Addressing Male Breast Enlargement: Liposuction Alone Vs Liposuction with Endoscope-Assisted Glandular Excision
- Admin
- Apr 4
- 4 min read
Gynecomastia, the benign enlargement of male breast tissue, affects approximately 30% of young males. While the condition is often benign, it can have profound effects on psychological well-being, contributing to low self-esteem, poor body image, and emotional distress. A recent study by Ali, Sheikh, Ahmed, Imran, Khurram, Mohammed, Rehman, Noha, and Abhishek, Rupraj, published in the Indian Journal of Plastic Surgery (2025), titled Gynecomastia Surgery: Liposuction Alone versus Liposuction with Endoscope-Assisted Glandular Excision – A Comparative Study, offers a detailed exploration of surgical options. This article summarizes their research, focusing on anatomical insights, surgical methods, and comparative outcomes for treating gynecomastia.
Understanding Gynecomastia
Gynecomastia arises from an imbalance between estrogen and testosterone, leading to hypertrophy of glandular breast tissue and, in some cases, excess adipose deposition. The condition is categorized into four grades:
Grade I: Minor enlargement without skin redundancy.
Grade IIa: Moderate enlargement without skin redundancy.
Grade IIb: Moderate enlargement with minor skin redundancy.
Grade III: Significant enlargement with substantial skin redundancy.
While mild cases may resolve spontaneously or with hormonal therapy, surgical intervention remains the definitive treatment for persistent or severe gynecomastia.
Traditional Surgical Approaches
Historically, gynecomastia surgery relied on open excision techniques. These methods, including subcutaneous mastectomy and skin excision, offered direct access to glandular tissue but often resulted in large, visible scars.
A recent two-year study compared outcomes for patients undergoing liposuction alone versus liposuction with endoscope-assisted glandular excision. Below, we detail the procedural steps, outcomes, and indications for each technique.
Comparing Techniques: Liposuction Alone vs. Liposuction with Endoscope-Assisted Glandular Excision
Liposuction Alone
Liposuction involves the removal of excess adipose tissue to contour the chest. The technique begins with preoperative markings to delineate areas of fat removal. Under general anesthesia, the patient is positioned supine with both arms abducted at 90 degrees.
Incisions: Two small incisions are made in the anterior axillary fold—one at the inframammary fold and another higher in the axillary region.
Tumescent Infiltration: A blunt-tipped 4-mm cannula delivers tumescent solution into the breast tissue, facilitating fat removal and reducing bleeding.
Fat Aspiration: Vacuum-assisted liposuction (VAL) is performed using progressively finer cannulas, such as the 3-mm spiral cannula, to ensure precise contouring. Care is taken to avoid over-resection.
Closure and Dressing: Incisions are closed with subcuticular sutures, and compression dressings are applied to optimize healing and reduce swelling.
Liposuction with Endoscope-Assisted Glandular Excision
This method combines liposuction with the excision of residual glandular tissue to address more severe cases of gynecomastia.
Endoscopic Visualization: After performing standard liposuction, an endoscope is introduced via the liposuction port to visualize any remaining glandular tissue beneath the nipple-areola complex (NAC).
Peri-areolar Incision: If glandular tissue is present, a semi-circular incision is made along the inferior border of the areola.
Glandular Excision: The gland is carefully separated from the overlying skin and underlying pectoralis fascia using Metzenbaum scissors and Allis forceps. Hemostasis is achieved to prevent hematoma formation.
Drains and Closure: Suction drains are placed to manage serous fluid, and the incision is closed with absorbable sutures. Compression garments are applied to promote skin redraping.
Outcomes: Statistical Comparisons and Insights
The study assessed 32 breasts: 17 treated with liposuction alone and 15 with the combined technique.
Aesthetic Results:
Both techniques yielded satisfactory cosmetic outcomes based on patient and surgeon evaluations using a 5-point Likert scale.
Patients undergoing the combined approach reported slightly higher satisfaction, especially in cases with severe glandular tissue (grades IIb and III).
Complications:
Liposuction Alone: Bruising was common (4 cases), and two patients experienced hematomas, managed conservatively. Persistent "puffy nipples" were noted in one patient, necessitating revision surgery.
Combined Approach: Crater deformities (4 cases) and minor skin necrosis (1 case) were observed but resolved with secondary interventions. One seroma and one hypopigmented scar were noted. These complications were more common in severe cases, highlighting the complexity of glandular excision.
Redo Surgeries:
Liposuction alone had a higher redo surgery rate (2 cases), resulting in one patient dissatisfaction due to persistent deformities.
The combined approach had no redo surgeries, emphasizing its efficacy for higher-grade gynecomastia and better resolution of deformities over time.
Operative Time:
Liposuction alone: ~46 minutes.
Combined approach: ~65 minutes (additional 10–15 minutes for glandular excision).
Advantages and Disadvantages of Each Technique
Liposuction Alone
Advantages:
Minimally invasive with shorter operative and recovery times.
Ideal for grades I and IIa gynecomastia where glandular tissue is minimal.
Disadvantages:
Limited efficacy for glandular or fibrous tissue.
Higher likelihood of secondary deformities like "puffy nipples", particularly in moderate to severe cases.
Liposuction with Glandular Excision
Advantages:
Comprehensive treatment for grades IIb and III, addressing both adipose and glandular tissue.
Reduced redo surgery rates and superior contouring for severe cases.
Disadvantages:
Increased complexity and operative time.
Higher risk of complications like crater deformities and scarring.
When to Use Each Technique
Liposuction Alone:
Best for patients with mild gynecomastia (grades I and IIa).
Recommended for individuals seeking minimally invasive options with rapid recovery.
Combined Approach:
Increased complexity and longer operative time.
Higher risk of complications like crater deformities and scarring, though these are often correctable with secondary procedures.
Conclusion
The choice between liposuction alone and combined techniques hinges on gynecomastia grade and tissue composition. While liposuction alone is effective for mild cases, combining it with glandular excision offers superior outcomes for severe cases. The study by Ali, Sheikh, Ahmed, Khurram, Rehman, and Abhishek highlights that tailored approaches and innovations like endoscopic visualization can enhance surgical precision and patient satisfaction. By refining techniques and addressing individual needs, surgeons can deliver optimal results that improve both aesthetics and quality of life.
Reference:
Ali, Sheikh & Ahmed, Imran & Khurram, Mohammed & Rehman, Noha & Abhishek, Rupraj. (2025). Gynecomastia Surgery: Liposuction Alone versus Liposuction with Endoscope-Assisted Glandular Excision—A Comparative Study. Indian Journal of Plastic Surgery. 10.1055/s-0045-1802327.
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