Donut mammoplasty in management of gynecomastia: general surgeon experience

Background
Gynecomastia is benign enlargement of the male breast. Although treatment is not indicated in most cases, esthetic reconstructive surgery is commonly performed for psychological reasons. This clinical study discusses the outcomes of the surgical management of gynecomastia by subcutaneous mastectomy using the donut mastopexy technique in different grades of gynecomastia and assesses the morbidity and complication rates associated with the procedure.
Materials and methods
From January 2013 till January 2017, we operated on 20 patients with bilateral idiopathic grades 1, 2, and 3 gynecomastia by subcutaneous mastectomy using the donut mastopexy technique. Exposure was excellent with the circumareolar incision. Patients were followed for at least 6 months.
Results
Excised specimens were weighed and sent for histopathological examination. The mean weight of the resected specimen was 92±44 g (range: 38–280 g). One patient showed bilateral atypical hyperplasia on histopathological examination. All patients achieved good esthetic contour of the chest. Circumareolar scars were satisfactory for all patients. No wound infection, hematoma, seroma formation, or nipple–areola complex necrosis was seen in any of the patients Areolar sensation was diminished in one (5%) patient and recovered within 6 months postoperatively. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in eight patients with grade 3 gynecomastia.
Conclusion
Donut mastopexy technique is indicated for grades 1, 2, and 3 gynecomastia. Circumareolar incision provides perfect exposure. It is considered to be less invasive, has minimal scarring, has low complication rates, and had good esthetic outcome. Moreover, it is oncologically safe through histopathological examination of excised specimens to discover pathological abnormalities and hidden malignancy.