PMC:4134643 / 3160-6699 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4134643","sourcedb":"PMC","sourceid":"4134643","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4134643","text":"MATERIALS AND METHODS\nThis was a 2-year (September 2011 to September 2013) prospective observational study conducted in the department of Plastic Surgery in our institution. Before starting the study, Institutional Ethical Committee clearance was taken. During the study period, total 36 gynaecomastia patients were admitted, among them 12 patients had grade IIb and grade III gynaecomastia, and taken as the study population. With prior consent, patients were examined clinically; with hormonal assays; with mammography and ultrasonography of breasts. Pre-operative and post-operative photography were also done. [Figures 1–3] Findings of each patient were recorded separately and compared at the end of the study [Table 1].\nFigure 1 Pre-operative (a) Anterior, (b) Lateral, (c) Post-operative photograph of case no 1\nFigure 2 Pre-operative (a) Anterior, (b) Lateral, (c) Post-operative photograph of case no 10\nFigure 3 Pre-operative (a) Anterior, (b) Lateral, (c) Post-operative photograph of case no 12\nTable 1 Clinical profiles of the study population\n\nPreoperative marking\nSize of the breast, areola, and position of the nipple was marked in the upright position pre-operatively in the operation theater.\nMarking of Areola (1st marking): In cases with significant increase of areolar diameter, the areolas were marked to be reduced to 2.8-3 cm, i.e. the average diameter of male areola. The nipple position was also estimated at the mid-humerus level just medial to the mid-clavicular line.\nMarking of Breast (2nd marking): The breast was marked along the inframammary fold encircling the enlarged breast tissue.\nMarking of skin excess (3rd marking): This marking was done in a circular manner, depending on the size and shape of the breast, with a 2-2.2 cm width from the 1st marking [Figure 4a].\nFigure 4 (a) Pre-operative marking of areola, breast and skin excess, (b) De-epithelisation of skin excess, (c) Fixation of areola and closure of the de-epithelised area\n\nOperative procedure\nAll cases were operated under general anaesthesia with endotracheal intubation. After anaesthesia, tumescent infiltration was done. The infiltration was about 1:1 with the expected aspiration volume, and covered the marked area of the chest with additional area for feathering from the clavicle to below the inframammary fold.\nAfter infiltration is complete, de-epithelisation of the marked area (between 1st and 3rd markings) was done in circular manner [Figure 4b] and liposuction is started with a 3 mm Mercedes Benz cannula through a small stab incision made along the outer lateral margin of the de-epithelised area.\nAfter the liposuction was completed, the lateral margin of stab incision for liposuction was extended 2-2.5 cm further. Through this window, the redundant portion of the breast tissue was removed by sharp dissection keeping 1.5-2 cm breast tissue under the nipple-areola complex.\nThe margin of the areola was then fixed at mid-humerus lavel just medial to the mid-clavicular line with pectoralis fascia at 10, 2, and 6 o'clock position with 3-0 monocryl. Outer border of the de-epithelised area was sutured by subdermal 3-0 monocryl suture, which gave a purse-string effect and made close contact of the two incision lines. These two lines were further apposed by few half buried horizontal mattress sutures [Figure 4c].\nA suction or a small corrugated rubber drain were inserted through a separate stab incision over anterior axillary line and usually removed after 24 hr. 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