It is widely accepted that some gynecomastia tissue should remain under the nipple-areola complex (NAC) after treatment (subtotal glandular resection) to minimize complications, such as contour irregularity, NAC depression, NAC distortion, and vascular compromise with possible necrosis. However, this approach is pursued even though leaving this tissue under the NAC can cause the undesirable appearance of “puffy nipples” and widened areolas while also increasing the possibility of recurrence and a compromised aesthetic result. Thus, a contradiction exists between potential NAC deformities caused by total gynecomastia tissue removal under the areola and the necessary removal of this tissue to produce the desired smaller, flatter NACs; minimize recurrence; and optimize chest masculinization. Accordingly, the objective of this study was to determine if complete removal of gynecomastia tissue without NAC deformity is achievable using an adjunctive layered closure technique.
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