Gynecomastia surgery

At the most expressed hypertrophy of mammary glands the most safe and reliable operation is reduction mammoplasty with a free transplantation of the nipple and areola, like a full-layer skin flap.

This operation is shown in those cases when the estimated mass of removed tissues exceeds 1200 g. In some cases, the determining factor in the decision is the distance from the jugular to the nipple. If it exceeds 45 cm, then it is usually not possible to transfer the nipple-areolar complex to a new position over a distance of more than 20 cm without disturbing its blood supply.

The principle of surgery is to remove a large part of the breast, the formation of a "new" gland of skin-fat flaps and a free transplantation of a nipple-areola complex consisting of the epidermis, dermis and muscle layer.

Markup. The new location of the nipple is determined when the patient is standing. This point is somewhat lower than usual: 1-2 cm below the pectoral fold and 24-28 cm from the jugular notch. After the removal of a significant number of tissues, the remaining stretched skin after some time is shortened and the pacifier-areolar complex moves to a more cranial position.

The markup is continued when the patient is lying down. Determine the medial border of resection, for which the iron is displaced laterally and draw a line from the point of the future projection of the nipple to the submammary fold. The lateral border of resection is also defined, with the difference that the gland is displaced medially (see Figure 37.3.3). At the top of the projection point, the nipple is measured downwards of 8 cm on each line, from points A and A1, the lines are drawn obliquely down to the intersection with the submammary fold (Figure 37.3.15).

Operation technique. After infiltration of the nipple-areolar complex, it is taken like a full-thickness skin flap with a diameter of 4-4.5 cm areola.

Excess gland tissue is resected in one block along the marking lines to the fascia of the large pectoral muscle. Skin-fat flaps sew together. Wounds are sutured tightly by multi-row sutures, drained with tubes with active aspiration of wound contents.

The new areola is deepidermosed. This place is placed graft nipple and areola, fixing it with thin seams and a pressure bandage.

Postoperative period. In some cases, according to the indications at the end of the operation or the first day after it, the patient needs a blood transfusion. Drainage is removed on the 2-3rd day, if necessary, the drainage system is left for a longer period. The pressure bandage from the transplant of the nipple-areolar complex is removed after 10 days. Stitches are removed 2 weeks after the operation.

As a rule, the operation gives a good cosmetic result with a small number of complications. At the same time, the objective consequences of this type of intervention are loss of nipple sensitivity, loss of feeding function, and the possibility of depigmentation of the nipple and areola.

Other types of reducing mammaplasty

In some cases, in the absence of ptosis and with minor (moderate) hypertrophy of the mammary glands, a decrease in their volume is possible without moving the nipple-areolar complex into a new position. The optimal candidates for this operation are young, nulliparous patients, in whom the elastic skin of the breast is able to contract.

Reduction mammoplasty is made from submammary access 6-10 cm long. The gland tissue is excised in its lower sector, not reaching the areola by 4 cm and keeping the thickness of the skin-fat layer at least 3 cm.

Naturally, this operation can not significantly affect the shape of the gland and, even more so, correct its omission.

With fatty hypertrophy of the mammary glands, it is possible to reduce their volume with liposuction.

Vacuum suction of fat is also used with the standard technique of reduction mammoplasty for additional contour correction.

[1], [2], [3], [4], [5], [6], [7]