Doc say Lipo only for the surrounding glands

[waynepeh]

Hi,

I got some taunting question and i would need any valuable advice for them. As below.

Concave depression, does it have 100% occurrence if all glands/fats are removed?
If concave depression occurs, does it go away some times or does working out helps to solve it or at least improve it?
If it does not improve/go away, what option of surgery are there?
Fluid after surgery, how to prevent or minimise this occurrence?

Also, can a surgeon be able to remove glands up about roughly 1.5 - 2 inches from top of aerola? Is it possible to remove gland situated that very much above the aerola?

Update: i just met a plastic surgeon and he mention that he will do lipo to sculpt the remaining glands that are left surrounding the aerola area. Actually i did a surgery before and the puffy nips were off me but still, my chest seems large cos of glands in the aerola surrounding area. So my question now is, is lipo a good option to further thin these glands/tissue? any input will be very appreciatted.

[Dr. Elliot Jacobs]

A concave depression can occur if too much tissue is removed from beneath the areola and insufficient tissue removed in the surrounding areas.  Everyone is different.  A very thin person, with minimal body fat, can have just a little bit of tissue remaining under the areola and be OK, provided that the surrounding tissues match it.  And vice versa.

In general, if there is a concave depression after surgery it will not respond to working out.  The best treatment will then be fat grafting to build up tissue underneath the areola and thereby raise it up to the level of the surrounding tissues.  This is always more difficult to do (and involves another operation) than to do the job right the first time by being careful not to excise too much tissue. That is why your initial choice of surgeon is so important -- it is better to do it right the first time than to try to fix it afterwards -- and you very rarely "catch up."

If fluid builds up after surgery, it should be removed by the doctor with a syringe.  A small amount of fluid will probably disappear by itself.  Fluid can be blood, in which case there was some bleeding during or immediately after surgery.  Or it can be serous fluid (like the fluid in a blister -- clear and yellow), which usually occurs somewhat later.  Both can be minimized by doing very limited activities after surgery and wearing a very snug compression garment.  And yet, with both of these being done, it can still occur.

Any surgeon worth his salt can remove glandular tissue through a nipple incision in any direction within 5-6 inches from the incision!

Dr Jacobs

[waynepeh]

A concave depression can occur if too much tissue is removed from beneath the areola and insufficient tissue removed in the surrounding areas.  Everyone is different.  A very thin person, with minimal body fat, can have just a little bit of tissue remaining under the areola and be OK, provided that the surrounding tissues match it.  And vice versa.

In general, if there is a concave depression after surgery it will not respond to working out.  The best treatment will then be fat grafting to build up tissue underneath the areola and thereby raise it up to the level of the surrounding tissues.  This is always more difficult to do (and involves another operation) than to do the job right the first time by being careful not to excise too much tissue. That is why your initial choice of surgeon is so important -- it is better to do it right the first time than to try to fix it afterwards -- and you very rarely "catch up."

If fluid builds up after surgery, it should be removed by the doctor with a syringe.  A small amount of fluid will probably disappear by itself.  Fluid can be blood, in which case there was some bleeding during or immediately after surgery.  Or it can be serous fluid (like the fluid in a blister -- clear and yellow), which usually occurs somewhat later.  Both can be minimized by doing very limited activities after surgery and wearing a very snug compression garment.  And yet, with both of these being done, it can still occur.

Any surgeon worth his salt can remove glandular tissue through a nipple incision in any direction within 5-6 inches from the incision!

Dr Jacobs

wow great info there dr jacobs!! By the way, you mention surrounding tissue that is under the skin outside of the aerola area. Don't surgeon remove those tissue? I am not fat but of average weight. Actually my case is glands spreading outwards from the aerola area. From what i feel when i touch it, it seems to be quite a thin layer and thickening abit near the aerola area (like a small 'mountain'). I am wondering can i remove all the glands and not suffer depression. Is there any case you had taken whereby you clear out all the glands? Need to understand the procedure to find a suitable doctor. Any input will be very much appreciated.

[Dr. Elliot Jacobs]

When gynecomastia is present, breast tissue (gland) is thickest under the areola and characteristically spreads out from there, gradually thinning out as it approaches the outer areas of the chest. Every case is individual -- that's why individual evaluation by a competent and experienced surgeon is invaluable.  In general, liposuction is utilized to even out all the tissues -- extending in all directions -- surrounding the areola.  We call it "feathering" -- I think you get the picture.  Then direct excision of the tissue under the areola may be performed if necessary and sufficient tissue (ie gland) should be left under the areola so that the total thickness of areola and remaining gland underneath it is the same thickness as the surrounding skin/fat tissue.  Then, you will have an even contour with a flat areola. 

I have developed and designed my own set of gyne instruments which are sharp enough to remove gland in about 50% of cases -- thus I only need to make a small nick in the armpit area.  In the other 50%, the gland tissue is so hard and dense that I do have to make a small incision around the edge of the areola.  That decision is made during surgery and I never hesitate to make the areolar incision if I feel it is necessary.  On the other hand, if I can avoid that incision in about 50% of cases and still obtain a fine result, then why not?

Dr Jacobs

[DrBermant]

Hi,

I got some taunting question and i would need any valuable advice for them. As below.

Concave depression, does it have 100% occurrence if all glands/fats are removed?
If concave depression occurs, does it go away some times or does working out helps to solve it or at least improve it?
If it does not improve/go away, what option of surgery are there?
Fluid after surgery, how to prevent or minimise this occurrence?

Also, can a surgeon be able to remove glands up about roughly 1.5 - 2 inches from top of aerola? Is it possible to remove gland situated that very much above the aerola?

I have seen many Crater Deformities After Gynecomastia Surgery from doctors who remove gland and not sculpt the remaining tissue. 

Very Large Glands can be removed from tiny incisions at the edge of the areola.  I have taken much larger glands from incisions that typically are less than 2 cm long. 

Gland left behind is firm unlike normal fat and does not compress like fat.  With my Dynamic Technique Male Chest Sculpture, I prefer to target this firmer gland first.  I then select from an Artist's Pallet of Surgical Tools Techniques to contour the remaining tissues. The areola chest skin interface is a great place to hide a scar.  Check out typical before and after surgery pictures of the nipple areola scars here.  Actually follow the links on that page to many more showing how nice the scars are hidden.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[waynepeh]

anyone comment for my desperate call?