Pediatric endoscopic subcutaneous mastectomy (pesma) with liposuction in adolescents with gynecomastia.
Adolescents
Endoscopic
Gynecomastia
Liposuction
MIS
Technique
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
21
05
2022
accepted:
07
08
2022
pubmed:
2
9
2022
medline:
18
1
2023
entrez:
1
9
2022
Statut:
ppublish
Résumé
Surgical techniques for treatment of gynecomastia are increasingly less invasive. We described technical standardization of pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction. All adolescents with primary gynecomastia, operated using PESMA with liposuction over the period June 2014-July 2021, were included. The video recording of procedures was analyzed to standardize the operative technique. After patient installation, 3 trocars were placed on the mid-axillary line. The technique included 5 steps: (1) subcutaneous injection of lipolysis solution and liposuction; (2) creation of working space using an inflated balloon; (3) gland dissection using 5-mm sealing device; (4) specimen extraction through the largest trocar orifice; and (5) placement of suction drainage tube. Twenty-four male adolescents, operated for Simon's grade 2B and 3 gynecomastia using PESMA with liposuction over the study period, were included. Mean patient age was 16 years (range 15-18). Gynecomastia was bilateral in 19/24 (79.2%) and unilateral in 5/24 (20.8%). One (4.1%) conversion to open was reported. The mean operative time was 87 min (range 98-160) for unilateral and 160 min (range 140-250) for bilateral procedure. The mean length of stay was 2.2 days (range 1-4). Patients wore a thoracic belt for 15 up to 30 days postoperatively. Post-operative complications occurred in 5/24 (20.8%): 2- or 3 mm second-degree burns in 4 (16.7%) and subcutaneous seroma in 1 (4.1%). All complications were Clavien 2 grade and did not require further treatment. Aesthetic outcomes were very good in 21/24 (87.5%). Three (12.5%) boys had persistent minimal breast asymmetry but did never perceive it negatively. PESMA combined with liposuction was feasible and safe for surgical treatment of gynecomastia in this selected cohort of patients. Although challenging, this procedure provided good aesthetic results, with no scars on the anterior thoracic wall. Standardization of the operative technique was a key point for successful outcome.
Sections du résumé
BACKGROUND
Surgical techniques for treatment of gynecomastia are increasingly less invasive. We described technical standardization of pediatric endoscopic subcutaneous mastectomy (PESMA) with liposuction.
METHODS
All adolescents with primary gynecomastia, operated using PESMA with liposuction over the period June 2014-July 2021, were included. The video recording of procedures was analyzed to standardize the operative technique. After patient installation, 3 trocars were placed on the mid-axillary line. The technique included 5 steps: (1) subcutaneous injection of lipolysis solution and liposuction; (2) creation of working space using an inflated balloon; (3) gland dissection using 5-mm sealing device; (4) specimen extraction through the largest trocar orifice; and (5) placement of suction drainage tube.
RESULTS
Twenty-four male adolescents, operated for Simon's grade 2B and 3 gynecomastia using PESMA with liposuction over the study period, were included. Mean patient age was 16 years (range 15-18). Gynecomastia was bilateral in 19/24 (79.2%) and unilateral in 5/24 (20.8%). One (4.1%) conversion to open was reported. The mean operative time was 87 min (range 98-160) for unilateral and 160 min (range 140-250) for bilateral procedure. The mean length of stay was 2.2 days (range 1-4). Patients wore a thoracic belt for 15 up to 30 days postoperatively. Post-operative complications occurred in 5/24 (20.8%): 2- or 3 mm second-degree burns in 4 (16.7%) and subcutaneous seroma in 1 (4.1%). All complications were Clavien 2 grade and did not require further treatment. Aesthetic outcomes were very good in 21/24 (87.5%). Three (12.5%) boys had persistent minimal breast asymmetry but did never perceive it negatively.
CONCLUSION
PESMA combined with liposuction was feasible and safe for surgical treatment of gynecomastia in this selected cohort of patients. Although challenging, this procedure provided good aesthetic results, with no scars on the anterior thoracic wall. Standardization of the operative technique was a key point for successful outcome.
Identifiants
pubmed: 36050608
doi: 10.1007/s00464-022-09550-x
pii: 10.1007/s00464-022-09550-x
pmc: PMC9839820
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
766-773Informations de copyright
© 2022. The Author(s).
Références
N Engl J Med. 2007 Sep 20;357(12):1229-37
pubmed: 17881754
South Med J. 2014 Jan;107(1):44-9
pubmed: 24389786
Biomed Res Int. 2018 May 29;2018:8364824
pubmed: 30003107
Exp Ther Med. 2013 Jun;5(6):1683-1686
pubmed: 23837054
Surg Laparosc Endosc Percutan Tech. 2009 Jun;19(3):e85-90
pubmed: 19542836
Biomed Pharmacother. 2002;56 Suppl 1:187s-191s
pubmed: 12487279
Pediatr Surg Int. 2014 Jun;30(6):641-7
pubmed: 24763713
Indian J Endocrinol Metab. 2014 Mar;18(2):150-8
pubmed: 24741509
Acta Biomed. 2017 Aug 23;88(2):204-213
pubmed: 28845839
J Plast Reconstr Aesthet Surg. 2011 Sep;64(9):e231-6
pubmed: 21570372
Plast Reconstr Surg. 1973 Jan;51(1):48-52
pubmed: 4687568
J Laparoendosc Adv Surg Tech A. 2019 Aug;29(8):1073-1076
pubmed: 31216208
J Laparoendosc Adv Surg Tech A. 2002 Oct;12(5):313-5
pubmed: 12470404
Clin Psychopharmacol Neurosci. 2021 Aug 31;19(3):498-506
pubmed: 34294618
Curr Opin Pediatr. 2008 Aug;20(4):465-70
pubmed: 18622206
Surg Endosc. 1999 Jan;13(1):43-7
pubmed: 9869687
Body Image. 2015 Sep;15:141-8
pubmed: 26408934
Breast. 2017 Feb;31:51-56
pubmed: 27810700
Ther Clin Risk Manag. 2011;7:145-8
pubmed: 21479145
Am J Surg. 1999 Jul;178(1):60-3
pubmed: 10456706
Surgery. 2002 Jan;131(1 Suppl):S324-9
pubmed: 11821832
J Pediatr Surg. 2010 Mar;45(3):650-4
pubmed: 20223338
Endocrine. 2017 Jan;55(1):37-44
pubmed: 27145756
Ann R Coll Surg Engl. 2010 Apr;92(3):198-200
pubmed: 20412670
Exp Ther Med. 2018 Aug;16(2):797-801
pubmed: 30116334
Surgery. 2021 Jul;170(1):39-46
pubmed: 33715850