Gynecomastia: The 4Dx technique

[madman]

Abstract

In surgery for gynecomastia, it is not sufficient to just remove the gland or do a liposuction that addresses the front of the chest only as it is not aesthetically pleasing for the patient and the surgeon alike. Most patients expect to achieve a sculpted look,which includes not only the breast area but also the surrounding areas such as the sides,the axillae, and the infraclavicular region. To tackle these areas and achieve a wellsculpted and aesthetic look, we describe the 4Dx (4 Directions) technique of liposuction for gynecomastia. It also makes the procedure more objective for plastic surgeons while allowing for individualization of the procedure.

 

[madman]

 

[madman]

Fig. 1 (A and B) Markings of the regions to be addressed (dark blue marker). “Bra-like” appearance of the marking for liposuction is noted. (C) Site of axillary and infra-areolar incisions (yellow marker); direction of strokes of the liposuction cannula from axillary incision (green arrows); from the infra-areolar incision (light blue arrows); cross-tunneling to opposite side (purple arrows) and upper inner quadrant (red outline) are marked.

 

[madman]

Fig. 2 (A) A case of gynecomastia operated elsewhere, liposuction of the prepectoral area and gland removal done. Please note the prominent scars and the wide and flat unnatural appearance of the chest, heaviness in the lateral side rolls. (B) After 4Dx liposuction, well defined contours seen.

 

[madman]

Fig. 3 (A) Preoperative (above) and postoperative (below) photographs of a patient with gynecomastia operated with the 4Dx technique. (B) Stealth incisions (axilla and infra-areolar) do not leave visible scars.

 

[madman]

Fig. 4 Preoperative (left) and postoperative (right) photographs of a patient who has side rolls (grade 3a). (A) Front views. (B) Side views. A well-contoured shape of the chest achieved with the 4Dx technique.

 

[madman]

Fig. 5 Preoperative and postoperative photographs of a case of gynecomastia grade 4b. (A) Front views. (B) Oblique views. Even after liposuction and gland removal, along with a lift for the nipple-areola complex (NAC), such patients have excess skin persistent in the lower part of the chest, which may be excised in a second stage as per the desires of the patient.

 

[madman]

Fig. 6 A case of gynecomastia grade 2a, preoperative (left) and postoperative (right). (A) Front views. (B) Oblique views. (C) Side views.

 

[madman]

Fig. 7 Another case of gynecomastia operated elsewhere, where only the gland removal and liposuction of surrounding areas was done. On photographic evaluation, it seemed like the patient has a lot of excess skin (left). However, on clinical examination, it was noted that the folds of the skin, especially on the sides had a lot of fat. The patient was treated as a grade 3a gynecomastia. With only the 4Dx technique of liposuction of the areas of concern, a well-balanced look of the chest was achieved at 3 months (right).

 

[madman]

Fig. 8 Preoperative (left) and postoperative (right) photographs of a patient with grade 2a gynecomastia operated with the 4Dx technique of liposuction. (A) Front views. (B) Side views. (C) Oblique views.