Aesthetic Plastic Surgery

, Volume 41, Issue 3, pp 531–541 | Cite as

Postero-Inferior Pedicle Surgical Technique for the Treatment of Grade III Gynecomastia

  • Sophie Thiénot
  • Nicolas BertheuilEmail author
  • Raphaël Carloni
  • Cécile Méal
  • Sylvie Aillet
  • Christian Herlin
  • Eric Watier
Original Article Breast Surgery



Surgical treatment of Grade III gynecomastia generally utilizes mastectomy techniques and free transplantation of the nipple–areola complex. Moreover, with rising obesity rates and the development of bariatric surgery, an increasing demand for correctional surgery for pseudogynecomastia has been observed, which is comparable to Grade III gynecomastia in terms of its surgical management. Here, we describe an innovative technique to deal with these new demands: fascio-cutaneous flap by postero-inferior pedicle.

Materials and Methods

All patients in the Department of Plastic Surgery from our University Hospital suffering from Grade III gynecomastia or pseudogynecomastia underwent surgery via the postero-inferior pedicle flap technique. Briefly, we performed extensive liposuction of the infero-internal and infero-external mammary quadrants followed by liposuction of the deep tissues of the superior quadrants, except in the area of the pedicle. After removing the skin just above the dermis of the inferior quadrants and performing de-epithelialization of the postero-inferior pedicle flap, the thoracic flap was lowered and the areola transposed.


Nine patients underwent surgery between March 2015 and March 2016, and their results were collected prospectively. The mean patient age was 46.6 years, the mean weight was 94.2 kg, and the mean body mass index was 30.8 kg/m2. In addition, the mean operative time was 132 min, the mean liposuction volume was 633 mL, the excised weight was 586 g, and the mean hospitalization and drainage durations were 3.8 days. No major complications occurred, no re-intervention was required, and no recurrence was found.


We report a new operative technique using a postero-inferior pedicle. Its main advantage is preservation of neurovascular function, which makes this a promising technique for patients who wish to maintain nipple sensitivity. This surgery is reliable and reproducible. We recommend it as the first line treatment for Grade III gynecomastia because of its low rate of major complications and favorable functional and esthetic results.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Gynecomastia Pseudogynecomastia Massive weight loss Postero-inferior pedicle Liposuction Male breast Surgery Male mastectomy 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Supplementary material

Supplementary material 1 (MP4 15724 kb)

Supplementary material 2 (MP4 29622 kb)

Supplementary material 3 (MP4 49158 kb)

Supplementary material 4 (MP4 20197 kb)


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Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  • Sophie Thiénot
    • 1
  • Nicolas Bertheuil
    • 1
    • 2
    • 3
    Email author
  • Raphaël Carloni
    • 4
  • Cécile Méal
    • 1
  • Sylvie Aillet
    • 1
  • Christian Herlin
    • 5
  • Eric Watier
    • 1
  1. 1.Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital SudUniversity of Rennes 1RennesFrance
  2. 2.SITI Laboratory, Etablissement Français du Sang BretagneRennes University HospitalRennesFrance
  3. 3.STROMAlab, UMR5273 CNRS/UPS/EFS – INSERM U1031Rangueil HospitalToulouseFrance
  4. 4.Department of Plastic, Reconstructive and Aesthetic Surgery, Nicolle HospitalUniversity of RouenRouenFrance
  5. 5.Department of Plastic and Burn SurgeryCHU of MontpellierMontpellierFrance

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