INTRODUCTION
Gynaecomastia is the most common benign breast pathology among males[1] and it causes considerable amount of psychological and social discomfort which compels them to seek treatment.[2] Amongst the different grades of gynaecomastia, high-grade gynaecomastia (Simon grade IIb and III) has the problem of skin excess along with enlarged and displaced nipple-areola complex, which can only be managed surgically.
Over the years surgical techniques for management of high-grade gynaecomastia have evolved a lot. Older techniques like ‘breast amputation with free nipple-areolar grafting’ had a devastating complication of graft necrosis. Further the conventional breast reduction surgeries where the nipple-areolar complex is preserved on a pedicle based flap, produced scars over male chest, which was aesthetically unappealing.
Scar-less techniques like ‘subcutaneous mastectomy through a peri-areolar or intra-areolar incision’ and ‘liposuction assisted gynaecomastia reduction’ is excellent for low-grade (Simon grade I and IIa) gynaecomastia, but ineffective to deal with the issue of skin excess, areolar enlargement, and nipple displacement of high-grade gynaecomastia (grade IIb and III).
To overcome these problems, we describe this combined circumareolar skin excision and liposuction technique to produces a good aesthetic result.