operate on a chest with contracted areolas

[gynebob3]

In some patients with puffy nipples/areola, the chest looks like a normal chest when nipple/areaola is pinched, or when being in a cold room...
how do you know you've removed enough gland/fat if the areolas are contracted during the whole surgery? also, most operating rooms are very cold...
and what if one areola is contracted and the other one isn't?

what if the areolas are contracted during the whole consultation?   can you get a good result without seeing the chest in uncontracted state?

[DrBermant]

In some patients with puffy nipples/areola, the chest looks like a normal chest when nipple/areaola is pinched, or when being in a cold room...
how do you know you've removed enough gland/fat if the areolas are contracted during the whole surgery? also, most operating rooms are very cold...
and what if one areola is contracted and the other one isn't?

what if the areolas are contracted during the whole consultation?   can you get a good result without seeing the chest in uncontracted state?

You are correct, room temperature is critical for evaluation of this situation. That is why I keep warm exam rooms and document the room temperature as part of my male chest areola measurements. There is a thin muscle just under the areola that flattens when stimulated. I have documented this effect for the education of the public. Once this muscle relaxes, the underlying contour again shows.

In the operating room that is a different matter. I run a very warm operating room that makes it harder for me and my staff's comfort but prevents the start of the pain cycle. Tumescent technique means a wet patient. A cold room and wet patient means shivering and discomfort on waking. By having a warm room, we prevent this condition and found our patients' comfort so much more critical than our own. We even have special devices to cool our staff down during surgery. The room temperature is not a factor in my dynamic technique for chest contouring. If you watch my video of my surgery, you will see me injecting numbing medicine under the nipple separating the gland from the muscle. This medication also paralyses this areola muscle nerves such that they are not a factor in determining contour during surgery.  When doing other surgery where the patient is not wet, we also prefer a cool operating room for everyone's comfort.

With this methodology, the before surgery, during surgery, and after surgery pictures have all been taken in warm rooms for consistency and more critical documentation of my results. Bad contour problems therefore will show more so in the warm room with that areola muscle relaxed. The converse is also true, you can hide mediocre results by having a cold room, only showing a few angles, and not demonstrating issues like flexing pectoral muscles or raising arms up overhead. Some of the patients coming to me after surgery done elsewhere commented about cold exam rooms in other doctors' office. In the many years of reviewing records from other doctors' offices, I have yet to see temperature of the room documented for the exam nor the operating room.

Hope this helps,

Michael Bermant, M.D.

[DrPensler]

I often tell patients if you could role in the snow every ten minutes you would not need surgery but if you lived in a sauna it would be a surgical emergency. All kidding aside as i am sure you have guessed the answer to your question is experience.
Jay Pensler,MD