Endoscope-Assisted Transaxillary Approach in Gynecomastia Correction

Sim, Hyung Bo; Hong, Yoon Gi

Abstract

Various approaches for gynecomastia correction have been described to remove glandular tissue. In recent years, standard and ultrasound-assisted liposuction became popular methods. However, these methods cannot meet all their needs in some patients who do not want to have scars on their breast's esthetic units and are known to have a tendency to form keloid. The purpose of this study is to introduce the usefulness of endoscope-assisted transaxillary removal of breast tissue in selected patients. Through a stab incision in the axilla, the entire surgical area was infiltrated using the tumescent technique. Ultrasoundassisted liposuction(UAL) was initially performed, followed by power-assisted liposuction(PAL). Then, the endoscope was introduced through a 3 cm axillary incision, and endoscopic electrocautery dissection of glandular tissue was performed under direct vision throughout the procedures. Adjuvant subcutaneous dissection around areola was done via 1 cm subareolar incision. Twelve male patients(22 breasts), whose age ranged from 19 to 38 years, underwent this technique from April 2007 to July 2008. Follow-up ranged from 2 to 16 months with a mean of 9 months. Average volume of aspirate was 290 mL, and mean amount of glandular tissue removed was 35g. No major complications occurred. The resulting scar in the axilla was inconspicuous, and patients were satisfied with postoperative breast contour. These results show that the combined use of an endoscope with the subareolar technique enables an effective treatment of gynecomastia and provides a smooth masculine breast contour without stigma of breast surgery.