Repair of patients with grade 3 gynecomastia with posterior-inferior pedicle flap and preservation of the nipple areola complex

In surgical treatment of Grade III gynecomastia, mastectomy techniques and free nipple, Free transplantation of the nipples and areolae are used in general. Besides, there has been increasing demand towards surgery for pseudo-gynecomastia which can be mixed with Grade III gynecomastia from the aspect of their surgical management in view of rising obesity rates and growth of bariatric surgery. Without damaging neurovascular function of posterior -inferior pedicled fasciocutaneous flap and nipples, successful operations can be completed with fewer scars. 12 Patients with problems of gynecomastia or pseudogynomastia in Grade III Gynecomastia admitted to the Department of Plastic Surgery, Faculty of Medicine at Gaziantep University from 2021 to 2022 are subjects of the study. A questionnaire called "SF36v2"with 36 questions are indicators of reviewing life quality both in pre- and post-operation phases has been conducted with these surveyee 12 patients. The surgical technique of posterior -inferior pedicled fasciocutaneous flap has been applied to patients. In other words, liposuction operation has been operated to the zone falling outside pedicle zone of deep tissues of upper quadrants. Following de-epitalisation of posterior -inferior pedicled fasciocutaneous flap,lower medial quadrants breast and lower lateral quadrants breast have been resected. Later, thoracic flap has been sutured in aligned with IMF and areola has been transposed to their new location. 12 patients were operated from January 2021 to January 2022 and the results have been gathered. Average age amongst the patient was 25,5 while average weight kg 65,42 and average body mass index being kg 29,56 kg/m2. Average duration of operation was 112,17 minutes, average liposuction volume mL 543,75. The weight excised in operations was gm 618,33 while the Length of Stay (LOS) and drainage durations were 4 days. No major complications have been recorded except for iv emerging uni lateral hematom. This hematom has been drained. Life Quality Questionnaire SF36v2 conducted with patients has revealed that patients have started enjoying considerably better physical functions in post-op. period in comparison to pre- op period. Protection of neurovascular function being the major advantage of this operation also makes the operation prime technique for patients attaching importance to keeping nipple sensitivity intact. The research has shown that this operation is both reliable and repeatable. Grade III gynecomastia is recommended as the first level treatment technique after considering low rate of major complications, relevant functional and esthetical results.