How to Avoid the Visible Scars for the Treatment of High - Grade Type Lipomastia How to Avoid the Visible Scars for the Treatment of High - Grade Type Lipomastia Sang Yub Yoon, M.D. Silhouette Clinic, Seoul, Korea Purpose of study: Lipomastia (fatty-type lipocomastia) may be defined as the benign enlargement of the male breast attributable to accumulation of the breast adipose tissue. It is not uncommon to encounter patients who have undergone surgery for lipomastia but who were not fully satisfied with the results because of visible scar. The aim of this study was to describe the operative technique avoiding the conspicuous scars on the male breast against the treatment of high-grade type lipomastia. Subjects and Methodology: A simple classification of lipomastia is as follows: type I – prominent breasts with elastic skin; type II – prominent breasts with visible inframammary fold; type III – ptotic breast with inelastic skin and/or well-defined inframammary fold. To treat the high-grade lipomastia, I applied the skin-fascia fixation between the posterior surface of the chest skin and pectoral fascia(Fig. 1) after ultrasound-assisted liposuction, scavenging suction lipectomy, fibroglandular excision via stab incision(Fig. 2). Results: These techniques were applied to 1,734 patients(Fig. 3 & 4). Complications were minimal. Thirteen patients got secondary operation (i.e. chest lifting) to improve the contouring. Conclusion: I present some minimally invasive technique for the management of lipomastia in patients with significant ptosis or skin excess that combined the advantages of ultrasonic liposuction with the precise and controlled excision of fibro-glandular breast tissue. These techniques are also alternative to treat the ptotic lipomastia, avoiding undesirable scars. Legend Fig. 1. (Above, left & right) The skin-fascia fixation procedure. (Below, left) Preoperative standing view. Note; prominent inframammary fold and ptotic breast. (Below, right) Postoperative standing view after 1 day. Fig. 2. The operative procedure. (Above, left) Lipocomastia design and periareoalr stab incision. (Above, right) Ultrasound-assisted liposuction and conventional suction-assisted lipectomy. (Below, left) Remained palpable firboglandular tissue which limited the margin of areolar diameter. (Below, right) Pull-out method for removal of the fibroglandular tissue. Fig. 3. A 22 year-old patient (type III, with well-defined inframammary fold) treated with skin-fascia fixation after peri-areolar stab incision, ultrasound-assisted liposuction, suction-assisted lipectomy and pull-out method. (Above, left) Preoperative view. (Above, right) Postoperative view after 1 day. (Below) Postoperative view after 2 years. Fig. 4. A 28 year-old patient (type III, ptotic breast) treated with skin-fascia fixation (Above, left) Preoperative view. (Above, right) Postoperative view after 1 month. (Below, left) Postoperative view after 4 months. (Below, right) Postoperative view after 13 months. 실루엣성형외과 윤상엽원장 02-3443-1180/1280 2017-05-15