Long-Term Outcome of Surgery for Grade 4 Gynecomastia: A Single-Center Experience

Area of Science:

• Plastic Surgery
• Aesthetic Surgery
• Male Breast Reduction

Background:

• Gynecomastia, characterized by feminine chest appearance, causes significant psychosocial distress.
• Grade 4 gynecomastia presents unique challenges, often yielding suboptimal results with standard liposuction and gland excision alone.
• This study evaluates the long-term efficacy of surgical interventions for severe (grade 4) gynecomastia.

Purpose of the Study:

• To assess the long-term surgical outcomes for patients with grade 4 gynecomastia.
• To compare the effectiveness of different surgical techniques based on gynecomastia grade (4a vs. 4b).
• To determine patient satisfaction and the need for secondary procedures.

Main Methods:

• Retrospective analysis of 81 patients with grade 4 gynecomastia treated between January 2021 and December 2022.
• Surgical procedures included VASER-assisted liposuction and gland excision, with crescentic nipple-areola complex (NAC) lift for ptosis in grade 4b cases.
• Data collected included symmetry, inframammary fold restoration, ptosis correction, and patient-reported outcomes.

Main Results:

• Symmetry achieved in 95% of grade 4a and 79% of grade 4b patients.
• Inframammary fold restoration in 90% of grade 4a and 59% of grade 4b patients.
• Ptosis correction successful in 83% of grade 4b patients, with a mean follow-up of 15 months; only 7 patients required further intervention.

Conclusions:

• Liposuction with gland removal (grade 4a) and with NAC lift (grade 4b) provides satisfactory outcomes for massive breast enlargement.
• Grade 4a gynecomastia generally shows better results and fewer complications than grade 4b.
• Despite differences, both grades achieve acceptable outcomes, emphasizing the need for realistic preoperative patient counseling.