目的

探讨“锁孔式”皮下腺体全切治疗男性乳房发育症的治疗和美容效果。

方法

男性乳腺发育症患者19 例,其中2 例为腺体型,4 例为脂肪型,其余13 例为腺体脂肪型;年龄18 ~28 岁,中位年龄22 岁,均为双侧乳房发育症。 治疗均采用“锁孔式”皮下腺体全切术。 在乳房肥大区域皮下脂肪层注射脂肪裂解液,采用负压吸引,经乳晕下“锁孔”大小切口抽吸该区域内的脂肪组织,经“锁孔式”小切口逐条切除增生肥大的乳腺组织。 术毕“锁孔”拉闭予生物胶贴合。 结合保留乳房手术美学评定标准对患者术后美容效果进行评分。

结果

手术时间为30 ~125 min,平均63 min;出血量均在30 ml 以内;术后负压引流管放置时间为3 d,日引流量<10 ml 拔除引流管。 术后住院时间平均2.8 (2 ~5) d。 中位随访时间10.2 (6 ~15)个月。 本组19 例患者,手术均获得成功,切口均达到I 期愈合且无明显疤痕;无乳头、乳晕坏死病例;胸部曲线平坦、自然,无凹凸不平感,乳头形态均正常。 本组患者均有手术区轻微疼痛,只需口服镇痛药止痛。 19 例患者对外形均满意,经美容效果评分,均达到10 分以上,均获得良好的美容效果。

结论

“锁孔式”皮下腺体全切术治疗男性乳房发育症,操作简单,安全,损伤小,出血少,恢复快。 该方法适用于各型男性乳房发育症。

Objective

To explore the treatment effect and cosmetics of “keyholestyle” total removal of the glands for male gynecomastia.

Methods

Nineteen patients with bilateral male gynecomastia including 2 glandular type, 4 fat type and 13 glandular plus fat type, aged 18-28 years (median 22 years), were treated in our hospital. All patients were operated on with the method of “keyhole-style” total removal of the glands. An tumescent anesthesia fluid was delivered to the subcutaneous fat area of the breast enlargement, vacuum aspiration was done through the keyhole incision under the areola to suck the fat tissue in the region, then the hypertrophical breast tissue was excised strip by strip through the same incision. After complete removal of the glands the keyhole incision was closed with medical biological adhesive. Cosmetic effect was scored using the aesthetics evaluation criteria for breast conserving operation.

Results

The operation time was 30 - 125 min (mean,63 min). The intraoperative bleeding was within 30 ml. The maintaining period of postoperative drainage tube was three days (the tube was removed when the daily drainage volume was < 10 ml). The hospitalization period after operation was 2-5 days (mean, 2.8 days). The median follow-up time was 10. 2 (6-15) months. The 19 patients were all successfully treated with the method, and all had healing by first intention and there was no obvious scar. No nipple or areola necrosis was found. The breast curve was flat and natural,and nipple appearance was normal in all patients. Slight pain after operation happened in all patients, only oral analgesics were given. The 19 patients were all satisfied with their breast appearance, and all were scored at more than 10 scores. Good cosmetic effect was obtained.

Conclusion

The method of “keyhole-style” total removal of the glands for male gynecomastia has the advantages of easy operation, safeness, less damage, less bleeding,and quick recovery. It fits all types of gynecomastia.