Fat Flap Sculpture Technique, is it neccessary!

[Aero360]

I'm young, lightly muscled, lean (body fat is 10-12%), I wanna remove both glands almost completely, leaving tiny glands around the size of an orange seed on each side. Because I'm afraid if I take steroid the gland will expand again.

Then I wanna have Fat Flap Sculpture to use surrounding fat to support the areolas. My only concern is with my low body fat, will I be able to have Fat Flap Sculpture surgery done? And I also would like to find out whether if Fat Flap Sculpture surgery is covered under Ontario health coverage. Do you guys think its a good idea for me to do it?

[Dr. Elliot Jacobs]

First, if you took steroids, stop!  It probably was the main culprit for your gyne.  And if you have surgery and plan to take steroids, your gyne will definitely recur.

There are many acceptable methods for doing gyne surgery and fat flaps are one of them -- every surgeon can do them.  The method employed for your surgery will depend upon the amount of tissue you have and the surgeon's preferred method of treating it.  There is no absolute right or wrong way to perform an operation.  Every surgeon has his own techniques and preferences, based on his learning and experience.  What counts is the final result -- not the method by which the final result was obtained.

Therefore, your first step is to visit an experienced gyne surgeon and have an exam.  It should be him telling you what should be done, not the other way around.

Dr Jacobs

[DrBermant]

I'm young, lightly muscled, lean (body fat is 10-12%), I wanna remove both glands almost completely, leaving tiny glands around the size of an orange seed on each side. Because I'm afraid if I take steroid the gland will expand again.

Then I wanna have Fat Flap Sculpture to use surrounding fat to support the areolas. My only concern is with my low body fat, will I be able to have Fat Flap Sculpture surgery done? And I also would like to find out whether if Fat Flap Sculpture surgery is covered under Ontario health coverage. Do you guys think its a good idea for me to do it?

I see many Canadian Patients with Gynecomastia who prefer my methods. Not all doctors use the same techniques and what insurance covers varies.

There are doctors who prefer to use liposuction only and yet other who first and only remove gland if the chest is not flat. However, gland does not compress like fat nor move like fat and what seems like a "flat" contour distorts on animation, flexing muscles, or relaxing of the areola muscles. A result that "looks good" on a single picture may not look good on animation and living life. For the athlete who enjoys his chest during activities, Residual Puffy Nipple Complication After Gynecomastia Surgery can ruin a great contour.

I also like targeting gland first to remove as much of the glandular tissue as practical to lower an unacceptable recurrence / revision rate I saw in the literature. My revision rate is less than 1%.  Check out typical literature on the subject:

• revision rate 7% - http://www.ncbi.nlm.nih.gov/pubmed/18026791?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
• recurrence rate 3/20 = 15% - http://www.ncbi.nlm.nih.gov/pubmed/11176630?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
• revision rates 10.3 to 38.1% - http://www.ncbi.nlm.nih.gov/pubmed/15269574?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
• revision rate 35/65  = 54% - http://www.ncbi.nlm.nih.gov/pubmed/18675546?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
• revision 7%  100 patients over 10 years - http://www.ncbi.nlm.nih.gov/pubmed/18026791?ordinalpos=44&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
• revision 2/10 = 20% - http://www.ncbi.nlm.nih.gov/pubmed/11252087?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

That high a revision rate is just not acceptable if it can be lowered with better screening and techniques. However, Anatomy of Puffy Nipple Gynecomastia has fingers of gland running through fingers of fat. It is not realistic to get all of the gland with any surgery, even with radical disfiguring removal cancer surgery, shreds of gland will remain behind. Then there is the supporting tissues of the chest that seem to be able to evolve into gland elements under the right hormonal stimulation. That is why prevention of recurrence is an important consideration.

Not all doctors use the same methods. Many years ago, I first described my Fat Flap Technique for gynecomastia surgery as a methodology to be able to target gland first and yet be able to still provide areola support advancing local fat still supported by its blood supply. It is but one element of my Dynamic Technique and I do not use it on all patients. It is unnecessary additional dissection and all patients do not need this step depending on their specific deformity.

I have found enough fat for my sculpture even on those in single digit body fat percentages. I work with many extremely low body fat Competition Bodybuilders with Gynecomastia. I ask such athletes to have surgery at their off season body fat to have enough resources for the surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction