Gynecomastia, or excessive male breast development, has an incidence of 32 to 65 percent in the male population. This condition has important physical and psychological impacts. Advances in elucidating the pathophysiology of
gynecomastia have been made, though understanding remains limited. Recommendations for evaluation and workup have varied and are often arbitrary. A diagnostic algorithm is suggested, with emphasis on a comprehensive history, physical examination, and minimizing unnecessary diagnostic testing. Medical management has had limited success; surgical
therapy, primarily through excisional techniques, has been the accepted standard. Although effective, excisional techniques subject patients to large, visible
scars. Ultrasound-assisted
liposuction has recently emerged as a safe and effective method for the treatment of
gynecomastia. It is particularly efficient in the removal of the dense, fibrous male breast tissue while offering advantages in minimal external
scarring. A new system of classification and graduated treatment is proposed, based on glandular versus fibrous
hypertrophy and degree of breast ptosis (skin excess). The authors' series of 61 patients with
gynecomastia from 1987 to 2000 at the University of Texas Southwestern Department of Plastic Surgery demonstrated an overall success rate of 86.9 percent using suction-assisted
lipectomy (1987 to 1997) and ultrasound-assisted
liposuction (1997 to 2000). The authors have found ultrasound-assisted
liposuction to be effective in treating most grades of
gynecomastia. Excisional techniques are reserved for severe
gynecomastia with significant skin excess after attempted ultrasound-assisted
liposuction.