Comparison of Circumareolar Mastopexy for Gynecomastia with a Semicircular Incision

A circumareolar approach to treat gynecomastia has received renewed attention. However, this method has been associated with areolar deformities. A "blocking" suture is recommended to limit areolar dilation. A semicircular incision along the lower areolar margin is a popular alternative approach.

An electronic literature review identified publications on circumareolar mastopexies for gynecomastia treatment. Clinical data were assessed, including complications. Published images from the literature were matched and areolar diameters were compared before and after surgery. A cohort of consecutive patients from the author's practice, treated with a semicircular incision, were similarly evaluated.

Sixteen publications included photographs that could be measured. There was no significant difference in the mean areolar diameter after surgery on either side. Complications included areolar noncircularity, widening, hypertrophic scars, nipple/areola numbness, and persistent pleating. Among 32 patients treated with a semicircular incision and subcutaneous mastectomy, along with liposuction, the mean postoperative areolar diameter was significantly reduced after surgery, by 0.2 cm on the right side and 0.3 cm on the left side. No complications of the nipple/areola complex were encountered and no areolar revisions were needed.

The concept of a blocking suture holds an intuitive appeal. However, the evidence does not support this practice. A circumareolar approach to gynecomastia treatment is associated with a high rate of areolar deformities. The thin tissues are intolerant of tension. Large, permanent sutures are often palpable and require later removal. Areolar scar revisions are common. A purse-string suture does not prevent areolar widening postoperatively back to the preoperative diameter. By contrast, an approach using an incision limited to the lower areolar margin avoids areolar deformities, the need for revisions, and produces results that consistently appear natural. When combined with liposuction, skin contraction can provide a significant, albeit modest, reduction in areolar diameter LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .