excision plus liposuction, n=56), Group 3 (Liposuction only, n=50) and Group 4 (Liposuction and arthroscopic shaver, n=76). Analysis of medical records and photographs were used to compare groups for complications and results. Groups were compared using the Kruskal-Wallis and Rank sum tests.
RESULTS: Over a 20 year period, 227 patients (436 breasts) underwent surgical treatment for gynecomastia. The condition was bilateral in 82.8% of patients. Mean age at surgery was 31.1 (range 11 to 77 years). Mean follow up was 6 months. Etiology was determined to be idiopathic (47%), physiological (34%), hypogonadism (10%), drug induced (7%) and liver failure (2%). Complications using the liposuction plus arthroscopic shaver technique included seroma (n=2), hematoma (n=1), scar revision (secondary to a superficial burn from ultrasonic liposuction, n=1) and skin button hole from the arthroscopic shaver (n=1). There was no difference between the groups in the overall incidence of complications (Fishers exact test, p<0.20). However, the number of seromas and hematomas in the liposuction plus arthroscopic shaver group (n=3), was lower when compared to the excision plus liposuction group (n=8). Four patients in group 4 (Liposuction with arthroscopic shaver) were operated for recurrence. Two patients were known to have hypogonadism. Etiology was unknown in the other two patients. Again, there was no statistical difference between the groups with regard to recurrence and need for reoperation (Fishers exact test, p<0.325). Results were scored on a scale of 1(poor) to 5(excellent). Group 4 (liposuction and arthroscopic shaver) had the overall highest mean score. However, the difference was statistically significant only between group 2 (Excision with liposuction) and group 4 (Liposuction and arthroscopic shaver); p <.0001. Based on a review of comments during the postoperative visits, patients in the liposuction plus arthroscopic shaver group (group 4) appeared to be more satisfied with their outcome than patients who had excision (groups 1 and 2).
CONCLUSIONS: We conclude that arthroscopic mastectomy for gynecomastia, is a safe and effective technique with excellent cosmetic results. When compared to the excision technique we have obtained superior results with an acceptable complication rate.