Eccentric skin resection and purse-string closure for skin reduction with mastectomy for gynecomastia

Skin redundancy following mastectomy for gynecomastia does not shrink and resolve in a predictable manner. Excess skin can be addressed best with resection at the time of the original operation if the scar can be minimized. Previously described techniques for resection of skin have shortcomings that include unacceptable scars, poor nipple positioning, and bulkiness of redundant, folded dermal tissue. The current technique for grade 2 and some grade 3 gynecomastias is performed with the creation of a 20-mm-diameter nipple-areolar complex based as a cephalad flap and designed eccentrically around the existing nipple. Eccentric skin resection in the vertical and horizontal planes is performed below the areolar flap. Wide access for completion of mastectomy is gained. The wound is then closed with a subcutaneous purse-string suture and inset of the areolar flap so that the scars are confined to the circumareolar area. This allows immediate skin recontouring with minimal skin scar. The patient does not have to endure prolonged anxiety while awaiting skin contracture, and this procedure eliminates the possible need for secondary surgery to resect redundant skin.