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Surgical management of gynecomastia by four-plane tumescent subcutaneous mastectomy (TSM)

Amit R Peswani, Talagavadi Channaiah Anudeep, Ishita Katyal, Prerepa Naga Suparna, Aravind Hosamani, Uday Bhat.


Introduction: Gynecomastia, or the enlargement of breast tissue in men, is one of the most common problems. Surgical management includes surgical excision, liposuction, or both based on grade. Surgical excision by Subcutaneous mastectomy(SM) is the standard for managing gynecomastia with only glandular hypertrophy without excess skin. We have evaluated the ease, safety and pitfalls of SM with the tumescent technique.
Aims and objectives: To describe our technique of tumescent subcutaneous mastectomy (TSM), its operative ease, postoperative analgesia, and complications.
Patients and methods: The study was conducted in a tertiary care hospital's plastic surgery department from August 2018 to July 2021. 53 SM without liposuction were included in the study.
Operative procedure: Infiltration solution consisted of Ringer Lactate - 500ml + 2% Lignocaine (12.5ml) + 1:1000 Adrenaline (0.5ml) + 0.5% Bupivacaine (12.5ml). 200-250 ml of tumescent solution was used per side using the four-plane technique (Sub glandular, glandular, supra glandular and subdermal). SM was done using a standard technique. Operative time, ease of surgery, duration of postoperative analgesia and postoperative complications were recorded on a questionnaire.
Results: 80% of operating surgeons reported very good visualization of tissue planes, and 79.2% reported dissection was easy. 85% of the excisions were performed using 2 or fewer gauze pieces. Post-operative analgesia was achieved for 4-6 hours in more than 75%. Complications like seroma (7.5%), epidermal loss (3.8%), contour abnormality (1.9%) and nipple flattening (3.8%) were noted.
Discussion: The effects of tumescent components like hydro-dissection, vasoconstriction and analgesia added to the benefits of this technique. The complications noted were like or less compared to standard SM.
Conclusion: TSM being safe and easy, with an additional benefit of postoperative analgesia, is a worthy option in managing gynecomastia with glandular hypertrophy without skin excess.

Key words: Gynecomastia, male breast, surgery, tumescent, subcutaneous mastectomy

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