SUCTION ASSISTED LIPOSUCTION (SAL) OF THE MALE BREAST

Transcription

1 SUCTION ASSISTED LIPOSUCTION (SAL) OF THE MALE BREAST PRESENTED BY: Dr. Josef Goldbaum M.B.B.S.(Melb), F.A.M.A.C., F.A.C.N.E.M., F.F.M.A.C.C.S. ACCS & CPSA Combined Conference Conrad Jupiters, Gold Coast 29 August to 1 September 2003 Dr Josef Goldbaum 1

2 Most males experience unilateral or bilateral breast enlargement during their life time. Gynaecomastia is the most common breast problem in men, and requires no treatment unless it causes embarrassment or discomfort, or is associated with malignancy. Dr Josef Goldbaum 2 2

3 v Male Gynaecomastia has traditionally been treated by surgical excision of glandular and associated adipose tissue. v The resultant aesthetic appearance is often poor with visible scars and irregular appearances. v v v v There is a significant rate of complication from general anaesthesia, acquired infection, nipple necrosis, loss of nipple sensation and post op breast enlargement. Whilst the causes of gynaecomastia are many and varied, the reasons for the procedure are primarily aesthetic and psychological. Enlarged breasts can occur in males with normal body weight; but is predominantly associated with obesity of the abdomen and hips. The triad of breasts, belly and love handles is a common presentation. Dr Josef Goldbaum 3 3

4 Simon in 1973 grouped patients into the following categories:- I. Mild breast enlargement without skin redundancy. Dr Josef Goldbaum 4 4

5 II(a). Moderate breast enlargement without skin redundancy. Dr Josef Goldbaum 5 5

6 II(b). Moderate breast enlargement with minor skin redundancy. Dr Josef Goldbaum 6 6

7 III. Gross breast enlargement with skin redundancy. (Pendulous type of breast) Dr Josef Goldbaum 7 7

8 Aetiology of Gynaecomastia Idiopathic Physiological Pathological Alcohol related Drugs Dr Josef Goldbaum 8 8

9 Idiopathic Most cases are idiopathic or genetic. Physiological Neonatal Puberty Senility Dr Josef Goldbaum 9 9

10 Pathological Primary testicular failure such as Kleinfelters, Mumps and Irradiation. Secondary testicular failure such as pituitary, adrenal, or testicular tumors. Carcinoma such as Lung and Lymphoma. Hepatic disease such as Cirrhosis and Haemachromatosis Drugs Alcohol Obesity Dr Josef Goldbaum 10 10

11 Drugs & Alcohol Drug Percentage* Total Number (sole suspected) Spironolactone (62) Cimetidine (39) Famotidine (6) Rantidine (25) Digoxin (7) Omeprazole (8) Verapamil (7) Simvastatin (11) Frusemide (0) Asprin (0) Percentage of all reports for that drug Report from the Australian Adverse Drug Reactions, August 1997 Dr Josef Goldbaum 11 11

12 Obesity Biological breasts can occur in males with normal body weight; however in this series it was predominantly associated with obesity of the abdomen and hips. The triad of breasts, belly and love handles was a common presentation. Whilst the causes of male gynaecomastia are many varied, the reasons for breast reduction are primarily psychological and aesthetic. The literature relating to gynaecomastia is sparse, reflecting primarily surgical management and incidences of carcinoma of the breast. The writer undertook a random retrospective study of 50 male patients, who had undergone liposuction of the breast, either as a single procedure or in conjunction with other body areas. Dr Josef Goldbaum 12 12

13 Common Risks of Gynaecomastia Surgery Various surgical techniques have been utilised through sub-mammary or periareolar incisions. The resultant scarring and deformities are often cosmetically unacceptable and the risks of the surgery significant. General anaesthesia Infection Nipple desensitization Nipple necrosis Hypertrophic scarring Post-op breast enlargement. Dr Josef Goldbaum 13 13

14 v v v v A review of 50 male patients treated by SAL was undertaken. Liposuction of the breasts was the only procedure or was included with other body areas. All procedures were performed under LA with or without mild sedation. Two angles of approach were used to facilitate:- - Maximum fat removal - Smooth aesthetic appearance - Avoidance of known areas for hypertrophic scarring Dr Josef Goldbaum 14 14

15 Percentage of Patients 58% multiple procedures 42% single procedures Dr Josef Goldbaum 15 15

16 The BMI was calculated for each patient producing the following chart. Basal Metabolic Rates 8% 22% 20% Healthy BMI 20 to 24.9 Overweight BMI 25 to 29.9 Obesity BMI 30 to 34.9 Morbid Obesity BMI 35 to % Average BMI = 28.6 Total 50 patients Dr Josef Goldbaum 16 16

17 Comorbidities All patients were assessed for pathology & comorbidities. Some patients exhibited several concomitant comorbidities Number of patients hypertension LFT Obesity Diabetes Hypothyroid Alcoholism Pacemaker Gallstones Nil Type of condition Dr Josef Goldbaum 17 17

18 Liposuction / liposculpture was performed utilising the wet technique of tumescent local anaesthesia. The levels of Xylocaine required to produce regional anaesthesia were in the range of 11 to 47 mg / kg Mg xylocaine/kg weight mg/kg % No. Patient Dr Josef Goldbaum 18 18

19 Volume of Fat Removed The volume of fat removed from the breasts ranged from 300 ml to 3200 ml. Average 850 ml Mls Dr Josef Goldbaum No. Patients 19

20 Volume of Fat vs Volume of Infranate By comparison the volume of Infranate removed was in the range of 100 ml to 700 mls Mls Fat Removed From Breasts mls Infranate 850 Fat 250 Infranate Dr Josef Goldbaum 20 20

21 Complications SIGNIFICANT COMPLICATIONS NIL ECCHYMOSIS (Extensive Bruising) 5 (10%) 2 related to alcohol 3 not related to alcohol Dr Josef Goldbaum 21 21

22 Results Satisfactory aesthetic results were achieved in all patients, even in those with redundant skin and / or tightly adherent inframammary crease / fold. Dr Josef Goldbaum 22 22

23 Results Dr Josef Goldbaum 23 23

24 Results Dr Josef Goldbaum 24 24

25 Results Dr Josef Goldbaum 25 25

26 Results Dr Josef Goldbaum 26 26

27 Results Dr Josef Goldbaum 27 27

28 Results Dr Josef Goldbaum 28 28

29 Conclusion Liposuction / Liposculpture of the male breast is a safe and effective method of treating benign male Gynaecomastia without resulting scarring or deformity. The wet technique of tumescent local anaesthesia allows the removal of maximum volume of fat and allows multiple areas to be treated within the safety range of Xylocaine. Male Gynaecomastia is often associated with comorbidities, and although no cases of male breast carcinoma were encountered in this series, it must be excluded prior to Liposuction. Ecchymosis or extensive bruising is a common complication, and may benefit from increasing the adrenaline content of the tumescing infiltrate. Dr Josef Goldbaum 29 29