Breast reshaping in gynecomastia by the “pull-through technique”: considerations after 15 years

Gynecomastia corresponds to abnormal and excessive development of breast tissue in male patients. It may be unilateral or bilateral and, depending on breast volume and skin redundancy, it can be classified, according to Simon, in four different groups. Standard therapy is surgery and different techniques have been described so far, including different type of incisions in the periareolar or intrareolar skin. In 1996 in this journal we described our personal technique, called "pull-through." Our technique combines liposuction that is performed on two planes, subcutaneous and subglandular, and sharp parenchymal excision, performed through the small liposuction incisions. These incisions are short (1-1.5 cm) and hidden in the inframammary fold and behind the anterior axillary pillar. Furthermore the operation can be performed under local anesthesia and with a short recovery period. Since then we have operated on 260 patients. We now present our 15 years experience and our review of literature, focused on authors who used and criticized our technique. Results, in terms of breast volume reduction, skin retraction, and minimal visibility of scars, were very good, even in cases more severe than in our first series (Simon's type IIb and female-to-male transsexuals). Patients' satisfaction rate was high as well and the incidence of complications was low. The results we observed in our series and the ones presented by different authors confirmed the validity and feasibility of the "pull-through" technique in terms of esthetic and functional results, patient satisfaction, and a low incidence of complications.