Large volume of fat sideways

[u_free_luv]

As iam suffering from gynecomastia,my concern is that i have huge volume of fat at side of chest i.e. Under armpits...iam confused wheather incision around aerola will suck the fat from dat region or incision under armits would be a better option.also the whole area around chest is very soft and there is no hardness at all in the chest area...does dat means its all fat and no gland.is lippo enough or gland removal also requires..also does the surgery gives the desired results in this particular case...pls suggest

[Dr. Elliot Jacobs]

It is very common for men with gynecomastia to have an additional amount of fat extending around the side of the chest.  I always point this out to my patients during examination for it would not look good to treat the gyne and ignore the fat on the side of the chest -- you would end up flat and contoured on your chest with bulges of fat on the sides.  That is why I always regard treatment of this area as part of the entire chest re-contouring operation.

I can usually treat both areas (chest and sides of the chest) with one tiny incision around 1/8th inch long.  It is strategically placed, in general, where the fold under the breast meets a line dropped straight down from the mid armpit.  With this incision, I can perform lipo of the chest and then turn around and perform lipo of the lateral chest.  Many times this is all that is necessary.

If there is additional tissue directly under the nipple that I am unable suction, then it is a simple matter to remove the extra tissue with a small incision around the edge of the nipple.

As for whether your tissue is "hard or soft", that is difficult to assess.  Even my experienced hands are unable to predict whether I can suction only to get a great contour, or whether I need to suction and then excise.  Remember, gland is often dense directly under the nipple, but it extends outwards as ribbons of gland interspersed with fat.  Using my aggressive cannula, I am frequently able to remove both fat and gland through one small incision.

Dr Jacobs

[DrBermant]

As iam suffering from gynecomastia,my concern is that i have huge volume of fat at side of chest i.e. Under armpits...iam confused wheather incision around aerola will suck the fat from dat region or incision under armits would be a better option.also the whole area around chest is very soft and there is no hardness at all in the chest area...does dat means its all fat and no gland.is lippo enough or gland removal also requires..also does the surgery gives the desired results in this particular case...pls suggest

The under arm region can be reached by either an incision under the nipples or in the under arm region. You can see typical plans for liposuction with the maps / markings on my website such as this this patient big gland gynecomastia and fat extending under the arms and this Obese Teenager with Gynecomastia.

I prefer one incision on each side instead of two and targeting gland first to get the best results that look good both at rest and in motion.

The problem is that Male Fat Pattern extends around the chest, under the arms, and around the back.  Plastic Surgery is not a good tool for a global fat problem.

I advise my patients to get to a weight / body fat percentage they are comfortable with before considering surgery.  A BMI Calculator does not differentiate between fat, muscle, and bone.  Body Fat Calculators can help with the fat percentage and are better at helping with the fat component.

For those with too much body fat, Weight Loss Before Gynecomastia Surgery can help with the fat, but not the gland.  However, you cannot pick where your fat comes from.

The biggest change I have noticed over the years, is that patients who lose weight tell me that they feel so much better about themselves. It often changes the front to a degree, but the sides and back can see a major benefit from getting the excess total body fat under control.

Plastic Surgery is not a good jump start tool for weight loss.  I have seen disasters from patients from other doctors with deformities from significant weight loss after their surgery.  Men tend to put fat on first in the belly and chest bands.  We tend to take of those areas last.  Early surgery and depending on weight loss to predictably change the body is a nasty gamble.  No Surgery Body Shaping Garments are a better temporizing choice.

As a surgical sculptor, I view weight loss as a coarse tool and my plastic surgery as a refinement tool.  I prefer to use the coarse tool first, and then my sculpture for refinement.

For those having compromise surgery before (or without) weight loss, try to check out before and after pictures from many different angles.  (You should carefully evaluate results with more than just one or 2 views for each patient, especially if those views change from patient to patient. Plastic Surgery is not an alternative to losing weight.  A fat person will still look like a fat person, just one with smaller breasts.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia