Successful B/L Liposuction & Gland Excision for Grade-IIB Pubertal Gynecomastia

Chief Complaints

A 21-year-old male patient with a body mass index (BMI) of 20 presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with persistent bilateral chest enlargement since puberty. The condition had led to considerable psychosocial distress, social withdrawal, and academic absenteeism due to peer bullying. Seeking a definitive and permanent correction, the patient consulted for surgical management of his condition.

The patient had no significant past medical history and was otherwise healthy. There was no history of endocrine disorders, chronic illnesses, medication use, anabolic steroid intake, substance abuse, previous chest surgery, or chest trauma.

On admission, the patient was conscious, coherent, and oriented with stable vital signs. General physical examination revealed no signs of systemic illness. Local examination of the chest showed bilateral symmetrical enlargement of the breast region with prominent subareolar fullness. The overlying skin was normal in color and texture, with no visible scars, ulceration, or discharge. The nipple–areolar complexes were centrally positioned. On palpation, the breast tissue was soft to firm in consistency, non-tender, and without any discrete palpable masses. No axillary lymph nodes were palpable. Systemic examination was otherwise normal.

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation, including a detailed review of his medical history and a thorough physical examination by the Plastic and Reconstructive Surgery team. The patient presented with a history of bilateral chest enlargement since puberty, associated with significant psychosocial distress, social withdrawal, and academic difficulties due to peer bullying. Clinical examination revealed bilateral breast enlargement consistent with persistent pubertal gynecomastia.

A complete diagnostic workup was carried out, including high-resolution ultrasound of the chest and routine pre-anesthetic investigations, which confirmed the presence of bilateral Grade-IIB gynecomastia. No underlying endocrine or systemic abnormalities were identified, and laboratory investigations were within normal limits, with no contraindications for surgical management. The patient’s general systemic condition was stable.

Based on the clinical and radiological findings, the patient was advised to undergo Bilateral Grade-IIB Pubertal Gynecomastia Treatment in Hyderabad, India, under the expert care of the Plastic and Reconstructive Surgery team.

After a detailed consultation with Dr. Kantamneni Lakshmi, Senior Consultant Plastic, Reconstructive & Aesthetic Surgeon, a comprehensive assessment was carried out to determine the most appropriate management plan for the patient diagnosed with Bilateral Grade-IIB Pubertal Gynecomastia.

Based on the clinical findings of persistent bilateral breast enlargement since puberty, confirmed Grade-IIB gynecomastia on high-resolution ultrasound, and significant psychosocial distress affecting the patient’s quality of life, it was determined that bilateral liposuction with gland excision under general anesthesia was the most appropriate treatment approach. 

This decision was made after careful evaluation of the chronicity and severity of the condition, lack of spontaneous regression since puberty, and the patient’s strong desire for definitive surgical correction to restore a normal masculine chest contour and improve psychological well-being.

The patient and his family members were counselled in detail regarding the diagnosis, planned surgical procedure, expected outcomes, potential risks and complications, and the importance of postoperative care, including compression garment use, activity restriction, wound care, and regular follow-up for optimal recovery.

Following the diagnosis, the patient was scheduled to undergo Bilateral Liposuction Surgery in Hyderabad at PACE Hospitals, along with Gland Excision under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anaesthesia and Positioning: The procedure was performed under general anaesthesia following pre-anaesthetic evaluation. The patient was placed in a supine position with both arms abducted, and the chest and axillary regions were prepared and draped under strict aseptic precautions.

• Marking and Tumescent Infiltration: Preoperative markings were made to delineate the areas of glandular prominence and planned incision sites. A tumescent solution was infiltrated into the bilateral chest tissues to facilitate fat emulsification, minimize bleeding, and improve the efficiency of liposuction.

• Liposuction via Axillary Ports: Small 0.5 cm hidden incisions were made in the axillary folds. Liposuction was performed using a cannula to remove excess adipose tissue from the subcutaneous plane of both breasts, helping to reduce volume and improve initial contour.

• Glandular Tissue Excision: An inferior periareolar incision was made bilaterally along the lower border of the nipple-areolar complex. The fibroglandular breast tissue was carefully dissected and excised while preserving the vascularity and integrity of the nipple-areolar complex.

• Hemostasis, Closure, and Dressing: Meticulous hemostasis was achieved using electrocautery. The incisions were closed in layers using absorbable sutures for deeper tissues and fine sutures for skin approximation. Sterile dressings were applied, followed by a compression garment to support contouring and reduce postoperative edema.
  

The patient had an uneventful postoperative recovery. Postoperative management included effective pain control, measures to prevent infection, and strategies to reduce fluid accumulation at the surgical site. The surgical site was regularly monitored to ensure proper wound healing and early identification of any complications. Supportive care was provided to facilitate optimal recovery and promote healthy tissue healing.

Upon discharge, medications were prescribed for pain control to ensure postoperative comfort, prevention of surgical site infection, and reduction of inflammation and swelling. Additional supportive measures were advised to minimize fluid accumulation at the surgical site and promote optimal wound healing and recovery.

The patient was advised strict use of a compression garment and to avoid strenuous upper limb activities and heavy lifting. He was also instructed to maintain wound hygiene, attend regular follow-ups, and report any pain, swelling, or discharge immediately.

The patient was advised to contact the emergency ward at PACE Hospitals in case of emergency or development of symptoms like fever, increasing pain, swelling, or discharge from the surgical site. 

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals as per the treating doctor’s advice for postoperative assessment and wound evaluation.

This case highlights the effective surgical management of Grade-IIB pubertal gynecomastia using a combined technique of liposuction and direct glandular excision. The procedure resulted in a well-contoured, flat, masculine chest with excellent cosmetic outcome. There was significant improvement in the patient’s psychosocial well-being with resolution of social anxiety and improved confidence. Overall, it demonstrates that surgical correction provides safe and definitive results in appropriately selected patients.

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