Prospective Analysis and Comparison of Periareolar Excision (Delivery) and Pull-Through Technique for the Treatment of Gynecomastia

Dear authors, We read with great interest the article titled ‘‘Prospective analysis and comparison of periareolar excision (delivery) and pull-through technique for the treatment of gynecomastia’’ by Tripathy S. et al. in which the authors compared the delivery technique with the pull-trough technique in 20 patients affected by gynecomastia from both surgical and aesthetical points of view [1]. We congratulate the authors for their results and for the effort to compare two different surgical approaches, but we have some elements to discuss. The chosen cohort included 20 patients, with a mean age of 23.6 years, and therefore both groups included 10 patients mostly affected by Simon’s grade IIa gynecomastia. The authors did not indicate whether any of the patients were affected by endocrinological disorders or drug abuse and whether eventually those patients were excluded from the study. In both groups, a small amount of gland was left under the nipple-areola complex to avoid the depression under the areola. Did the authors have any recurrences? Since the longest follow-up is 6 months, we retain that longer follow-up should be applied to these patients to confirm the absence of recurrence [2]. In the present paper, all patients have a similar BMI and body type, but, in our experience, we found that final satisfaction for the surgical outcome is strictly connected to the preoperative condition. We published a paper describing the surgical approach and cosmetic results in 312 selected patients affected by gynecomastia, grouping patients based on different body types [3]. The authors selected a cohort of patients with a narrow grade of heterogeneity, and therefore we retain that assuming that both techniques are equally effective is only partly true, since awider cohort of patients should be recruited to better compare the two techniques [4, 5]. In our paper, 309 surgical procedures were performed under local anesthesia, in day-surgery regimen. Do the authors ever consider correcting gynecomastia under tumescent anesthesia, considering that both techniques include the use of liposuction? In our experience, we retain that moderate cases of gynecomastia could be treated under local anesthesia thus reducing the mean hospital stay (72 h for group A and 76.8 for group B). Even though there are still a few limitations, we appreciate the paper and authors’ work, assuming that further studies, with longer follow-up and larger cohort of patients, should be considered to better compare different surgical approaches in such a very interesting field as the surgical treatment of gynecomastia.