Introduction: With the advent of liposuction, key-hole surgery for gynecomastia is on the rise. However, the skin excess in Grade 2b/3 gynecomastia that exists in vertical and horizontal axes in most cases has to be excised after completion of the liposuction. For the management of patients with Grade 2b/3 gynecomastia, we propose the helmet design for removing skin excess effectively and for relocating the nipple-areola complex in proper position concomitantly with suction-assisted liposuction. Method: The helmet design technique is described here. This technique was performed on 5 consecutive patients with Grade 2b/3 gynecomastia treated at our institute over a period of 2 years from November 2006 to November 2008 with a minimum follow-up period of 3 months. The aesthetic outcome was evaluated by patients on a grading scale from Grade 1 to Grade 3 (Grade J = poor, Grade 2 = satisfactory, Grade 3 = good). All patients were treated on a day care basis. Results: The helmet design technique takes care of the excess skin that remains after liposuction and avoids the skin pleating and puckering that result from use of the circumareolar method of skin excision. We did not encounter any complications when using this technique. Two patients had decreased nipple sensation that recovered later. The aesthetic outcome was rated as Grade 2 by 1 patient and Grade 3 by 4 patients. Conclusion: The helmet design excision used in patients with Grade 2b/3 gynecomastia treated with suction-assisted liposuction helps in relocating the nipple-areola complex to proper position and in achieving complete removal of excess skin. This is an effective single-stage treatment for patients with Grade 2b/3 gynecomastia.
Systematization of the Incisions in Nipple-Sparing Mastectomy
