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

Abstract

Introduction

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.

Results

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.

Conclusions

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 www.springer.com/00266.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    https://www.plasticsurgery.org/documents/News/Statistics/2016/body-contouring-gender-confirmation-surgery-2016.pdf. Accessed 12 Apr 2018

  2. 2.

    Cogliandro A, Barone M, Cassotta G, Salzillo R, Persichetti P (2018) Mastopexy on reconstructed breast following massive weight loss: an innovative technique using Dermo-Capsular flaps. Aesthetic Plast Surg 42:396–399

    CAS  Article  Google Scholar 

  3. 3.

    Barone M, Cogliandro A, Morelli Coppola M, Cassotta G, Di Stefano N, Tambone V, Persichetti P (2018) Patient-reported outcome measures following gynecomastia correction: a systematic review. Eur J Plast Surg 41:109–118

    Article  Google Scholar 

  4. 4.

    Matarasso A, Roslin MS, Kurian M (2007) Plastic Surgery Educational Foundation Technology Assessment Committee. Bariatric surgery: an overview of obesity surgery. Plast Reconstr Surg 119:1357–1362

    CAS  Article  Google Scholar 

  5. 5.

    Vilà J, Balibrea JM, Oller B, Alastrué A (2014) Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients. Plast Reconstr Surg 134:448–454

    Article  Google Scholar 

  6. 6.

    Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51:48–52

    CAS  Article  Google Scholar 

  7. 7.

    Persichetti P, Tenna S, Brunetti B, Aveta A, Segreto F, Marangi GF (2012) Anterior intercostal artery perforator flap autologous augmentation in bariatric mastopexy. Plast Reconstr Surg 130:917–925

    CAS  Article  Google Scholar 

  8. 8.

    Tenna S, Brunetti B, Coppola MM, Persichetti P (2017) The anterior intercostal artery perforator flap: clinical applications in partial breast reconstruction. Plast Reconstr Surg 140:746e–747e

    CAS  Article  Google Scholar 

  9. 9.

    Kwei S, Borud LJ, Lee BT (2006) Mastopexy with autologous augmentation after massive weight loss: the intercostal artery perforator (ICAP) flap. Ann Plast Surg 57:361–365

    CAS  Article  Google Scholar 

  10. 10.

    Oki K, Murakami M, Tanuma K, Ogawa R, Ozawa H, Hyakusoku H (2009) Anatomical study of pectoral intercostal perforators and clinical study of the pectoral intercostal perforator flap for hand reconstruction. Plast Reconstr Surg 123:1789–1800

    CAS  Article  Google Scholar 

  11. 11.

    Hamdi M, Van Landuyt K, de Frene B, Roche N, Blondeel P, Monstrey S (2006) The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg 59:644–652

    Article  Google Scholar 

  12. 12.

    Minabe T, Harii K (2007) Dorsal intercostal artery perforator flap: anatomical study and clinical applications. Plast Reconstr Surg 120:681–689

    CAS  Article  Google Scholar 

  13. 13.

    Badran HA, El-Helaly MS, Safe I (1984) The lateral intercostal neurovascular free flap. Plast Reconstr Surg 73:17–26

    CAS  Article  Google Scholar 

  14. 14.

    Barone M, Cogliandro A, Salzillo R, Tambone V, Persichetti P (2018) Patient-reported satisfaction following post-bariatric surgery: a systematic review. Aesth Plast Surg 42:1320–1330

    CAS  Article  Google Scholar 

  15. 15.

    Klassen AF, Cano SJ, Scott A, Tsangaris E, Pusic AL (2014) Assessing outcomes in body contouring. Clin Plast Surg 41:645–654

    Article  Google Scholar 

  16. 16.

    Rasch G (1993) Probabilistic models for some intelligence and attainment tests. MESA Press, Chicago

    Google Scholar 

  17. 17.

    Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation outcomes (PRO) measures: report of the ISPOR task forcenfor translation and cultural adaptation. Value Health 8:94–104

    Article  Google Scholar 

  18. 18.

    Ibrahiem SM (2016) Severe gynecomastia: new technique using superior pedicle NAC flap through a circumareolar approach. Ann Plast Surg 76:645–651

    CAS  Article  Google Scholar 

  19. 19.

    Webster J-P (1946) Mastectomy for gynecomastia through semi-circular intra-areolar incisions. Ann Surg 124:557

    Article  Google Scholar 

  20. 20.

    Cannistra C, Piedimonte A, Albonico F (2009) Surgical treatment of gynecomastia with severe ptosis: periareolar incision and dermal double areolar pedicle technique. Aesthet Plast Surg 33:834–837

    Article  Google Scholar 

  21. 21.

    Copcu E (2009) Treatment of severe gynaecomastia (grade III) by Moufarrege technique. J Plast Reconstr Aesthet Surg 62:131–133

    CAS  Article  Google Scholar 

  22. 22.

    El-Khatib HA (2007) A single stage liposuction and dermopexy for grade 3b and grade 4 pseudogynecomastia after massive weight loss: an observational study. Int J Surg 5:155–161

    Article  Google Scholar 

  23. 23.

    Klinger ME, Bandi V, Vinci V, Forcellini D, Maione L (2011) Innovations in the treatment of male chest deformity after weight loss: the authors’ technique. Aesthet Plast Surg 35:856–858

    Article  Google Scholar 

  24. 24.

    Tashkandi M, Al-Qattan MM, Hassanain JM, Hawary MB, Sultan M (2004) The surgical management of high-grade gynecomastia. Ann Plast Surg 53:17–20

    Article  Google Scholar 

  25. 25.

    Salim F, Chana J (2010) Intercostal adipofascial perforator flap for reconstruction of overcorrected gynaecomastiadeformity. J Plast Reconstr Aesthet Surg 63:1385–1387

    CAS  Article  Google Scholar 

  26. 26.

    Persichetti P, Berloco M, Casadei RM, Marangi GF, Di Lella F, Nobili AM (2001) Gynecomastia and the complete circumareolar approach in the surgical management of skin redundancy. Plast Reconstr Surg 107:948–954

    CAS  Article  Google Scholar 

  27. 27.

    Barone M, Cogliandro A, La Monaca G, Tambone V, Persichetti P (2015) Cognitive investigation study of patients admitted for cosmetic surgery: information, expectations, and consent for treatment. Arch Plast Surg 42:46–51

    Article  Google Scholar 

  28. 28.

    Barone M, Cogliandro A, Di Stefano N, Aronica R, Tambone V, Persichetti P (2017) Linguistic validation of the “FACE-Q rhinoplasty module” in Italian. Eur Arch Otorhinolaryngol 274:1771–1772

    CAS  Article  Google Scholar 

  29. 29.

    Cogliandro A, Barone M, Persichetti P (2017) Italian linguistic validation of the FACE-Q instrument. JAMA Facial Plast Surg 19:336–337

    Article  Google Scholar 

  30. 30.

    Barone M, Cogliandro A, Persichetti P (2017) Ethics and plastic surgery/What is plastic surgery? Arch Plast Surg 44:90–92

    Article  Google Scholar 

  31. 31.

    Cogliandro A, Persichetti P, Ghilardi G, Moss TP, Barone M, Piccinocchi G, Ricci G, Vitali M, Giuliani A, Tambone V (2016) How to assess appearance distress and motivation in plastic surgery candidates: Italian validation of Derriford Appearance Scale 59 (DAS 59). Eur Rev Med Pharmacol Sci 20:3732–3737

    CAS  PubMed  Google Scholar 

  32. 32.

    WHO (World Health Organization). Process of translation and adaptation of instruments. http://www.who.int/substance_abuse/research_tools/translation/en/. Accessed 12 Apr 2018

  33. 33.

    http://www.mapi-trust.org. Accessed 12 Apr 2018

Download references

Acknowledgement

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. Barone.

Electronic supplementary material

Below is the link to the electronic 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)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barone, M., Cogliandro, A., Tsangaris, E. et al. Treatment of Severe Gynecomastia After Massive Weight Loss: Analysis of Long-Term Outcomes Measured with the Italian Version of the BODY-Q. Aesth Plast Surg 42, 1506–1518 (2018). https://doi.org/10.1007/s00266-018-1232-9

Download citation

Keywords

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