A new application of cyolipolysis proves to be an effective non-invasive option in the treatment of pseudogynecomastia, according to a randomized, split body study presented at the 37th annual conference of the American Society for Laser Medicine and Surgery in San Diego in April.
Presenting author Isabela T. Jones, M.D., says there are generally two treatment options for men bothered by fatty tissue around their breasts: liposuction or surgical reduction.
“Liposuction and surgery have certain side effects and complications. For men who don’t want to undergo those types of procedures, they often look for noninvasive methods for improving the appearance of their breasts,” says Dr. Jones, who is completing a year-long fellowship in cosmetic dermatologic surgery at Cosmetic Laser Dermatology, with Mitchel P. Goldman, M.D., in San Diego, Calif.
Cryolipolysis (CoolSculpting, Allergan, Zeltiq) has been shown to effectively address pockets of fat around the abdomen, flanks and inner and outer thighs. But the device’s efficacy for removing breast fat hasn’t been impressive.
In a study published in 2015, researchers looked at the use of two cryolipolysis treatments, given 60 days apart, for nonsurgical treatment of pseudogynecomastia. Ultrasound measurements of fat thickness showed a mean reduction of 1.6 mm from treatment.1
“They were using an older applicator. The original cryolipolysis applicator that is still used for some areas is just not great for the breast because it was designed to use vacuum suction in order to draw the target tissue between the parallel plates. You can imagine … it’s kind of hard to draw male breast tissue into the applicator,” Dr. Jones says.
The flat applicator
CoolSculpting has since come out with a flat applicator. It doesn’t require suctioning and has been used successfully on the outer thighs — another body area that’s difficult to treat with the original applicator design, she says. So, Dr. Jones and co-authors decided to study use of the flat applicator in men with fatty breast enlargement.
In their study of 10 men, they were very careful to make sure that the subjects had pseudogynecomastia and not true gynecomastia, according to Dr. Jones.
“Patients with pseudogynecomastia really only have an increase in fatty tissue, while men with gynecomastia actually have glandular tissue, and that glandular tissue wouldn’t be amenable to treatment with cryolipolysis,” she says.
At baseline, the researchers used ultrasound to measure thickness of the fatty tissue of each breast. They randomized each man’s breast with the thicker fatty tissue to receive two cryolipolysis treatments, given six weeks apart.
“We re-measured the adipose tissue using the ultrasound when they came back at week six, prior to receiving their second treatment, and then we measured it again at week 12, when they came in for their final visit,” Dr. Jones says.
The other breast served as a control. Dr. Jones says to verify that any changes in thickness of breast fat were attributable to treatment, the researchers monitored patients for weight fluctuation.
They found that the mean fat thickness of the treated breasts at baseline was 20.3 mm. The mean thickness after the first visit, at week six, was 12.36 mm. And when the men came in at week 12, mean thickness on the treated breast went down to 11.9 mm, a reduction of 8.7 mm after two treatments with cryolipolysis.
Patient satisfaction, adverse effects
“We measured patient satisfaction, and patients were significantly more satisfied with the treated breast vs. the control breast. No patients were satisfied with the control breast,” she says.
Patients experienced mild and transient erythema, and some edema and tenderness, at the treatment area. Side effects lasted at most two weeks. And none of the patients had any lasting side effects, according to Dr. Jones.
All men elected to have their second breast treated with two treatments to balance out the effects, but those results were not recorded in the study.
While the patients indicated they were satisfied with the results, many would have been happy with a little bit more fat reduction in their breasts, according to Dr. Jones.
“Moving forward, we need to figure out when people might need multiple treatments to get where they want to be,” she says.
Another question that needs an answer is how far apart should treatments be performed for ideal results, according to Dr. Jones.
“We noticed that the amount of reduction from the baseline to the first treatment was pretty significant, but they didn’t get that much more improvement after their second treatment. We think that maybe there was inflammation around from the first treatment that may have interfered with the second treatment,” she says.
Overall, the study’s findings offer dermatologists confidence that cryolipolysis is a feasible option for pseudogynecomastia patients, according to Dr. Jones.
“They may need multiple treatments, and it may never be as effective as liposuction, but it certainly has been shown to be effective,” she says. Â
1 Munavalli GS, Panchaprateep R. Cryolipolysis for Targeted Fat Reduction and Improved Appearance of the Enlarged Male Breast. Dermatol Surg. 2015;41(9):1043-51.