An Alternative Treatment of Pseudogynecomastia in Male Patients After Massive Weight Loss

Abstract Background There has been an increase in body contouring procedures following massive weight loss (MWL), including male breast reduction procedures. Treating male chest deformity after MWL using standard mastopexy techniques often leads to suboptimal results. Objectives The authors describe a technique to treat pseudogynecomastia using a modified elliptical excision and nipple-areola complex (NAC) transposition on a thinned inferior dermal pedicle as an alternative to conventional techniques. Methods A retrospective chart review from January 2011 to January 2019 identified a total of 14 male patients who underwent excision of pseudogynecomastia using the described technique. Results Patients were characterized by age, method of weight loss, pre-weight loss body mass index (BMI), post-weight loss BMI, total weight loss, grade of pseudogynecomastia, and concurrent procedures performed. Patients were followed for a period ranging from 3 months to 1.5 years (average, 8.1 months). Pre-weight loss BMI and post-weight loss BMI averaged 52.0 kg/m2 and 29.6 kg/m2, respectively. The average weight lost was 79.72 kg and the average total amount of tissue removed was 2615 g. All patients had concurrent procedures with an average operative time of 274 minutes. Four out of 14 patients (28.6%) experienced minor complications, which included asymmetry, delayed wound healing, seroma, and hyperpigmentation. There were no wound infections, hematomas, flap necrosis, or dysesthesia. Conclusions Due to several cosmetic advantages and low complication profile, our technique using a modified elliptical excision and NAC transfer on an inferior dermal pedicle is an attractive option for treating male chest deformity after MWL. Level of Evidence: 4

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Is body-contouring surgery a right for massive weight loss patients? A survey through the European Union National Health Systems

European Journal of Plastic Surgery ◽

10.1007/s00238-020-01779-w ◽

2021 ◽

Author(s):

Federico Lo Torto ◽

Jacopo M. Frattaroli ◽

Juste Kaciulyte ◽

Ugo Redi ◽

Marco Marcasciano ◽

...

Keyword(s):

Weight Loss ◽

National Health ◽

Body Contouring ◽

National Health System ◽

Well Being ◽

Massive Weight Loss ◽

The European Union ◽

Complex Situation ◽

Level Of Evidence ◽

Eu Countries

Abstract Background Obesity is pandemic nowadays, and hanging skin with consequent functional and psychological impairments is a common price to pay for massive weight loss. Plastic surgery in postbariatric patients represents a fundamental step to regain possession of a positive self-image. The authors aimed to investigate how EU countries’ National Health System (NHS) behaves regarding reimbursements for body-contouring procedures after massive weight loss. Methods A 1-item survey was sent to contacts found on the NHS official Web sites of 27 EU countries. The question focused on postbariatric surgery practice and investigated the accessibility criteria for NHS coverage concerning body-contouring procedures after massive weight loss. Results Responses were collected between January 2020 and February 2020. Response rate was 65%, and access criteria to NHS coverage for postbariatric surgery presented great variation across EU countries. Only one country presented an NHS with no coverage for postbariatric surgeries. Conclusions Despite the conspicuous variability found among the EU NHS, none of them admit reimbursement in cases of merely aesthetic procedures: postbariatric patients need to display functional or health impairments due to the extensive weight loss. The results of the current study describe a complex situation among EU countries, but a common lead towards postbariatric patients’ care shows off. The ultimate goal of bariatric patient’s healing should be full restoration of physical and psychological well-being. NHS of EU countries are facing this increasing request in various ways, and more studies should be performed in order to understand which is the best approach. Level of evidence: Not ratable.

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Reply to: An Alternative Treatment of Pseudogynecomastia in Male Patients After Massive Weight Loss

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02390-5 ◽

2021 ◽

Author(s):

Annalisa Cogliandro ◽

Silvia Ciarrocchi ◽

Mauro Barone ◽

Paolo Persichetti

Keyword(s):

Weight Loss ◽

Alternative Treatment ◽

Massive Weight Loss ◽

Male Patients

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Evaluation of the Vertical Movement of Ribeiro’s Dermolipoglandular Mammary Flap One Year After Mammaplasties in Post-Bariatric Patients

Aesthetic Surgery Journal ◽

10.1093/asj/sjz188 ◽

2019 ◽

Vol 40 (1) ◽

pp. NP21-NP31 ◽

Cited By ~ 3

Author(s):

Rodrigo P Sizenando ◽

Marco Túlio C Diniz ◽

Paulo Roberto da Costa ◽

Luiz Gustavo S Manhães

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Plastic Surgery ◽

Breast Tissue ◽

Vertical Movement ◽

Level Of Evidence ◽

Significance Level ◽

Areola Complex ◽

Ptotic Breast ◽

One Year

Abstract Background In 1971, Ribeiro isolated a segment in the inferior pole of the ptotic breast, nourished by muscular perforating vessels, and moved it cranially to the posterior region of the remaining detached breast tissue, where it was fixed to the pectoral fascia. This maneuver created a flap with autologous implant function, independent from the rest of the breast’s support, that maintained long-term mammary projection. Objectives The objectives of this study were to measure the vertical movement of this flap 1 year after mammaplasty and to evaluate the factors involved. Methods The sample included 13 patients who had previously undergone bariatric surgery. The position of a titanium marker attached to the Ribeiro flap was compared on chest radiographs taken 1 day and 1 year after the mammaplasty. The significance level was set at 5%. Results All of the titanium markers moved 0.6 cm to 4.1 cm caudally during the study period (average, 2.4 cm ± 1.02 cm). The greater the weight loss after the plastic surgery, the further the marker’s descent. Weight loss between bariatric surgery and plastic surgery, the vertical dimension of the ptotic breast tissue immediately before plastic surgery, the vertical extent of the nipple-areola complex elevation during mammaplasty, the Ribeiro flap thickness and volume, and the breast volume after mammaplasty were not associated with the vertical movement of the flap. Conclusions The Ribeiro flap employed in mammaplasty of patients who previously underwent bariatric surgery undergoes ptosis that is exacerbated by weight loss after mammaplasty. Level of Evidence: 4

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