Liposuction technology for glandular tissue?

[ducky]

I had a consultation with a surgeon who said he uses a form of liposuction that was designed for gynocamastia surgery. The cannula able to cut through soft  gland or something...

He said my glandular tissue is softer than most, and i that i should go into surgery expecting both lipo and excision, but i may end up only needing that special liposuction.
What was he talking about? Do agree with his approach to "softer" glandular tissue? 

[Dr. Elliot Jacobs]

Yes,I do agree with your surgeon.

Gynecomastia is a combination of fat and breast tissue -- the ratio is different for every individual.  Sometimes the tissues are soft enough so that lipo alone can provide a good result.

Years ago, I developed and designed my own instruments which are aggressive and in many circumstances, capable of removing both fat and gland without the need for direct excision.  However, I am never sure about this until I am actually performing the surgery.

Thus, I developed a staged process for all my procedures.  First, I perform very aggressive lipo of the excess tissue.  If I am successful in removing all the excess tissue, then I stop there and the patient has a small 4mm scar only.  However, if I am in doubt or if there is some really dense tissue (usually beneath the areola) that I am not pleased with, then I proceed to make a peri-areolar incision and remove the remaining dense tissue under direct vision.  This will make a very smooth result and allow me to remove virtually all breast tissue under the areola.

I know your next question is how often I am able to get the best result with lipo only.  The answer is about 10% of the time; the other 90% needs excision.  The exception is when I operate on older men (roughly 45 and above).  Their tissues seems to be softer and are more amenable to lipo only.  I can often do their surgery with lipo only in roughly 20-25% of the time.

Hope this has helped.

Dr Jacobs

[Dr. Schuster]

There are several different technologies that can be used on gynecomastia. But I agree with Dr. Jacobs that the basic steps usually require that glandular tissue needs to be directly excised (and this can be done a number of different ways) I prefer to use Ultrasonic Assisted liposuction. this technology creates a high energy sound wave which disrupts the fat and much of the glandular tissue. Other technologies include laser and an oscillating type of razor (similar to that used in arthroscopic joint surgery). If the surgeon gets good predictable results, don't worry too much how he / she does it.

[DrPensler]

There are two types of tissue in a patients breast with gynecomastia. The two types of tissue are fat (adipose tissue) and glandular tissue ( breast gland). I have performed thousands of cases and written papers which  examine  the tissue.I have also reviewed numerous articles for  surgical journals on the subject.I am not aware of any significant variability in the density of the glandular component of breast tissue. There are cases where there may be fat interspersed among clusters of gland.There is a variability in the consistency of the adipose ( fat) component.
There are three types of liposuction The first uses a hollow tube hooked up to a suction machine (standard liposuction). There may be variability in the cannulas utilized for this and as others have noted I have designed a number of specific cannulas and had the cannulas custom constructed for use in my patient population.There are a large number of variations in technique used by different surgeons. The second types of liposuction which was announced with major fanfare is laser liposuction which uses light energy to destroy fat cells.The machines are very expensive and the results not that impressive (my opinion).The third method is Ultrasonic Assisted Liposuction.The cannulas move at a fast rate (thousands of times per second) and generate ultrasonic waves that cause the fat cells to implode. Because the cannulas move rapidly there is a tendency for heat to build up locally in the tissue . In an attempt to circumvent this pulsed ultrasonic machines were developed .These machines alternate between on and off in a manner to facilitate some blow flow through the tissue allowing some of the heat to dissipate ,sort of like a radiator in a car engine.I personally like these.
In any case it is very unusual for excision of the glandular component not to be required to optimize the final result.

[Litlriki]

There are various cannulas that are variably successful in some surgeons' hands to avoid making the peri-areolar incision, but I was unimpressed when I tried this approach.  So I start with aggressive liposuction using conventional technique, followed by excision through a peri-areolar incision in the greatest majority of my patients.