Gynecomastia: evolving paradigm of management and comparison of techniques.

Background: Since 1997, the authors have used a minimally invasive technique for the management of gynecomastia using ultrasound-assisted liposuction and the arthroscopic shaver to remove breast tissue through a remote incision. This technique has allowed for a consistent, refined, "unoperated" postoperative appearance in this patient population. This study analyzes the outcomes of this procedure and compares the procedure against established techniques.

Methods: A retrospective study was performed on all patients who underwent surgery for gynecomastia at the authors' institution between January of 1988 and October of 2007. A total of 227 patients were divided into four groups: group 1, open excision only (n = 45); group 2, open excision plus liposuction (n = 56); group 3, liposuction only (n = 50); and group 4, liposuction plus arthroscopic shaver (n = 76). Medical records and photographs were used to compare groups for complications and results.

Results: Complications using the liposuction plus arthroscopic shaver technique included seroma (n = 2), hematoma (n = 1), scar revision (n = 1), and skin buttonhole from the arthroscopic shaver (n = 1). There was no difference between groups in the overall incidence of complications (p < 0.20) or the need for reoperation (p < 0.325). Results were scored on a scale of 1 (poor) to 5 (excellent). Group 4 (liposuction plus arthroscopic shaver) had the overall highest mean score, with statistical significance between group 2 (open excision plus liposuction) and group 4 (p < 0.0001).

Conclusion: Arthroscopic mastectomy for gynecomastia is a safe and effective technique, with excellent cosmetic results and an acceptable complication rate.