Comparison of Circumareolar Mastopexy for Gynecomastia with a Semicircular Incision

Area of Science:

• Plastic Surgery
• Surgical Techniques
• Gynecomastia Treatment

Background:

• Circumareolar approaches for gynecomastia are gaining traction but often lead to undesirable areolar deformities.
• A "blocking" suture is sometimes used to mitigate areolar dilation, with a semicircular incision being a common alternative.

Purpose of the Study:

• To evaluate the effectiveness and complication rates of different surgical approaches for gynecomastia, specifically comparing circumareolar techniques with a semicircular incision.
• To assess the impact of surgical methods on areolar diameter and aesthetic outcomes.

Main Methods:

• An electronic literature review of circumareolar mastopexies for gynecomastia was conducted.
• Clinical data and published images were analyzed to compare pre- and post-operative areolar diameters and complications.
• A cohort of patients treated with a semicircular incision was evaluated using similar metrics.

Main Results:

• No significant difference in mean areolar diameter was observed after surgery using the circumareolar approach.
• Complications associated with the circumareolar method included noncircularity, widening, hypertrophic scars, and numbness.
• The semicircular incision group (n=32) showed a significant reduction in mean areolar diameter (0.2-0.3 cm) with no nipple/areola complex complications or need for revisions.

Conclusions:

• The use of blocking sutures in circumareolar gynecomastia treatment is not supported by current evidence and is associated with a high rate of areolar deformities.
• The semicircular incision technique effectively avoids areolar deformities and revisions, yielding natural-looking results.
• Combining a semicircular incision with liposuction can lead to a modest reduction in areolar diameter due to skin contraction.