Comment to “Percutaneous Intradermal Purse-String Closure for Correction of Male Tuberous Nipple-Areola Complex Deformity”

Abstract

Dear Editor, We read with great interest the paper entitled ‘‘Percutaneous Intradermal Purse-String closure for Correction of Male Tuberous Nipple-Areola Complex Deformity’’ [1] in which Carvajal et al. presented an innovative variation in a surgical technique for the correction of a male tuberous breast deformity combining the traditional lower hemiareolar approach with a percutaneous intradermal pursestring periareolar suture. We would like to congratulate Carvajal and coworkers for the paper and we would like to thank them for the citation. The described work describes a variation in the surgical technique for the correction of male tuberous nipple-areolar complex (NAC) deformity, avoiding the use of a limited periareolar incision, while implementing a conventional lower hemiareolar approach with a percutaneous intradermal purse-string suture in the superior areolar margin to reduce the areolar diameter. We appreciated the variation in the surgical technique proposed by the authors since we believe that the tuberous breast deformity is an increasing issue not only in women but also in the male population [2]. In our experience, the treatment for the tuberous breast deformity in females has already been widely addressed [3]. On the other hand, concerning the male stenotic breast, we have recently published a paper in which we described our new surgical classification of gynecomastia where we identified three classes of patients: patients with true gynecomastia, pseudo-gynecomastia and mixed forms, each of them furtherly divided into ptotic and non-ptotic. We identified six classes of patients, and for each of them, we proposed a specific surgical correction, including surgical glandular removal, liposuction and, if necessary, a mastopexy (periareolar, vertical or T-inverted mastopexy). This new classification, compared to the previous ones described in the literature, has the main advantage of guiding precisely the surgical plan [4]. Focusing on the case presented by Carvajal et al., according to our classification, it belongs to IA grade and we would have approached it with a surgical glandular removal through an inferior hemiareolar incision; however, we believe their innovative approach can be as well an excellent solution. We would like to conclude by highlighting the importance of the periareolar incision for the correction of almost the totality of ptotic male breasts; through the time we have gained much experience in this approach which has shown to be the perfect solution for removing and & Benedetta Agnelli [email protected]