Excision vs liposuction

[DS]

Hi, I was just wondering under what circumstances would lipo only be required when dealing with gynecomastia?...For example, I have chest fat or pseudo gynecomastia, no hard lumps under the nipples or under the armpits what so ever. Yet, I recently saw a doctor, whose name gets mentioned a lot on these forums, and he suggested doing excision on my chest? At the time, I failed to ask why excision would be necessary, considering i don't exhibit the above listed traits. Do surgeons have to cut you open under the nipple, just to have a look to determine whether you even need removal of the gland? Thanks

[George Pope, M.D.]

In some cases, even though the tissue feels soft like fat, you can't get out everything behind the nipple areola without direct excision of tissue.  Some of the fat in that area can be more fibrous and difficult to extract with a standard cannula.

Dr. Pope, MD

[DS]

Thank you for the response. Just to be clear though, are you suggesting that even though I may or may not have fibrous fat behind the nipple, I would have to have the surgeon make an incision below the nipple anyway, just to verify what kind of fat is there?...I guess my concern is, if I don't need to have a scar along my nipple, then I would prefer not to. Is there any way to determine what kind of fat is present without getting cut open?

[George Pope, M.D.]

If you get a good result with liposuction alone, no incision around the nipple areola for direct excision of tissue is necessary. 

Dr. Pope, MD

[Litlriki]

I tell all of my patients that they may require excision, since I can't really tell from just palpating the tissue in the office what the character will be when I do the procedure.  As soon as I start, when injecting the solution for tumescent anesthesia, I can often tell if there's more fibrous tissue under the nipple, since the blunt injection cannula won't go through it easily.  I do the liposuction first, and in doing that, if there is a mass remaining under the nipple, then an incision is required.  I would guess that this occurs in excess of 95% of my cases.  Even in those patients in whom the tissue is mostly fat, there is still usually tissue under the nipple that doesn't come out with suction.  The scar that results is usually nearly undetectable, compelling me to make the incision, rather than leave unwanted tissue behind.

Rick Silverman

[DS]

Thank you for the replies, gentlemen

One final question...is this a standard process when performing surgery, to use liposuction first, then determine whether excision is necessary? Which sounds like it is, in more cases than not

Thanks again

[Dr. Elliot Jacobs]

My approach to gyne surgery is much the same as Dr. Silverman -- lipo as much as possible at first.  Then, and only if necessary, excise any remaining solid tissue directly under the areola.  It works.

There is only one surgeon that I know of who does excision first -- and then lipo.  It too can work.

Dr Jacobs

[DrPensler]

Fat (adipose ) tissue is removed via liposuction ,glandular tissue requires resection. Most cases are a combination of glandular and adipose tissue.If a majority of your tissue is fat a majority will be corrected with liposuction,to remove the residual  glandular component will require a resection.