Transumbilical approach for pseudogynecomastia liposuction.

Pseudogynecomastia, a common phenomenon caused by increased male breast subcutaneous fat deposition, usually occurs bilaterally. The development of pseudogynecomastia may cause significant psychological distress and embarrassment, particularly in young men and adolescents. Unfortunately, pseudogynecomastia responds poorly to diet and exercise. For this reason, surgery is the first-line treatment. Liposuction (using a vacuum-suction cannula) via the axillary approach usually is recommended [1]. Liposuction provides a well-defined contour for the male breast with small axillary scars. However, even after successful operations, this approach could leave visible postoperative skin scars. To avoid these axillary scars, we have used a transumbilical approach for pseudogynecomastia liposuction, as in transumbilical breast augmentation (TUBA). Using the transumbilical approach, we make only one vertical incision inside the umbilicus at the 12 o’clock position and remove the fatty tissue with a traditional tumescent liposuction (Fig. 1). Tumescence is accomplished using one ampule of adrenalin (1 mg.) per liter of infiltrated isotonic saline solution. The cannulas most often used are 3 and 4 mm in diameter and 30 to 35 cm long. The liposuction is always performed starting in the deep plane and ending in the superficial plane using the thinnest stems. The umbilical incision is closed with 5-0 nylon stitches. After liposuction, all the patients are wrapped with compressive bandages for 6 weeks to improve contraction of the skin. The advantages of the transumbilical approach are the easy access it provides to both breasts with only one incision. Furthermore, it permits a more comfortable position for the surgeon and leaves a small and inconspicuous skin scar inside the umbilicus, eliminating the stigma of breast surgery. We have used this approach for 10 patients with mild to moderate pseudogymecomastias, and none of the patients had postoperative complications. There were no treatmentinduced asymmetries, contour deformities, or irregularities (Fig. 2). No open excision or skin reduction procedures were required. Tumescent liposuction using a single entry site inside the umbilicus is a new access for the treatment of pseudogynecomastia, resulting in a high level of patient satisfaction.