Aesthetic Outcome of Gynecomastia Management with Conventional Liposuction and Cross-Chest Liposuction: A Prospective Comparative Study

Dear editors, We read with great interest the article titled ‘‘Aesthetic Outcome of Gynecomastia Management with Conventional Liposuction and Cross-Chest Liposuction: A Prospective Comparative Study’’ by Singamsetty et al. [1]. The authors proposed an interesting comparison between two techniques, conventional liposuction and cross-chest liposuction, as adjunctive procedures with subcutaneous mastectomy in patients affected from Simon’s grade I and IIA–IIB gynecomastia. We congratulate with the authors for the interesting paper and for their results, but we have some elements to discuss. The main goal of cross-chest liposuction is to reduce scarring by using the same emiperiareolar incision for treating the medial side of the contralateral breast and therefore avoiding lateral incisions, created for cannula insertion, on the lateral part of the chest. Scarring is an extremely important part of the surgical procedure, and the main goal is to achieve the best cosmetic result with minimal scarring. We personally retain that cross-chest liposuction, even if not particularly demanding for a skilled plastic surgeon, has no advantages compared to the conventional liposuction. Especially in patients with grade Simon IIA or Simon IIB gynecomastia, the residual cavity requires the use of drains and, as stated in the paper, drains are always used in each patients [2]. The surgical access that needs to insert drains, necessarily resulting in a scar, could be used at the same time to perform liposuction. For these reasons, drains access, representing an adjunctive scar, must be previously carefully planned and meticulously hidden [3, 4]. Involving the sternal area, cross-chest liposuction could represent a more aggressive procedure in terms of morbidity, compared to traditional liposuction, producing a wider undermined area that doesn’t need to be treated [5]. Moreover, we personally retain that conventional liposuction can better address the subareolar area [6]. This permits an adequate areolar shrinking, since larger areolas are often seen as disturbing in gynecomastia patients, especially in cases with more feminine aspect of the thorax region, and reduce the need for circumareolar incision, whose scars are usually of bad quality. We personally retain that a larger sample of patients with longer follow-up is needed to evaluate whether there is a significant improvement of the aesthetic outcome with cross-chest liposuction compared to traditional liposuction, whose complications and satisfactions’ rates are exhaustively reported in the literatur