Management of Gynecomastia in Patients With Different Body Types: Considerations on 312 Consecutive Treated Cases

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To the Editor:
We read with interest the recent article by Innocenti et al1 in Annals of Plastic Surgery. In the study, the authors innovatively analyze different patients' expectation according to their body type and provide us a new perspective regarding personalized management of gynecomastia. Although inspired, we still have puzzles and suggestions regarding several aspects of this study.
In this study, the patients were selected between January 2007 and January 2015, but the questionnaire used for patients' satisfaction rating was suggested in November 2009.2 From this, we understand that this is a retrospective study and at least the patients selected between January 2007 and November 2008 could not answer the 12-month-postoperative questionnaire reported in November 2009. Did they use another questionnaire? Or did they answer the same questionnaire but at different follow-up time? In either way, the assessment lacks consistency; thus, the analysis of satisfaction scoring is not convincing enough. By the same token, since this is an 8-year retrospective study, the reasons for undergoing surgery of most patients were given several years after the surgery. The recall bias may be significant.
The authors advocate an adipocutaneous flap as soon as possible to get the maximum contouring of pectoralis area in high muscle mass patients, even at the cost of considerable risk of skin depression. We are curious about the postoperative satisfaction of the patients who encountered depression: Did they regard the “extreme definition of the pectoralis major” more important than the risk of cutaneous depression? Did they require a secondary surgery to correct the depression?
In our experience, the choice of surgical technique for gynecomastia depends on the severity of breast enlargement and the presence of excessive fat tissue. More references recommend liposuction only to correct mild gynecomastia and a combined treatment of liposuction and subcutaneous mastectomy to correct severe gynecomastia.3 Without detailed elucidation, the authors only mentioned that liposuction was performed “when necessary.” We look forward to the further information from the authors to introduce their experience.
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