Breast reduction and mastopexy with vaser in male breast hypertrophy

Abstract

In the early 1980, few articles were published on suction lipectomy as part of a combined surgical solution for gynecomastia, and it was suggested to utilize SAL (suction assisted lipoplasty) in conjunction with sharp surgical resection of the subareolar breast bud and wherever necessary the parenchymal tissue (Fig. 30.1). Courtiss [1] suggested extensive removal of fat with suction lipectomy, and used knife or scissors to remove the subareolar breast cone (Fig. 30.2). It was a general thought that it was impossible to remove parenchymal tissue via SAL alone, due to the resistance fibrosis of the gland. Rosenberg [2] showed to be competent in using SAL alone to remove successfully fat and parenchymal tissue, without complications (Fig. 30.3). Histology confirmed the accuracy of fat as well as breast tissue cleaning in gynecomastia treatment using SAL. Nydick [3] showed that there was an incidence of gynecomastia in 65% of pubertal males, and resolution almost always occurs, but in another study by Nuttal [4] of 306 adult males, clinical gynecomastia was seen in 36%, with a greater incidence (57%) in men over 44 years. Regarding the etiology, an increasing responsibility has been addressed to drugs and medications, such as steroids, Zantac, Tagamet, Nizoral, as well as Marijuana. Anabolics, of course, can increase male breast volume [5]. Obesity is a part of the problem, as a certain deposit of fat in male breast is always connected with an increase in body weight by man, with intensification with age and loss of breast tone and pectoralis muscle power. Surgical intervention is the only real radical treatment, which does not interfere with hormone balance. Nearly 80% of American plastic and cosmetic surgeons seem to approach gynecomastia with open surgical breast tissue excision with or without SAL as a support for defining contouring of the thorax-breast [6]. The consistency of the fibrous male breast can be expressively addressed with the new vibration assisted sound et resonance (Vaser) ultrasound-assisted technique. Vaser (S.S.T. Denver, Co US) uses solid probes introduced via small cutaneous incisions to emulsify fat as well as breast tissue and dissolve them, thus aspirating the emulsion through a suction cannula. © 2009 Springer-Verlag Berlin Heidelberg.