| Objective: (1)Through the measurement of aesthetics markers of Chinese adult male' s breast, to acquire the normal average value of Chinese adult male' s breast and reference value of nipple and areola of breast of Chinese adult male' s breast in order to reference of operation plasty of nipple and areola of breast, to acquire the reference values of many lines, to suggest the proper location way of the nipple-areola complex and offer the available evidence for plastic surgery of moderate and severe gynecomastia and operation of female to alter mail. To observed the difference of anatomical parameter in adult male's chest in Youth group (age 18 to 25), Prime group (age 26 to 45) and Middle Old-Age group (age >45) ,to plent aesthetic theory of male breast. (2)To research the clinic using value of aesthetics markers of Chinese adult male' s breast in operation of gynecomastia in order to rise the treatment level of gynecomastia. (3)To improve and bring new ideas of operation method of gynecomastia in order to establish new operation method of breast double ring incision, out-upside dermo-mammary single pedicle of nipple and periareola, mastectomy with tumescent anesthesia of gynecomastia.Methods: (1) 595 male volunteers without gynecomastia between the ages of 18 to 69 years were chosen for this study. We measured the following parameters: stature, weight, chest circumference at the lever of the nipples, nipple length, nipple width, areola length, areola width, nipple protruding, nipple height measured from the thenar, distance ofsuprasternale-to- thelion, clavicle midpoint to thelion, thelion to thelion, suprasternale to the thelion plane, suprasternale to symphysion, thelion to symphysion, and thelion to omphylion. For each anatomical parameter, the minimum value, maximum value, mean value and standard deviation were calculated using SPSS 10.0 statistics software. So did correlations between the each measured parameters. The ratio tite of two markers which were more correlation significantly was calculated, too. The difference of anatomical parameters in adult male' s chest in Youth group, Prime group and Middle Old-Age group was stated and analyzed. (2) Using the result of aesthetics markers of Chinese adult male' s breast in 15 cases severe gynecomastia operations. (3)Read the literature, to analyze of treatment methods of gynecomastia, to advance the choice suggestion of treatment and operation methods of gynecomastia. To improve and bring new ideas of operation method of gynecomastia, to establish new operation method of breast double ring incision, out-upside dermo-mammary single pedicle of nipple and periareola, mastectomy with tumescent anesthesia of gynecomastia. The outline of this operation method was as follow: the inside wreath of breast double ring incision was in areola. Its diameter was 2.0~3.0cm, wind nipple. The outside wreath of breast double ring incision was in breast skin outside areola, parallel with inside wreath. The distance between inside wreath and outside wreath was 1~5cm, according to the size of breast. Out-upside dermo-mammary single pedicle of nipple and periareola located the upper part outside the nipple, reported fan- shaped Its width was 1/3 ~ 1/2 circumference of periareola. The part between inside wreath and outside wreath should go to wipe the epidermis off. Except reservation of nipple and periareola in the inside wreath with 0.8 cm thick out-upside dermo-mammary single pedicle of nipple and periareola tissue, others were resected thoroughly. After stopping bleeding many small "V" shaped incisions were performed in the outside ring, suturing between the side to side and making its circumference equal to inside wreath or pouchingsuturing to reduce outside ring, rebuilding the new edge of periareola. This method was used in 135 side breasts of 72 cases during Mar,1996— Mar, 2003.Results-. The normal average reference value of aesthetics markers of Chinese adult male' s breast: The value of nipple length, nipple width, areola length, areola width, nipple protruding, nipple height measured from the thenar, suprasternale-to-thelion, clavicle midpoint to thelion, thelion to thelion, suprasternale to the thelion plane, suprasternale to symphysion, thel ion to symphysion, and thelion to omphylion was 0. 646, 0.628, 2.194, 2.136, 0.269, 128.741, 17.063, 16.169, 20.832, 14.079, 55.722, 43.386 and 28.377 cm respectively.Two markers which were more correlation significantly (r>0.05, /X0. 01, value of correlation from lager to small) among all measured parameters were as follow respectively: Suprasternale to thelion plane and suprasternale -to-thelion; nipple height measured from the thenar and stature; weight and chest circumference; clavicle midpoint to thelion and suprasternale-to- thelion; suprasternale to the thelion plane and clavicle midpoint to thelion; thelion to symphysion and suprasternale to symphysion; thelion to thelion and chest circumference at the lever of the nipple; thelion length and width; thelion to symphysion and thelion to omphylion; suprasternale-to-thelion and chest circumference at the lever of the nipple; thelion to thelion and weight; suprasternale-to-thelion and weight; clavicle midpoint to thelion and chest circumference at the lever of the nipple; suprasternale to thelion plane and circumference at the lever of the nipple; suprasternale to thelion plane and weight; suprasternale to symphysion and chest circumference at the lever of the nipple; clavicle midpoint to thelion and weight; areola length and width; suprasternale to symphysion and thelion to omphylion; clavicle midpoint to thelion and thelion to thelion; thelion to thelion and suprasternale to the thelion plane.The ratio tite of two markers which were more correlationsignificantly and could be used to ensure the proper location of the nipple-areola complex was as follow. Suprasternale to thelion plane / suprasternale-to- thelion=0. 824; nipple height measured from the thenar / stature=0. 755; weight / chest circumference=O. 845; clavicle midpoint to thelion / suprasternale-to-thelion=0.950; suprasternale to thelion plane / clavicle midpoint to thelion=0.871; thelion to symphysion / suprasternale to symphysion=0.779; thelion to thelion / chest circumference at the lever of the nipple=0. 239; thelion width / thelion length =0.976; thelion to omphylion / thelion to symphysion=0.655; suprasternale-to-thelion / chest circumference at the lever of the nipple=0. 195; thelion to thelion / weight=0.299; suprasternale-to-thelion / weight=0.245; clavicle midpoint to thelion / chest circumference at the lever of the nipple=0. 186; suprasternale to thelion plane / circumference at the lever of the nipple=0. 161; suprasternale to thelion plane / weight=0. 202; suprasternale to symphysion / chest circumference at the lever of the nipple=0. 639; clavicle midpoint to thelion / weight=0.232; thelion to omphylion / suprasternale to symphysion=0.510; clavicle midpoint to thelion / thelion to thelion =0.779; suprasternale to thelion plane / thelion to thelion =0.677.The difference of anatomical parameters in adult male' s chest in Youth group, Prime group and Middle 01d-Age group: Their height average value was 172.9, 169.8 and 167.6cm respectively; the differences among three groups was significant. Their weight average value was 65.97, 75. 03 and 72. 74kg respectively; their differences were significant, too. Their average value of chest circumference at the lever of the nipple was 83. 88, 89. 46 and 90. 4cm respectively; Youth group' s was smaller than Prime group' s and Middle Old-Age group' s. Their was no significant difference in the marker of nipple protruding, nipple width and areola length. The value of suprasternale-to-thelion, clavicle midpoint to thelion, thelion to thelion, suprasternale to thelion plane, suprasternale to symphysion, thelion to symphysion, and thelion toomphylion was large in turn; their were most significant difference between Youth group' s and Prime group' s or Middle Old-Age group' s.The male breast esthetics index sign was used in the surgical operation of severe gynecomastia. ?Preoperation designing was performed and the proper location way of the nipple-areola complex, the distance between inside wreath and outside wreath were suggested. (2) The proper location way of the nipple-areola complex and the distance between inside wreath and outside wreath were made sure farther. (3) It was used in follow-up after operation. The result revealed breast esthetics index sign could improve the treatment level of gynecomastia.Breast double ring incision, out-upside dermo-mammary single pedicle of nipple and periareola, mastectomy with tumescent anesthesia of gynecomastia was a new operation method with technique perfect, method stabilization, complications little and effect better. Tumescent anesthesia could fulfil the need of operation. There were little bleeding, well-off operating and slight injuring under tumescent anesthesia. lOOg to lOOOg tissue was resected from each breast. Breast tissue was resected thoroughly using Breast double ring incision. The breast skin beside nipple and periareola was resected equality and place of nipple and periareola come back. Blood circulation and feel of nipple and periareola was saved good. No serious complication as nipple necrosis. Follow-up 3 to 60 months, average 32 months, satisfactory results showed as follow except there was mild scar hypertrophy on the incision of periareola. There was no gland hyperplasia. The renew outline of chest was satisfied It was approximate to normal male' s. The feel of nipple was good. The scars beside periareola were slight and secluded. This method resolved goodly below five problems: ?the excessive mammary glands and fat tissues was cut off thoroughly going with long- Term stability result; (DPeriareola was reduced and normal place of nipple and periareola was resumed; (3) The superfluous and loose breast skin was tightened, attaining the ideal male breast appearance; ?Blood circulation and feelof nipple and periareola was saved good; ?After incisions were sewed up, the scar locating the periareola edge was small and concealment.Conclusion: (1) Acquired the reference value of nipple and areola of breast of Chinese adult male's breast for reference of operation plasty of thelion and areola of breast. (2) Acquired the normal reference values of many lines relating to proper location way of the nipple-areola complex and offer the available evidence for plastic surgery of moderate and severe gynecomastia and operation of female to alter mail. (3) Stature, weight, chest circumference at the lever of the nipples and suprasternale, thelion, clavicle midpoint, symphysion, omphylion paid an impoetant role in making proper location way of the nipple-areola complex certain. Stature, chest circumference, suprasternale to the thelion plane, suprasternale to symphysion were called calculating target. One or more ratio tite of suprasternale to thelion plane / suprasternale-to- thelion, clavicle midpoint to thelion / suprasternale-to-thelion, suprasternale to thelion plane / clavicle midpoint to thelion, thelion to symphysion / suprasternale to symphysion, thelion to omphylion / thelion to symphysion, thelion to omphylion / suprasternale to symphysion, suprasternale-to-thelion / chest circumference at the lever of the nipple, clavicle midpoint to thelion / chest circumference at the lever of the nipple, thelion to thelion / weight, suprasternale-to-thelion / weight, suprasternale to thelion plane / weight, clavicle midpoint to thelion / weight, clavicle midpoint to thelion / thelion to thelion, weight / chest circumference at the lever of the nipple were called validating target. This method to make proper location way of the nipple-areola complex was simple, practical and believable. (4) There were definite difference among Chinese adult male' s breast, Chinese adult female' s breast and Europe America adult male' s breast in result of aesthetics markers of breast. Plastic surgery of gynecomastia didn' t comply the same standard. (5) The breast anatomical parameters in adult male' s chest in Youth group, Prime group...
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