Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1506–1518 | Cite as

Treatment of Severe Gynecomastia After Massive Weight Loss: Analysis of Long-Term Outcomes Measured with the Italian Version of the BODY-Q

  • M. BaroneEmail author
  • A. Cogliandro
  • E. Tsangaris
  • R. Salzillo
  • M. Morelli Coppola
  • S. Ciarrocchi
  • B. Brunetti
  • S. Tenna
  • V. Tambone
  • P. Persichetti
Original Article Breast Surgery



The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia.

Materials and Methods

Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss. Patients answered the Italian version of BODY-Q postoperative module. All patients had experienced substantial weight loss (> 30 kg), presented with bilateral severe tissue ptosis of the breast, follow-up of almost 2 years and had a good understanding of the Italian language, and signed consents were included in the study. The sample was studied about age, BMI, comorbidity, bariatric surgical procedure, follow-up, type of post-bariatric surgical procedure, complications and secondary procedures.


We performed 487 severe gynecomastia corrections from 2008 to 2016; 80 patients adhered to the inclusion criteria and formed our study group. This cross-sectional study compared three cohorts: 52 access using a circumareolar scar, 18 with an inframammary fold scar, 10 with an inframammary fold scar using intercostal perforator flaps. There were 16 secondary procedures in group one, 2 in group two and 1 in group three. We compared the secondary procedures of group 1 with the other groups, and we obtained a significant difference with a P = 0.04. The mean patient age was 36.5 years, and the average body mass index was 27.5 kg/m2 at the time of surgical correction of gynecomastia. From the BODY-Q analysis, the group of patients undergoing adenomammectomy with inframammary fold scar using intercostal perforator flaps has achieved significantly better results regarding the satisfaction with chest, psychosocial function, satisfaction with outcome and better body image.


This is the first study that used the BODY-Q to analyze the correction of severe gynecomastia following massive weight loss with long-term results. The use of this patient-reported outcome measure underlined that the intercostal artery perforator flap, used in the correction of severe gynecomastia following massive weight loss, is a safe and effective technique with good outcomes and high patient satisfaction.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Gynecomastia Perforator flap Plastic surgery Cosmetic surgery BODY-Q Patient-reported outcome 



The authors do not have any commercial associations that might pose or create a conflict of interest with information presented in this communication. No intramural or extramural funding supported any aspect of this work.

Supplementary material

Video 1: Illustration of surgical technique using a double flap advanced cranially and divided into medial and lateral parts, with the medial part sutured on the pectoralis major fascia and the lateral part sutured under the pectoralis major muscle and to the perichondrium of the second rib. (MP4 10373 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Plastic and Reconstructive Surgery UnitCampus Bio-Medico University of RomeRomeItaly
  2. 2.Research Group “To be and to appear: Objective indication to Plastic Surgery” of Campus Bio-Medico University in RomeRomeItaly
  3. 3.Department of Surgery, Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  4. 4.Institute of Philosophy of Scientific and Technological ActivityCampus Bio-Medico University of RomeRomeItaly

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