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Scar stigma

Article-Scar stigma

Key iconKey Points

  • Standard approaches to treating gynecomastia, or male breast overdevelopment, leave obvious scars
  • Scars are bothersome for patients
  • Surgeons have developed new techniques that minimize the appearance of postsurgical scars

TORONTO, CANADA — There are various approaches to minimizing sagging breasts in men.

The patient is 25 years old and is seen immediately before and two years after his "boomerang" gynecomastia correction during a single stage Total Body Lift in February 2005. Also performed were a lower body lift, abdominoplasty and medial thighplasty. At 6' 2", he weighed 215 pounds at the time of his total body lift and was 450 pounds before gastric bypass. (Photo credit: Dennis J. Hurwitz, M.D., F.A.C.S.)
The condition known as gynecomastia, or male breast overdevelopment, was mocked in a Seinfeld episode in which George Costanza's father was described as having "breasts." Frank Costanza and Kramer developed a "bro" to wear as a supportive undergarment for men who have full breasts. In real life, neither its prevalance nor the embarrasment its sufferers often endure are laughing matters. It's estimated that gynecomastia, which may affect one breast or both, occurs in 40 percent to 60 percent of men. There are various surgical approaches to treat the condition. Some of those surgeries were presented at the recent 7th Annual Toronto Breast Surgery Symposium and the 37th Annual Aesthetic Plastic Surgery Symposium held in Toronto.

Frank Lista, M.D., medical director and founder of the Plastic Surgery Clinic in Mississauga, Ontario, Canada, chief of plastic surgery at the Trillium Health Centre and former president of the Canadian Society of Aesthetic (Cosmetic) Plastic Surgery, notes that gynecomastia is largely a condition of idiopathic origin. It can be brought on by a hormonal imbalance, use of marijuana, use of anabolic steroids, or being overweight.

"In the majority of cases, the cause is unknown," says Dr. Lista in an interview with Cosmetic Surgery Times . "It is a source of psychological discomfort for patients."

There is a standard technique for gynecomastia correction that involves a small incision around the nipple. However, the procedure leaves a scar that resembles a half moon around the lower half of the nipple.

MINIMAL-SCAR PROCEDURES "Patients don't like that they have scar tissue around the nipple after the standard operation," says Dr. Lista. "They don't take their shirts off because of the scar. It is a stigmatizing scar."

To address gynecomastia, Dr. Lista has developed a procedure in which a small incision is made and both glandular tissue and breast tissue are removed from the breast. He uses power-assisted liposuction in the procedure.

"The most important part of the operation is when we remove the breast tissue through the liposuction incision using a specialized grasping device," explains Dr. Lista. "First, we use a 'v' dissector to divide the attachments between the breast tissue and the skin. Then we use the grasping device to remove the breast tissue. This is all done through the 4-mm liposuction incision. This is the revolutionary part of this operation."

The procedure minimizes trauma and accelerates recovery, notes Dr. Lista.

"It is not a difficult procedure to do," says Dr. Lista. "It's more of a conceptual challenge to the surgeon, that is, the idea that with minimal access you can do everything you can with a regular operation."

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