Maximum cosmesis for patients with primary hyperparathyroidism: a case for larger incisions.

While minimally invasive parathyroidectomy is an advantage to many properly selected patients, longer incisions and even wide skin resection may be optimal in a select few. We present an 80-year-old woman with primary hyperparathyroidism and bothersome excess neck skin and subcutaneous fat. The parathyroid adenoma was easily excised through a vertically-oriented cervical excision that removed an ellipse of fat and skin. Midline wound closure with a small Z-plasty to avoid wound tethering facilitated a cosmetic closure well within the surgical capabilities of endocrine surgeons. This technique is useful for select patients and their surgeons and may avoid the expense of cosmetic surgery. We offer this controversial case to highlight the pros and cons of maximizing efficient surgical care to our endocrine surgery patients.