Nipple incision vs no nipple incision (Fielding vs Lista) Toronto, ON

[healthpro77]

My intention in writing the following is to explore two different techniques practice by two experienced surgeons in the city of Toronto.  I have had a consultation with Dr. Fielding and have watched Dr. Lista's videos.  From my research it is my understanding that these are two of the top gynecomastia surgeons in Toronto.  My intention is to explore the advantages and disadvantages of both of the surgeons and the methods they use.  Both of these plastic surgeons are well known for preforming hundreds of gynecomastia procedures a year. Dr. Fielding uses the traditional two incision method, one incision around the nipple, and one incision on the side of the breast closer to the armpit.  The incision around the nipple is used to remove the glandular tissue, and the incision closer to the armpit is used for traditional liposuction.  Dr. Lista uses the single incision method, the incision closer to the armpit, and has been named by some as the scarless method.  He uses a liposuction technique though this incision; additionally, he uses a long pair of scissors that are used to cut away the glandular tissue under the nipple.  According to Dr. Lista's written information, and the video's on his website, this procedure is best for removing the fat portion, or liposuction part of the procedure.  In other words not the glandular portion.  Furthermore, while Dr. Lista states that this procedure is superior for scar reduction, it does have to preformed by feel.  This is important, so I'll say it another way, he cannot see what he is doing when he cutting away and attempting to remove the glandular tissue.  So why is the glandular tissue so important?  While fat can be broken up and extracted with suction, the glandular tissue cannot; also, the glandular tissue is what is responsible for the puffy nipples and is the "female" part of the breast tissue that really shouldn't be there.  I have read all the reviews for both these surgeons on ratemds.com and Dr. Fielding has 4.1/5 and Dr. Lista has a 4.0/5.  There were some negative things about Dr. Fielding, but none of them regarding the results of a gynecomastia procedure.  Dr. Lista have a couple complaints regarding gynecomastia surgery results; however, they were not serious.  Example for Dr. Lista was in motion complaints.  These do scare me though; this is when the breast looks good standing still but in motion it looks freakish.  A complaint I heard from many patients from other parts of the country and the USA.  So to sum up this topic, with Dr. Fielding and the two incision method you will have a slightly visible incision around the nipple; however, because he can see what he is doing during the procedure the risk of having irregularities is much less.  With Dr. Lista, who uses the single incision method, aka the scarless method, he cannot see what he is doing as he is chopping away at the glandular tissue.  Dr. Lista has to go by feel during the procedure; therefore, there is a higher risk of having irregularities, especially when the breast or pec is in motion.
Price: based on having regular sized gynecomastia, say 250 ml of breast tissue per, you are probably looking at $3000 from Dr. Fielding and $6000 from Dr. Lista. 
My deciding factor: laser scar removal.  I think at the top end, and for the best procedure, you'll be looking at $1500 for laser scar removal.
In conclusion, it is my opinion that Dr. Fielding has the superior procedure.  While Dr. Lista's procedure produces less scars, there is higher a risk of irregularities, especially in motion.  If you feel there is a need you can take some of the $3000 that you saved going to Dr. Fielding and invest it in laser scar removal. 

It has been a pleasure to use this forum to collect my thoughts though the preceding writing.  It is my hope that my thoughts will be peer reviewed in that there may be some aspects that I have missed, so please comment and offer your opinion.  I also hope that this might help others, as it wasn't until I started my education in the health sciences that I began to have a clue what I had or how to treat it.  I have personally been dealing with this since puberty and I am 30 this year.  I have everything going for me...but I got man boobs.  I'm not going to lie it held me back a lot *insert everything men hate about having man boobs here*
I will be getting my procedure done by Dr. Fielding sometime after final exams in April or May.  I will update this forum on the procedure, and even though I'm not thrilled about it I'll try and put up some before and after pictures.  Maybe I'll offer to be Dr. Fielding's gynecomastia poster boy for a discount.  I know that when we talked he wanted to put pictures up, but he still hasn't.
One last thing, I know that Dr. Lista has written an academic paper on his one incision procedure, I would like to access through the university database if I can; furthermore, it would interesting in general to research this topic through all the medical databases and peer reviewed medical journals.  Something that I hadn't really thought about till just now.  The thought does cross my mind that the search log in the academic databases will available for faculty to see.  The shame and guilt follows this topic around like a bad smell.  I would also be curious to know what causes this condition, there is literature on the topic within the academic databases I know; however, it would take a significant time investment to complete.  Realistically, one that could only be done paired with a essay in one of my courses; however, do I really want to present this topic to all my peers.  Lmao. 

[healthpro77]

One thing that I forgot to mention was my conversations with my family doctor.  So there is way to get the procedure done free of charge; however, there are strings attached.  First of all you must prove that the gynecomastia condition either produces serious physical or psychological discomfort, and with the help of your family doctor this could probably be accomplished.  Heres the catch, OHIP only pays a certain amount, and that amount is less than the average plastic surgeon would like to charge.  The way my family doctor described it to me was that when new plastic surgeons have gaps in their schedule they will take these cases on to gain experience.  Thats is less money is better than no money, like keep the cash-flow going, and to bring on lots of guinea pigs early in their practice.  I know one guy who did this maybe a decade ago, and his one nipple is messed up a bit, it is caved in, not the end of the world but... For me it's worth the $3000 to have someone experienced like Dr. Fielding do the procedure.

[gynoboy88]

My intention in writing the following is to explore two different techniques practice by two experienced surgeons in the city of Toronto.  I have had a consultation with Dr. Fielding and have watched Dr. Lista's videos.  From my research it is my understanding that these are two of the top gynecomastia surgeons in Toronto.  My intention is to explore the advantages and disadvantages of both of the surgeons and the methods they use.  Both of these plastic surgeons are well known for preforming hundreds of gynecomastia procedures a year. Dr. Fielding uses the traditional two incision method, one incision around the nipple, and one incision on the side of the breast closer to the armpit.  The incision around the nipple is used to remove the glandular tissue, and the incision closer to the armpit is used for traditional liposuction.  Dr. Lista uses the single incision method, the incision closer to the armpit, and has been named by some as the scarless method.  He uses a liposuction technique though this incision; additionally, he uses a long pair of scissors that are used to cut away the glandular tissue under the nipple.  According to Dr. Lista's written information, and the video's on his website, this procedure is best for removing the fat portion, or liposuction part of the procedure.  In other words not the glandular portion.  Furthermore, while Dr. Lista states that this procedure is superior for scar reduction, it does have to preformed by feel.  This is important, so I'll say it another way, he cannot see what he is doing when he cutting away and attempting to remove the glandular tissue.  So why is the glandular tissue so important?  While fat can be broken up and extracted with suction, the glandular tissue cannot; also, the glandular tissue is what is responsible for the puffy nipples and is the "female" part of the breast tissue that really shouldn't be there.  I have read all the reviews for both these surgeons on ratemds.com and Dr. Fielding has 4.1/5 and Dr. Lista has a 4.0/5.  There were some negative things about Dr. Fielding, but none of them regarding the results of a gynecomastia procedure.  Dr. Lista have a couple complaints regarding gynecomastia surgery results; however, they were not serious.  Example for Dr. Lista was in motion complaints.  These do scare me though; this is when the breast looks good standing still but in motion it looks freakish.  A complaint I heard from many patients from other parts of the country and the USA.  So to sum up this topic, with Dr. Fielding and the two incision method you will have a slightly visible incision around the nipple; however, because he can see what he is doing during the procedure the risk of having irregularities is much less.  With Dr. Lista, who uses the single incision method, aka the scarless method, he cannot see what he is doing as he is chopping away at the glandular tissue.  Dr. Lista has to go by feel during the procedure; therefore, there is a higher risk of having irregularities, especially when the breast or pec is in motion.
Price: based on having regular sized gynecomastia, say 250 ml of breast tissue per, you are probably looking at $3000 from Dr. Fielding and $6000 from Dr. Lista. 
My deciding factor: laser scar removal.  I think at the top end, and for the best procedure, you'll be looking at $1500 for laser scar removal.
In conclusion, it is my opinion that Dr. Fielding has the superior procedure.  While Dr. Lista's procedure produces less scars, there is higher a risk of irregularities, especially in motion.  If you feel there is a need you can take some of the $3000 that you saved going to Dr. Fielding and invest it in laser scar removal. 

It has been a pleasure to use this forum to collect my thoughts though the preceding writing.  It is my hope that my thoughts will be peer reviewed in that there may be some aspects that I have missed, so please comment and offer your opinion.  I also hope that this might help others, as it wasn't until I started my education in the health sciences that I began to have a clue what I had or how to treat it.  I have personally been dealing with this since puberty and I am 30 this year.  I have everything going for me...but I got man boobs.  I'm not going to lie it held me back a lot *insert everything men hate about having man boobs here*
I will be getting my procedure done by Dr. Fielding sometime after final exams in April or May.  I will update this forum on the procedure, and even though I'm not thrilled about it I'll try and put up some before and after pictures.  Maybe I'll offer to be Dr. Fielding's gynecomastia poster boy for a discount.  I know that when we talked he wanted to put pictures up, but he still hasn't.
One last thing, I know that Dr. Lista has written an academic paper on his one incision procedure, I would like to access through the university database if I can; furthermore, it would interesting in general to research this topic through all the medical databases and peer reviewed medical journals.  Something that I hadn't really thought about till just now.  The thought does cross my mind that the search log in the academic databases will available for faculty to see.  The shame and guilt follows this topic around like a bad smell.  I would also be curious to know what causes this condition, there is literature on the topic within the academic databases I know; however, it would take a significant time investment to complete.  Realistically, one that could only be done paired with a essay in one of my courses; however, do I really want to present this topic to all my peers.  Lmao. 

You haven't done any real research beyond reading some reviews online and therefore you can't say with any certainty which method is truly "riskier".

You seem like you're trying to convince yourself/others that the less expensive option is the better one, and for some people it may be.

However, the best approach is to meet different doctors, consider your budget, and go with whoever you are most comfortable with.

I went with Lista because he performs 200-300 gyno surgeries per year and is very experienced.  In addition, his method of not cutting around the nipple appealed to me, as one of my primary concerns was loss of nipple sensation and I wanted to minimize that as much as possible. These concerns outweighed the cost factor for me. I'm thrilled with the results.

My friend went with Fielding and is equally pleased with his results.

It is pointless to try and debate this.  Just go with the doctor that best suits your personal needs/factors.

[healthpro77]

Thanks for sharing your thoughts gynoboy88.  You are right that I haven't done any academic research on this topic yet, and I don't know if I will have time before I book my operation date, which I will do in about 2 weeks.  This forum has been a great source of knowledge and has helped me in many ways.  Also, while meeting with doctors and considering your budget is a good place to start but I want more.  For me the best approach is every approach in combination, and that is something I don't have the time or energy to do; however, this forum is an excellent tool for doing that.  I want to meet with doctors, get reviews and testimonials, consider others perspectives, and read summarized and simplified versions of the academic literature.  I want it all, and this forum comes pretty close.  It appears that according to many, yourself included, that Dr. Lista is very talented at what he does and this is really good to know, especially considering that his technique does offer the possibility of the best case scenario (no nipple incision.)  With that said, I still believe my perspective on the single incision, or scarless method is still valid, and maybe more so with a less experienced surgeon.  
What I would really like to know but haven't been able to find on this forum is regarding in motion irregularities (the pec looks funny when moving.)  Does the risk of this happening dry up when you have the procedure done by surgeons that do hundreds of them a year?  

[dharry]

 To Health Pro and Gyno Boy. Thanks for all the info. I am new on here, I find you guys very informative. Check out my new post from dharry [Ask the Doctors]. If you have any comments or info please reply.

 I am from the Vancouver area, if I have surgery I will probably go to Toronto for it. With regards to your debate, both surgeons sound great.

I will probably go to Dr Fielding, a larger scar or scars do not bother me, I have a hairy chest and secondly don't really care about scars. The lower price is obviously a bonus.

I am glad scars are not an issue for me because it would be tough to choose between Fielding and Lista.

A question for you guys?
 

 I hope I fully understand the weight loss discussion I keep reading about.

 I like the idea of losing weight to see if a person's gynecomastia is improved enough to not have surgery. If it is greatly improved [where surgery isn't required] a person now has huge motivation to keep the weight off, in a sense the weight loss is the surgery. I get that.

 But if the weight loss isn't enough shouldn't a person go into surgery weighing what he can [realistically] maintain. If a person goes into surgery 30 pounds lighter than what he can [realistically] maintain isn't that a bad idea. When he gains the 30 pounds back isn't that counterproductive to the surgery.

Thanks for all replies.

[healthpro77]

So I have had another consultation with Dr. Fielding and booked my procedure for the end of April.  I asked him about my concern of the pec looking weird when it was in motion.  His answer regarding experienced surgeons such as himself and Dr. Lista is that in rare instances the nipple may bond or heal to the tissue underneath.  What I understood was that if this were to happen, it could be fixed.  I think that other factors come into play, however, when the procedure is done by a less experienced surgeon.  
I asked Dr. Fielding about Dr. Lista and what his take on his procedure was.  He responded that they were in school together, graduated the same year even I think, and that they had both seen each others work.  Dr. Fielding explained that the reason he preferred his procedure was that he could preform the liposuction from two different points that intersected at 90 degrees, and this in his opinion made for a more uniform removal.  To help you understand a little further, I believe the procedure of liposuction involves inserting and removing a rod multiple times through the fat tissue in order to remove it.  With Dr. Lista's procedure there is one point of origin, and as the procedure is preformed the rod removing the fat tissue will essentially fan out.  With Dr. Fielding's procedure he has two points of origin and two fanning patterns for the fat tissue removal.  He also mentioned that he prefers to see what he is doing when he is removing the glandular tissue.  And most importantly, he says that the scars left around the nipple are inconsequential and that the vast majority of patients have no problem with the aesthetics.  It is also important to note that Dr. Lista may use a slightly different technology with his liposuction procedure and this is something I don't have any interest in researching at this point.  
Dharry, I read your posts in ask a doctor.  Your gynecomastia picture does not show puffy nipples, and it is the presence of puffy nipples that denotes the presence of glandular tissue.  Now this may be because it was cold at the time of the photo.  My situation looks similar to yours; however, I do have puffy nipples, which are a sure sign of glandular tissue.  It appears to me that your main concern is that you are unsure of whether you should have the procedure done at 180 lbs or 200 lbs; additionally, you are concerned that if you did have it done at the lighter weight that if you did gain in the future the gynecomastia may return.  From my understanding of physiology/anatomy, which at this point is only first year courses, I think the way it works is that generally the fat cells will just expand and contract.  In other words the production of new fat cells would not be a concern unless you started heading north of 225lbs, like really started putting on the weight.  So from this perspective, whether you get the procedure done at 180 or 200 lbs will have little consequence.  The fact the you do not have puffy nipples, which at this point I don't know for sure, means that you mainly suffer from fat deposits that would most likely be reduced if you reduced your overall weight.  With that said you may still not be satisfied at 180 lbs.  I will say that our chests sizes are very similar, and that if I didn't have the puffy nipples I would not go ahead with the surgery.  But I do, and I will.  Hope that helps and good luck with your decision.  

[dharry]

   Hey Health Pro

 Thanks for the reply. Good luck with your surgery.

 When I press on my chest it feels thick and tough, my chest really sticks out. I lift weights but I am no Arnold S. I think it is fat and excess glandular tissue. My Grandfather looked similar and my Dad is similar. If I got down to 160 pounds I doubt my chest would be flat. My son is 5'11'' 170 pounds with some abs [works out] and has the puffy nipple look. But when he was overweight it was more like my chest, couldn't really see the puffy nipples. If it is just fat, my family genetics has us gaining as much fat on our chests as our waists. Argh!
I am including another pic.

I think I will do a consult with Dr Fielding, worst case I get a trip to Toronto.

Thanks again for the reply