madman
Super Moderator
Abstract
Background
Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years.
Methods
Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out.
Results
The average volume of tumescent solution infiltrated during TLA was 300 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy.Follow-up time ranged from 30 days to 1 year.
Conclusions
We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique,supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies.
Discussion
When starting therapy for gynecomastia, it is crucial to perform a thorough assessment of the patient’s medical history and rule out other potential causes, such as endocrine disorders or certain medications. It is also important to note that gynecomastia often resolves on its own and may regress spontaneously. Pharmacological treatments that address hormonal imbalances can be effective, especially in the early stages. However, surgical intervention is considered the most effective treatment for gynecomastia that persists beyond two years of therapy [10, 11]. Most individuals seeking surgical treatment for gynecomastia are usually young or middle-aged. They often prefer quick recovery and minimally invasive procedures due to their busy work or study schedules. Our study indicates that the surgical approach we propose effectively meets the needs of patients seeking swift recovery with minimal complications. In our study, most participants were between 21 and 43 years old, with a mean age of 31. According to our data, 87% of the patients had bilateral gynecomastia, and 13% unilateral. These findings are consistent with Tolba et al. study [12], which reported 87% bilateral gynecomastia with an average age of 22.5 years. Murali et al. [13] found over 80% bilateral cases with an average age of 33 years, and Chang Li et al. [14] reported 87.8% bilateral cases with a mean age of 27 years. The literature and our study suggest the third decade is the most common age for presentation, with bilateral pathology being more prevalent[15–17].
Conclusion
We discussed our results with a surgical approach for treating gynecomastia, which involves a comprehensive rehabilitation regimen combined with the liposuction plus periareolar excision technique, all performed on an outpatient basis under local tumescent anesthesia. Our findings validate the feasibility of this proposal for gynecomastia treatment, resulting in expedited recovery and high patient satisfaction rates without an increase in complication rates. Consequently, the adoption of this approach, incorporating local anesthetic techniques, merits serious consideration in gynecomastia management strategies.
Background
Tumescent local anesthesia (TLA) involves infusing a saline solution containing lidocaine and epinephrine into tissues to achieve localized anesthesia and vasoconstriction. While liposuction under general anesthesia remains the most used treatment, we introduce a novel TLA approach for gynecomastia surgery, drawing from our extensive experience in recent years.
Methods
Between the years 2010 and 2023, we performed gynecomastia surgery on 60 male patients under TLA. The gynecomastia was treated by liposuction plus periareolar excision technique. Liposuction was carried out on both breasts in every case, regardless of whether the gynecomastia was bilateral or unilateral. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated between the pectoral fascia and the mammary gland, and then the surgery was carried out.
Results
The average volume of tumescent solution infiltrated during TLA was 300 mL per breast. There were no reports of adrenaline or lidocaine toxicity, and no cases required a conversion to general anesthesia. Patients experienced no pain or discomfort during the preoperative infiltration or surgical procedure. We observed a major postoperative complications rate of 6.7%, represented by three incident of hematoma and one case of seroma. A minor complication rate of 5% was observed: two cases of retraction of the NAC and one case of gynecomastia recurrence, the latter undergoing an additional combination procedure with liposuction and subcutaneous mastectomy.Follow-up time ranged from 30 days to 1 year.
Conclusions
We developed a new outpatient surgical method for gynecomastia using liposuction and periareolar excision under tumescent local anesthesia. This technique,supported by a comprehensive rehabilitation plan, proved a successful and quick recovery, and high patient satisfaction. Our results suggest it is a feasible and effective option, warranting further consideration in gynecomastia treatment strategies.
Discussion
When starting therapy for gynecomastia, it is crucial to perform a thorough assessment of the patient’s medical history and rule out other potential causes, such as endocrine disorders or certain medications. It is also important to note that gynecomastia often resolves on its own and may regress spontaneously. Pharmacological treatments that address hormonal imbalances can be effective, especially in the early stages. However, surgical intervention is considered the most effective treatment for gynecomastia that persists beyond two years of therapy [10, 11]. Most individuals seeking surgical treatment for gynecomastia are usually young or middle-aged. They often prefer quick recovery and minimally invasive procedures due to their busy work or study schedules. Our study indicates that the surgical approach we propose effectively meets the needs of patients seeking swift recovery with minimal complications. In our study, most participants were between 21 and 43 years old, with a mean age of 31. According to our data, 87% of the patients had bilateral gynecomastia, and 13% unilateral. These findings are consistent with Tolba et al. study [12], which reported 87% bilateral gynecomastia with an average age of 22.5 years. Murali et al. [13] found over 80% bilateral cases with an average age of 33 years, and Chang Li et al. [14] reported 87.8% bilateral cases with a mean age of 27 years. The literature and our study suggest the third decade is the most common age for presentation, with bilateral pathology being more prevalent[15–17].
Conclusion
We discussed our results with a surgical approach for treating gynecomastia, which involves a comprehensive rehabilitation regimen combined with the liposuction plus periareolar excision technique, all performed on an outpatient basis under local tumescent anesthesia. Our findings validate the feasibility of this proposal for gynecomastia treatment, resulting in expedited recovery and high patient satisfaction rates without an increase in complication rates. Consequently, the adoption of this approach, incorporating local anesthetic techniques, merits serious consideration in gynecomastia management strategies.
