Improving Surgical Treatment for Severe Gynecomastia and Avoiding Skin Resection: Skin Redistribution and Fixation Approach for Aesthetic Excellence

Abstract Background Gynecomastia, a common condition involving benign breast tissue enlargement in men, poses challenges for plastic surgeons, especially in severe cases. Current surgical methods for severe gynecomastia often require complex, invasive procedures with skin resection, resulting in significant scarring. Conversely, techniques avoiding skin resection frequently leave skin redundancy and an unsatisfied chest contour. Objectives The authors of this study introduce a skin redistribution and fixation approach, which help to improve aesthetic outcomes and eliminate the need for skin excision. Methods The surgical procedure comprised 4 stages: an initial liposuction, a mastectomy, a subsequent liposuction session, and an approach for the redistribution and fixation of skin. Liposuction was extended across the breasts, chest wall, and lateral chest wall. Subcutaneous mastectomy was performed through small infraareolar incisions. The redistribution and fixation approach involved 2 steps: surgeons manually distributed the loose and accumulated skin evenly across the chest, followed by the application of a sterile, self-adhesive foam dressing to secure the skin on each side of the chest. Results Between July 2018 and January 2024, 77 patients with severe gynecomastia received treatment with skin redistribution and fixation, whereas 73 underwent traditional liposuction and mastectomy. Follow-up periods ranged from 13 months to 5 years. Patients received skin redistribution and fixation approach reported improved satisfaction regarding the final shape, contour, and symmetry. Conclusions The skin redistribution and fixation approach could help to enhance aesthetic outcomes and achieve better chest contour in surgical treatment for severe gynecomastia. Level of Evidence: 4 (Therapeutic)