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
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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
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
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
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
Simon BE, Hoffman S, Kahn S (1973) Classification and surgical correction of gynecomastia. Plast Reconstr Surg 51:48–52
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
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
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
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
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
Minabe T, Harii K (2007) Dorsal intercostal artery perforator flap: anatomical study and clinical applications. Plast Reconstr Surg 120:681–689
Badran HA, El-Helaly MS, Safe I (1984) The lateral intercostal neurovascular free flap. Plast Reconstr Surg 73:17–26
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
Klassen AF, Cano SJ, Scott A, Tsangaris E, Pusic AL (2014) Assessing outcomes in body contouring. Clin Plast Surg 41:645–654
Rasch G (1993) Probabilistic models for some intelligence and attainment tests. MESA Press, Chicago
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
Ibrahiem SM (2016) Severe gynecomastia: new technique using superior pedicle NAC flap through a circumareolar approach. Ann Plast Surg 76:645–651
Webster J-P (1946) Mastectomy for gynecomastia through semi-circular intra-areolar incisions. Ann Surg 124:557
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
Copcu E (2009) Treatment of severe gynaecomastia (grade III) by Moufarrege technique. J Plast Reconstr Aesthet Surg 62:131–133
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
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
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
Salim F, Chana J (2010) Intercostal adipofascial perforator flap for reconstruction of overcorrected gynaecomastiadeformity. J Plast Reconstr Aesthet Surg 63:1385–1387
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
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
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
Cogliandro A, Barone M, Persichetti P (2017) Italian linguistic validation of the FACE-Q instrument. JAMA Facial Plast Surg 19:336–337
Barone M, Cogliandro A, Persichetti P (2017) Ethics and plastic surgery/What is plastic surgery? Arch Plast Surg 44:90–92
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
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
http://www.mapi-trust.org. Accessed 12 Apr 2018
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.
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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
- Perforator flap
- Plastic surgery
- Cosmetic surgery
- Patient-reported outcome