Only one areolar incision for lean patients

[spooon]

Hello,

I attended a consultation with a gyne surgeon along with my friend. He is super lean at 8% body fat with a few lumps nothing major. I am 12% body fat with a mild case of squidgy gyno that has not gone away after dieting down from 25% bf . The surgeon said that since we are lean, by friend particularly so, only one incision at the areolar would be necessary and any fat removal could be done through vaser lipo via this incision. Do surgeons on this site have a view on this? It does sound kind of logical, and hopefully entails quicker recovery time?

Thanks

[Dr. Schuster]

I use VASER on nearly every case. I perfer to use a small incision laterally. I suspect it can be done from the areola.

[Dr. Elliot Jacobs]

The tiny incision on the side of the chest (less than 1/4 inch) heals so very well that for most guys, it produces a faint scar that is difficult to find (after 6-12 months).

I tend to do my gynecomastia surgery in stages.  First, the lateral nick in the skin and aggressive liposuction.  In about 20% of my cases, I can get everything out and there is no cut on the areola at all. I can do this using a variety of specially designed, sharp and semi-sharp cannulas.  

For the other 80%, I do a peri-areolar incision in order to facilitate direct excision of sub-areolar breast tissue under direct vision -- this gives me perfect control.  If there is any hint at a crater deformity, I see it at this time and immediately correct it.  The peri-areolar incision tends to heal incredibly well.

Every surgeon has his own favorite technique -- what counts, though, is the final result -- and it really doesn't matter which route was taken to achieve that result.

Dr Jacobs

[Litlriki]

I use a tiny stab wound incision near the armpit, which I put in a skin fold or stretch mark, and this is my approach for the liposuction initially. Like Dr. Jacobs, if I can get a complete result with just liposuction, I might not need to make the peri-areolar incision, though I almost always use the peri-areolar incision as well. I've only had an issue with the small scar one time on one side, and that was corrected under local in the office in about 5 minutes. I like to come at the liposuction from a spot remote to the areola, since that gives me better control. 

[spooon]

Thanks guys. I’m confused. In my simple mind the most direct access, and therefore giving most control, to breast tissue would be via incision at 6 o clock to nipple. Why would you need anything on the side of the chest or armpit for a very lean individual?

[DrPensler]

I typically use a small incision on the pec tendon for the UAL. As far as the "control" issue the probe is fairly long around 12 inches I am estimating and the business end is the tip .It is technically easier to use and position the probe from an incision 6 inches away from the area of treatment as opposed to millimeters away. The probe oscillates around 40K per second so if it touches the incision (areola) it can result in adverse scaring. So in non surgical slang its just a lot easier and safer to not use the areolar incision. The healing of the areolar scar is very important.

[Dr. Schuster]

Liposuction cannulas come in certain lengths and I think it is easier to control the removal with the cannula using a small incision from the side. I think helps to reduce over resction, retraction and nipple deformities by using this approach.