Technical refinements in the surgical treatment of gynecomastia.

The authors present their experience with liposuction of breast fat followed by sharp excision of the breast gland, when needed. Liposuction is performed, introducing a short uterine curette through a hemicircular periareolar incision. The suction is carried out as close as possible to the glandular tissue and all around the areola in a fan shape until the boundaries of the mammary region are reached in all directions to allow better skin redraping. Because the fat layers are encased in the fibrous septi of the superficial fascial system, suction of the fat lobules allows shrinkage of the septi and also enables skin retraction in patients with marked gynecomastia and considerable skin redundancy. Moreover, because liposuction causes an increase of coagulative factors in the treated area, it plays an important role in spontaneous hemostasis. In fact, the hypercoagulative state of the fat treated by liposuction implies minimal bleeding in additional surgery. The removal of the residual mammary gland is very easy, hemostasis is usually not needed, and drains are usually not used.