The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia

Dear Editors, We read with great interest the article titled ‘‘The vacuumassisted breast biopsy system is an effective strategy for the treatment of gynecomastia’’ by Qu et al. [1]. We congratulate the authors for their interesting article proposing a new tool for plastic surgeons’ practice, addressing new technologies to better serve the gynecomastia population as an adjunctive technique to be incorporated in their practice. Less invasive and safe methods are nowadays one of the most important items to maximize final results, patients’ satisfaction and reduce complications and adverse effects, but we have some elements to discuss. Gynecomastia affects a large part of the male population, including several physical body shapes out of the affected subjects. Even if the vacuum-assisted breast biopsy (VABB) system represents a valid method for a restricted cohort of patients, it requires the use of very sophisticated technologies, representing sensitive costs, including both logistic and economical aspects. Moreover, although the procedure is performed in an outpatient setting under local anesthesia, surgery time is longer compared to other techniques and requires a specific learning curve for surgeons and technicians. Since today economical aspects represent a very sensitive item in medical and surgical practice, we consider essential a detailed cost analysis compared to traditional techniques. Gynecomastia correction is a surgical procedure that could be performed under local anesthesia in a day-surgery setting, even the most severe forms, without the use of additional and expensive instruments. Recently, we published an article reporting our personal experience with this surgical approach, with more than 300 patients [2]. Furthermore, gynecomastia includes several clinical local aspects that should not be addressed with the use of VABB, such as NAC enlargement, breast ptosis and extra-skin redundancy, observed in a large part of patients. As reported by the authors, these clinical features have not been corrected, but only gland removal was transcutaneously performed. We personally maintain that the final goal of gynecomastia correction is not only the removal of glandular tissue [3], but is recontouring a masculine aspect of the thorax, taking into account specific characteristics that male patients want to obtain, such as small areolas, skin tightening and a very defined pectoral region [4, 5]. Open surgery allows a direct surgical approach with small incisions (mean length 2.5 cm) placed in a hidden region and rarely represents a reason for patients’ claims, instead of a poorly defined aspect of the thorax, with a reasonable cost/benefits ratio with short operative time and hospitalization [6]. Compliance with Ethical Standards