Surgical approach to the treatment of gynecomastia according to its classification

Background: Gynecomastia is the most common benign proliferation of the glandular tissue of the male breast and is caused by an alteration of the balance between estrogen and androgen concentrations. In most cases, the treatment of choice is surgery. In this study, we aimed to indicate the efficacy of established surgical procedures for the correction of gynecomastia, as evaluated according to Simon’s classification, and to present a novel contribution. Methods: This study was performed between March 2009 and March 2011. It included 32 male patients, aged between 13 and 45 years. The type of incision was chosen on the basis of the need for skin resection. We used 4 techniques described in the literature and a modified procedure of circular incision with inferior, superior, lateral, and medial extensions, which we employed when excess skin was also present in the lower pole of the breast. Results: Idiopathic gynecomastia was the most common etiology among our patients, followed by obesity and by use of anabolic steroids. Conclusions: The common procedure to correct gynecomastia was based on the inferior periareolar incision proposed by Webster, which we employed in patients who did not require skin resection. In the presence of excess skin, the technique chosen varied according to the amount of tissue to be resected. In the present report, we propose a novel technique that facilitates larger dermal, glandular, and fatty breast tissue removal when compared to other procedures previously used by this surgeon.