Apple-coring technique for severe gynecomastia.

In evaluating cases of gynecomastia it is important to differentiate between physiologic and pathologic forms. The authors review gynecomastia with reference to its occurrence in various age groups, the pathologic features and etiology, and the differentiation and classification of the two types. If the gynecomastia is large or longstanding, surgical treatment may be necessary. The authors review the various surgical techniques used from the early descriptions up to the present. The apple-coring technique has the advantages of leaving an inconspicuous scar, allowing correction of the hypertrophic areola and good chest-wall contour, maintaining the viability of the nipple and decreasing the common complications of inverted nipples and a doughnut-shaped deformity. The results and outcome in four patients treated by the apple-coring technique are reported. Although the method is not perfect, the results are encouraging and the technique is an addition to the armamentarium of surgeons treating large gynecomastia.