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Tetris Technique for Surgical Treatment of Gynecomastia: Case Series
Aleksandr Shteynberg, MD
Omar Jamal Eldeib, MD
Elizabeth Avshalomov, BS
Vantage Plastic Surgery
SUNY Downstate Health Sciences University
2024-02-01
Presenter: Elizabeth Avshalomov, BS
Affidavit:
Shteynberg 60%, Eldeib 20%, Avshalomov 20%
Director Name: Aleksandr Shteynberg
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Surgical correction of gynecomastia is often a tailored approach, revolving around the removal of excessive tissue and reshaping remaining components to achieve a more masculine appearance of the breast. To address higher grades of gynecomastia, presenting challenges such as loss of sensation, the necessity for a free nipple-areolar complex (NAC) graft, ischemia, depigmentation, excessive scarring, sunken appearance, excessive projection, and the need for revisions, we employed a novel surgical technique akin to assembling a Tetris puzzle for Grade III or IV gynecomastia (Cordova Classification). The Tetris technique involves fitting the inferior pedicle into a precisely carved 'Tetris' recipient site along the superior skin flap. Results from three patients who underwent surgery between 2018 and 2022 were collected retrospectively. The mean patient age was 28.3 years, the mean weight was 101.5 kgs, and the mean body mass index was 33.2 kg/m2. Excised breast weight averaged 294g and 249g on the right and left sides, respectively. All patients achieved a flat, masculine-appearing chest with a viable and sensate NAC. The Tetris Technique preserves innervation and blood supply while avoiding excessive thickness in the overlap area of the inferior pedicle and superior skin flap, optimizing Grade III and IV gynecomastia correction. With an increasing trend in gender-affirming surgeries, this method proves valuable for creating a more masculine appearance of the chest wall in female-to-male transitions.
