Water-Jet-Assisted Liposuction for the Treatment of Grade I and II Gynecomastia

Background: Gynecomastia is characterized by male breast enlargement on the chest wall, creating a feminine-looking upper torso profile that can be a source of great psychological stress and social embarrassment. The enlargement, most often idiopathic, is caused by mixture of ductal, stroma, and/or fat tissue proliferation in the region, and surgical correction can be considered in most cases of persistent gynecomastia. Aim and Objectives: Current surgical treatment of gynecomastia involves various liposuction techniques. Water-jet-assisted liposuction (WAL), introduced in 2007 as a thirdgeneration liposuction technique, uses a dual-purpose cannula that emits a pulsating, fan-shaped water jet while simultaneously removing soft tissue through aspiration. The pulsating water jet is designed to break down soft tissue while performing the aspiration procedure. Currently, it is a popular option in body-contouring procedures at our institution, and we use it on a regular basis to treat gynecomastia. Materials and Methods: From 2010 to 2014, 18 male patients diagnosed with gynecomastia were treated at our institution with water-jet-assisted liposuction. An additional pull-through procedure was carried out in an area directly underneath the areola if nipple protrusion was still evident postprocedure. The procedure is performed on an outpatient basis and did not require postoperative drain insertion. After the wound was dressed with gauze, a custom-made elastic vest was used immediately after surgery; the patient was advised to wear the vest for at least 1 month. Results: At the 1-month postoperative follow-up examination, patients were given a questionnaire pertaining to their satisfaction with (1) the appearance of the scar and (2) postoperative chest wall contour and (3) any improvement in self-confidence. Patients were asked to rate their satisfaction with the procedure on a scale from 1 to 10, with 10 being the most satisfied. The average rating was 9 and above for all three questions. Conclusion: We conclude that WAL liposuction combined with a limited pull-through technique underneath the areola can effectively manage grade I and II gynecomastia categorized by Rohrich classification.