Procedure

Authors: Mia Demant, MD, Magnus Balslev Avnstorp, MD and Mia Steffensen, MD

The traditional surgical treatment of GM in Denmark is liposuction combined with a subcutaneous mastectomy ad modum Webster.

Step 1: Pre-operative markings and incision

The patient is marked while standing, where areas of excess glandular tissue is visualized. Access is created through a semicircular incision, from where excess glandular tissue is removed.

Step 1: Breast tissue division and excision

The breast ducts are divided while retracting the areolar flap.

Breast tissue excision while traction is maintained outwards aided by a Kocher clam

Step 3: Klein’s solution

Prior to the liposuction procedure, Klein’s solution is introduced into the fat. Klein’s solution contains lignocaine, epinephrine, and large amounts of saline. The saline balloons the fat tissue, epinephrine causes vasoconstriction, thus, decreasing bleeding, and lignocaine induces local anaesthesia.

Step 4: Liposuction

The initial incisions for liposuction is 5-7-mm scalpel stabs made through the IMF and lateral chest.

Pre-tunneling before liposuction is carried out using a liposuction cannula through the incision.
A 3-mm-diameter liposuction-cannula with the “Mercedes-Benz-tip” is inserted and liposuction of the ipsilateral breast is completed.
A 5-mm thick layer of subcutaneus fat is left in all regions.
The procedure is repeated on the opposite breast.
Liposuction is carried out using a power-assisted device.
The volume of aspirated fat from each breast is noted.

Alternative procedures

Alternative techniques includes liposuction through smaller, peripheral incisions, and the glandular tissue can hereafter be removed through these small incisions.
In severe cases with a large skin excess, it is often necessary with skin removal by either a concentric (shown below) of vertical mastopexy.

Acknowledgments

Illustrators: Christian Paaskesen, med.stud.