Gynecomastia isn’t “just fat.” It’s a spectrum—ductal tissue, stroma, and fat—driven by hormonal shifts across life stages. In this episode, we walk through a clean clinical framework: etiology → pathology timeline → exam/workup → severity grading → surgical plan, with pearls that prevent the most common aesthetic failures.

We cover when you can stop the workup, how to interpret florid vs fibrous disease by duration, and how Simon grading dictates whether you’re doing lipo, excision, pull-through, or formal skin resection. Then we get practical: incision placement, contour strategy, compression, drains, and how to avoid the nightmare complications—hematoma, under-resection, and the classic subareolar “saucer” deformity.

Key takeaways

• Gynecomastia peaks in neonatal, adolescent, and >65 age groups—think T:E ratio shift.

• Pathology tracks duration: florid <4 mo, intermediate 4–12 mo, fibrous >1 yr.

• Simon grade guides skin management—2b often deserves time + compression before skin excision.

• Preserve a 1–1.5 cm subareolar cuff to prevent NAC adherence/depression.

• If lipo leaves a residual “bud,” add pull-through (don’t accept under-resection).

Citations (AMA)

1. Rohrich RJ, Ha RY, Kenkel JM, Adams Wand management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. 2003;111(2):909-923. doi:10.1097/01.PRS.0000042146.40379.25. PMID:12560721.

2. Hammond DC. Surgical correction of gynecomastia. Plast Reconstr Surg. 2009;124(1 Suppl):61e-68e. doi:10.1097/PRS.0b013e3181aa2dc7. PMID:19568140.

3. Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52. doi:10.1097/00006534-197301000-00009. PMID:4687568.

4. Hammond DC, Arnold JF, Simon AM, Capraro PA. Combined use of ultrasonic liposuction with the pull-through technique for the treatment of gynecomastia. Plast Reconstr Surg. 2003;112(3):891-895. doi:10.1097/01.PRS.0000072254.75067.F7. PMID:12960873.

Disclaimer: This content is for educational purposes only and is not medical advice.

#PlasticSurgery #Gynecomastia #PRS #SurgeryEducation #Residency #AestheticSurgery #Liposuction

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