High Volume Adrenalin Solution Infiltration for Surgical Treatment of Gynaecomastia

J Clin Exp Invest 2018;9(4):145-149.



Download Full Text (PDF)


Objectives: Bleeding is an important problem in the surgical treatment of gynecomastia. The most implemented method to decrease the amount of bleeding is adrenaline infiltration, but adrenalin is mostly infiltrated with the fluid in the volume less than 250 cc in the clinic. It is expected that adrenaline will accumulate more in the tissue and thus, exhibit more bleeding-reducing effect by increasing the fluid volume used in the infiltration. In this study, the aim is to reveal the effect of increasing the amount of adrenaline in tissues by infiltrating a higher-volume solution without increasing the adrenaline concentration in patients who have received gynecomastia treatment by an open surgery on the postoperative blood loss and surgical complications in patients.
Materials and Methods: Patients who had undergone open gynecomastia surgery between 2011 and 2017 were retrospectively examined. Patients not subjected to infiltration were described as Group 1 (n:9), patients infiltrated with adrenalin 100 cc were described as Group 2 (n:13), and patients infiltrated with adrenalin 500 cc were described as Group 3 (n:23).
Results: The average decrease in the hemoglobin level (bleeding) after the operation was calculated to be 2.00±0.37 in Group 1, 1.5±0.4 in Group 2, 0.7±0.30 in Group 3 and the differences between groups were statistically significant (p<0.001).
Conclusion: The infiltration of adrenaline in the same concentration with a fluid of a higher volume decreases blood loss after the gynecomastia surgery operation.


gynecomastia, blood loss, infitration


  • Erol S, Orhan E, Sevin A, Erdoğan B. Trauma: a new pseudogynecomastia cause. Aesthetic Plast Surg. 2010;34:404-5.
  • Schröder L, Rudlowski C, Walgenbach-Brünagel G, et al. Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction. Breast Care (Basel). 2015;10:184-8.
  • Fagerlund A, Lewin R, Rufolo G, et al. Gynecomastia: A systematic review. J Plast Surg Hand Surg. 2015;49:311-8.
  • Al-Allak A, Govindarajulu S, Shere M, et al. Gynaecomastia: a decade of experience. Surgeon. 2011;9:255-8.
  • Song YN, Wang YB, Huang R, et al. Surgical treatment of gynecomastia: mastectomy compared to liposuction technique. Ann Plast Surg. 2014;73:275-8.
  • Arvind A, Khan MA, Srinivasan K, Roberts J. Gynaecomastia correction: A review of our experience. Indian J Plast Surg. 2014;47:56-60.
  • Wojnikow S, Malm J, Brorson H. Use of a tourniquet with and without adrenaline reduces blood loss during liposuction for lymphoedema of the arm. Scand J Plast Reconstr Surg Hand Surg. 2007;41:243-9.
  • Orhan E. The efect of high volume adrenalin solution in infiltration on blood loss in reduction mammaplasty. J Clin Anal Med. 2018;9:213-7.
  • Kaplan JL, Rotemberg S, Yetman R, et al. Breast reduction: does the tumescent technique affect reimbursement? Plast Reconstr Surg. 2008; 122: 693-700.
  • Hardwicke JT, Jordan RW, Skillman JM. Infiltration of epinephrine in reduction mammaplasty: a systematic review of the literature. Plast Reconstr Surg. 2012; 130: 773-8.
  • Wong KY, Malata CM. Conventional versus ultrasound-assisted liposuction in gynaecomastia surgery: a 13-year review. J Plast Reconstr Aesthet Surg. 2014;67:921-6.
  • Jarrar G, Peel A, Fahmy R, Deol H, Salih V, Mostafa A. Single incision endoscopic surgery for gynaecomastia. J Plast Reconstr Aesthet Surg. 2011;64:e231-6.
  • Sevin A, Senen D, Sevin K, Erdogan B, Orhan E. Antibiotic use in abdominoplasty: prospective analysis of 207 cases. J Plast Reconstr Aesthet Surg. 2007;60:379-82.
  • McKee DE, Lalonde DH, Thoma A, Glennie DL, Hayward JE. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg. 2013;131:811-4.
  • Qutob O, Elahi B, Garimella V, Ihsan N, Drew PJ. Minimally invasive excision of gynaecomastia--a novel and effective surgical technique. Ann R Coll Surg Engl. 2010;92(3):198-200.
  • Keskin M, Sutcu M, Cigsar B, Karacaoglan N. Necessity of suction drains in gynecomastia surgery. Aesthet Surg J. 2014;34:538-44.
  • Beveridge M, Bell M. The tumescent technique for bloodless breast reduction. Can J Plast Surg. 1994; 2: 121-4
  • Conroy PH, O’Rourke J. Tumescent anaesthesia. Surgeon. 2013; 11: 210-21.


Orhan E. High Volume Adrenalin Solution Infiltration for Surgical Treatment of Gynaecomastia. J Clin Exp Invest. 2018;9(4):145-9. https://doi.org/10.5799/jcei/4001