Excision area....

[Grandpa Bambu]

Recently I saw some pics of a woman who had breast enlargement ( implants ). The point of access to the breast as far as I could see, was in the arm pit area and not at the edge of the areola. I am wondering if us guys with Gyne could have our PS use the arm pit rather than the areola edge as a point of access. I would rather not have a scar on my chest. I'm sure people will ask "Why do you have scars under your areolas? What's up with that?".  

The PS who performed this breast enlargement was Dr. F. Lista. Something else of interest on Lista is that on his WebSite he states that women can opt to have their breast surgery at the hospital where he is Chief of Plastic Surgery, rather than his office/clinic. If this is the case, I wonder why his Gyne operations cannot be done at the hospital and subsequently be covered under OHIP. At present, Lista performs excision/lipo in his office only and as a result, the operation is not covered by OHIP.

[headheldhigh01]

the rule seems to be armpit access for lipo, circumareolar for excision.  any competent ps should try to disguise scars.  

[UKgyne]

UK_Duzted was operated on by a surgeon in the UK who used the armpit as the access point for both lipo and excision.  He seemed very pleased with how successful the results were.

I can't remember the doctor's name though.

Mike

[Grandpa Bambu]

UK_Duzted was operated on by a surgeon in the UK who used the armpit as the access point for both lipo and excision.  He seemed very pleased with how successful the results were.

I can't remember the doctor's name though.

Mike

Well thar ya go!  

I will ask Dr. Fielding about the posibilty of an armpit entry point. However, if he has only done circumareolar access for Gynecomastia removal, he may not want to try the armpit technique.  :-/

[vaio]

When the cut out gland, they have to see what they are cutting out. When they do implants, they make a pocket and push the implant into the pocket.

[DrBermant]

Recently I saw some pics of a woman who had breast enlargement ( implants ). The point of access to the breast as far as I could see, was in the arm pit area and not at the edge of the areola. I am wondering if us guys with Gyne could have our PS use the arm pit rather than the areola edge as a point of access. I would rather not have a scar on my chest. I'm sure people will ask "Why do you have scars under your areolas? What's up with that?".  

Each surgeon used the tools and techniques he / she prefers.

The armpit exposure is easier for me when the problem is only fat.  The surgery tends to take less time and less work.  The problem is that gland removal is suboptimal through the armpit and I cannot use many of the tools available for sculpting tissue when I have more direct exposure.  The armpit scars can look bad.  Lift the arms playing basketball or volleyball, and it just does not look natural.  Sleeveless shirts also leave this region very exposed.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like.  The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques.  

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my dynamic technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Grandpa Bambu]

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

DrBermant....

Thanks very much for the info and answering my question. Very interesting!

BTW... the link for 'pictures of the tumecent technique' is a no-go.

[Grandpa Bambu]

The armpit scars can look bad.  Lift the arms playing basketball or volleyball, and it just does not look natural.  Sleeveless shirts also leave this region very exposed.

Yeah, you have a good point there.

[DrBermant]

DrBermant....

Thanks very much for the info and answering my question. Very interesting!

BTW... the link for 'pictures of the tumecent technique' is a no-go.

Thank you fixed

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture