Surgery Question??

[marcd312]

I just recently went to see a Plastic Surgeon and when he examined me he said he thought he could get the glanular tissue out with lipo alone.He said an incision might be possible.My Gyno  is a decent size bigger than a marble.From what i read on here seems all the top Dr are doing some sort of incision.I would hate to have to do this all over.He is Board Certified but Gyno isnt his specialty.Is Lypo alone even possible??Thanks

[DrBermant]

I just recently went to see a Plastic Surgeon and when he examined me he said he thought he could get the glanular tissue out with lipo alone.He said an incision might be possible.My Gyno  is a decent size bigger than a marble.From what i read on here seems all the top Dr are doing some sort of incision.I would hate to have to do this all over.He is Board Certified but Gyno isnt his specialty.Is Lypo alone even possible??Thanks

Liposuction is a great tool for fat based gynecomastia surgery. Here are examples of some of the many patients I have seen who came to me complaining of:

• Residual Gynecomastia after Liposuction Alone
• Revision Puffy Nipples after Liposuction Alone
• Redo Surgery for Remaining Gland after Liposuction

all after other surgeons' work. I have seen many many other patients unhappy after contouring from other doctors who claimed that their liposuction alone was enough to manage the gynecomastia. In the Anatomy of Gynecomastia there are fingers of gland that run through the fat.  Unfortunately all forms of liposuction, Vaser, Ultrasonic, Power Assisted, "Smart," sharp cutting cannula all preferentially will target the softer fat first. Suck out the fat first, and the fingers of gland condense behind. On this page of Puffy Nipple Anatomy, hold your screen cursor over the link "Remaining Gland after Gynecomastia Surgery" to see residual gland that can be left behind when working using liposuction from a remote site that depicts on common problem I have seen in such cases. Then look at the gland / scar tissue complex in each of the revision cases I have posted to see what I mean.

With my Dynamic Technique I prefer to  target the gland first and then contour the remaining defect. By waiting until I find out how much gland should come out first, remaining fat can be contouring tool. Even subtle Puffy Nipple Gynecomastia can detract from a cut look on the male chest.

When I start the Tumescent Infiltration Anesthesia and find the gland component trivial, I will only use liposuction to contour the chest. This results in a tiny scar hidden at the edge of the areola. Unfortunately, I find significant gland contributions in so many of my patients. You can see some of the Gland Component of Gynecomastia I removed from typical cases.

If the final contour is not being hidden by swelling (which can hide deformities), looks good with the areola muscles relaxed Puffy Nipple Deformity Can Be Hidden by Areola Muscle Stimulation, and looks good on animation (arms up, muscles tensing, and in motion), then that is a good result.  Fine male chest sculpture should look good from all angles and while exposed living lift, not just in a few select pictures taken in a cold room the angle of view seems to change based on what looked better on that patient.

Board Certification can be in many different specialties. Board Certification is Plastic Surgery is a good starting point. However, not all Board Certified Plastic Surgeons have the same skills.  Some of the Crater Deformities after bad gynecomastia surgery I have seen came from Board Certified Plastic Surgeons.

I have posted on how to pick a gynecomastia surgeon here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

It is not the tool the artist sculpts with, but the results. However, these results should look good both at rest and in animation, or arms up, or muscles tensing, and enjoying life without concerns about hiding a chest deformity.

Hope this helps,

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

[Paa_Paw]

We live in an age where it is not uncommon to find that people have specialized in rather narrow areas within a larger field.

Gynecomastia is one such sub-specialty, Find a surgeon who does a significant number of these surgeries for best results.

[MrRossZ28]

I had lipo and glad done.

[Dr. Cruise]

Gynecomastia surgery is a subspecialty within plastic surgery.  It is not often taught in residency and there are very few plastic surgeons who specialize in it. Gynecomastia is like any other surgery, in that expertise requires experience.  Liposuction is useful when you have fatty gynecomastia.  In your case, you mentioned yours is primarily glandular which is almost impossible to remove with liposuction alone.  In fact, liposuction may only accentuate puffy nipple.  Excision of the glandular tissue is your best option.