Extensive Ultrasonic Liposuction in Gynecomastia: An Alternative Approach without Surgical Gland Excision

ABSTRACT
Aim: Skin and gland removals made on the chest wall may result in noticeable scars that can be challenging for patients to tolerate. This study aimed to define an extensive ultrasonic liposuction approach without surgical excision for gynecomastia. We also investigated its effectiveness in reducing complications and improving cosmetic outcomes. 
Materials and Methods: Gynecomastia patients with Rohrich grades II and III were evaluated according to skin quality. 46 patients who met these criteria underwent ultrasonic liposuction performed by the senior author between February 2021 and April 2023. These patients were compared with 58 who underwent surgery using suction-assisted liposuction combined with peri areolar mastopexy and glandular excision. 
Results: Our study found that patients who underwent extensive ultrasonic liposuction had a complication rate of 8.7%. Of the total number of patients, only one experienced a seroma complication, and three experienced residual breast tissue/ptosis. None of the patients required revision surgery. In comparison, the control group that underwent peri-areolar mastopexy and glandular excision had a higher complication rate (10.3%). 
Conclusion: We used the basic principles of plastic surgery for wound contraction. Distributing the wound healing mechanisms to a broad surface allowed us to achieve better cosmetics without forming a noticeable scar on the chest wall. 
Keywords: Breast Ptosis, Extensive Liposuction, Gynecomastia Surgery, Ultrasonic Liposuction, Vaser Liposuction