The New Classification for Fatty-Type Gynecomastia (Lipomastia) and 1000 Cases Review

Yoon, Sang Yub; Kang, Min Gu

Abstract

PURPOSE
The authors propose the new classification of fattytype gynecomastia (lipomastia) which can serve as a guide for modifying the periareolar technique.
METHODS
A retrospective analysis was made on 1000 cases of lipomastia operated on in the last 17 months. The extent of the clinical result, the technique employed, and the complications were observed. On the basis of this review the authors observed that at grade I (fat component < 50 mL, fibroglandular component < 3 g each breast), flattening of the thorax can be achieved by means of stab incision, ultrasoundassisted lipectomy (UAL), scavenging suctionassisted lipectomy (SAL) and tissue shaving. At grade II (50 << 150 mL, 3 << 5 g), stab incision, UAL, SAL and pullout method (POM) using small curved scissors. At grade III (150 << 300 mL, 5 << 15 g and prominent inframammary fold (IMF)), minimal incision (56 mm), UAL, SAL and POM using small angulated scissors, and blunting IMF. At grade IV (300 << 500 mL, 15 << 30 g, and glandular ptosis), minimal incision (56 mm), UAL, SAL, fibroglandular excision using small angulated scissors, cutting IMF and fixation of nippleareola complex (NAC) becomes necessary. At grade V (> 500 mL, > 30 g and ptosis), small incision (78 mm), UAL, SAL, fibroglandular excision using large angulated scissors, cutting IMF, upper repositioning of NAC and delayed circumareolar skin reduction or chest lifting becomes necessary.
RESULTS
The complications were minimal but there occurred hematoma (n = 7), infection (n = 3) and hypertrophic scar (n = 13). Most of the patients were satisfied with the outcome.
CONCLUSION
This simple classification may help in choosing the most suitable treatment, thus avoiding insufficient or invasive treatments and undesirable scars.