LASER-ASSISTED LIPOSUCTION AND SUTURE SUSPENSION OF FLAP TECHNIQUE FOR THE TREATMENT OF GYNECOMASTIA Daniel Man, MD*; Vinod Podichetty, MD,MS Dr. Man Aesthetic Surgery Center, Boca Raton, FL 33486. USA SUMMARY Gynecomastia has considerable impact on patient’s quality of life, estimated in 65% of normal adolescents. The objective is to study laser assisted liposuction (LAL) and suture suspension of the sagging flap procedure without skin excision as a superior technique for most forms of gynecomastia. The study technique involved the use of 1064nm and 1444nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with 400 µm fiber (Lutronic Inc., NJ) assisted liposuction to remove fatty breast tissue. We conclude that combining laser assisted liposuction with suture suspension of flap technique has proven to correct all grades of gynecomastia with less morbidity, inconspicuous scar and uniformly excellent aesthetic results

STUDY DESIGN and METHODS BACKGROUND Gynecomastia has considerable impact on patient’s quality of life, estimated in 65% of normal adolescents. Treatment is preferably surgical, whether it results from glandular hypertrophy, fat accumulation or both. Of the wide range of surgical liposuction techniques currently in use, there is disagreement on the most favorable option for different grades of gynecomastia. STUDY DESIGN and METHODS This technique involved the use of 1064nm and 1444nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with 400 µm fiber (Lutronic Inc., NJ) assisted liposuction to remove fatty breast tissue. Twelve men (ages 20 to 64 years) were treated between January 2008 and October 2008 for grade I (n=4), II (n=4), III (n=1) or IV (n=3) gynecomastia. Surgical data, patient satisfaction and cosmetic outcome at 3-month follow-up were analyzed. OBJECTIVES We studied laser assisted liposuction (LAL) and suture suspension of the sagging flap procedure without skin excision as a superior technique for most forms of gynecomastia. AccuSculpt Lutronics Inc.

Twelve patients (24 breasts) were successfully treated using LAL. RESULTS Twelve patients (24 breasts) were successfully treated using LAL. Patients (n=4) corrected using 1444nm Laser showed better results in fat removal and operative time than patients (n=8) treated with 1064nm. The average liquefied breast tissue aspirated was 820cc (range, 150 to 2700cc). 4 patients (two in each group) had seroma and hematoma as complications. 1064nm used in one patient required a revision surgery. Since gynecomastia causes significant emotional distress and embarrassment, we conducted a two-mode outcome analysis. At three months, 85.5% of all patients were ‘satisfied’ to ‘very satisfied’ using a 5-point Likert score. Cosmetic outcome for shape, symmetry and scar appearance measured on standardized photographs scored ‘excellent’ in 11 of the 12 patients. PRE - OPERATIVE POST-OPERATIVE

CONCLUSIONS PRE - OPERATIVE POST - OPERATIVE Since the introduction of 1064 and 1444nm Lasers, the technique has been successfully used to treat gynecomastia patients. Combining laser assisted liposuction with suture suspension of flap technique has proven to correct all grades of gynecomastia with less morbidity, inconspicuous scar and uniformly excellent aesthetic results 4