Please Forgive me if this question has been asked/answered in a previous post. A Lil background. I have lived with gynecomastia for as long as I can remember. I am currently 28, 6'5, 195 lbs. This like many of you I'm sure, has effected my life in a drastic way. I live in Las Vegas where it's constantly hot and people are walking around shirtless. Frankly, I'm Sick and tired of wearing loose t-shirts and avoiding pool parties like the plague. Its well past time to do something about it.
I am very fit and slim. I lift/hoop 4-5 times a week. The hard glandular tissue (gyno) under both my nipples is very evident as I have very little body fat. Without posting pictures (which I will do soon) I would equate the size of the glands to about the size of a womans A cup. (k maybe a bit smaller) Another poster gave a great analogy of cutting a tennis ball in half and sliding them under your nipples. A doctor I saw a while back labeled my gyno as an "extreme case". I'm hard pressed to find anything in a t-shirt that does not show my "man boobs". Don't ask... I refuse to wear a chest binder. 
Anyway
My question:
I recently heard of Vaser lipo. Is this the best way to remove the large glands? Or should I go with the more traditional method of gyno removal? The majority of Vaser lipo videos and pictures I come across show overweight males and no gland removal at all. Just fat. Will the Vaser procedure be as good as the traditional way for gland removal? Is there any other procedure I should look into?
If anyone has any info, it would be greatly appreciated. Thank you in advance!
Liposuction Is Great for Sculpting FatVarious types of ultrasonic, laser, vaser, and power assisted liposuction (UAL and PAL) have been around for quite some time. Each surgeon uses the tools and techniques he / she prefers. There is a lot of hype that is just very poorly proven by the advocates of these methods. These instruments are more expensive, but can help surgeons get through a case faster. More cases, more money, but not a good choice if the results are not equal or better.
There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery. Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.
The ultrasonic, pulsed ultrasonic (Vaser), laser ("Smart"), and lipodisolve (injections that destroy fat cells) all have in common the explosion / destruction of the fat cell membrane releasing the fat material inside the body. Subsequent liposuction only removes a portion of the released fat. The remaining debris must be managed by the body with a subsequent tissue reaction of swelling, bruising, and prolonged healing. Yet, many doctors and instrument companies hype these "advances" with claims that I have yet to see well documented. Try to find early after surgery pictures or movies after such liquification fat cell technology. Better yet try to find any other technique that can show
After Gynecomastia Bruising and Swelling anything close to what I have evolved over the years. Less swelling, less bruising, and better technique lead to more rapid
Healing and Recovery after Gynecomastia Surgery.
Liposuction such as ultrasonic, VASER, 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. Gland has the density of connective tissue, dermis (layer under the skin), and fascia (layer covering the muscle). Crank up the energy of the device to supposedly "liquefy" gland, and these supporting structures will be injured also. You should see the mess I find on patients unhappy with other doctors attempts to remove gland that way. The scar / residual gland often extend from the skin, through the condensed remaining gland, and attach firmly to the fascia. This can result in horrible animation deformities. The fat is needed as a lubrication layer. With the fat gone, the resulting tissues just do not move normally. Also try to find movies of how patients move after these techniques. What may look good in a single view photograph, just can look like a disgusting mess as the chest moves.
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 for
Revision Gynecomastia Chest Sculpture.
Here is an example of Revision Surgery after Liposuction alone.
Here is another revision after liposuction alone.I have seen just too many unhappy patients with puffy nipples remaining after axilla or armpit attempts alone using sharp cutting cannula or other such instruments by other doctors. Check out this drawing of
Puffy Nipple Anatomy after Remote Gland Removal Drawing.
Here is another patient unhappy with
Residual Puffy Nipples After Gynecomastia Surgery by another doctor. Check out the
movies before and after this revision surgery and listen to the patient describe his experiences.
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. The incision at the edge of the areola opens up my entire spectrum of artist's pallet of tools for my sculpture. A remote incision robs me of many options and just does not looks as nice. I prefer to avoid this unnecessary additional scar. One small scar for each side, in my opinion is better than 2 or more, others not hidden by the natural color change of the areola. Keeping the arms down to hide the lateral scars may look good on limited pictures for posting on a website, article, or office presentation, but my patients want to look good in a pool or playing shirtless.
I have also seen patients with channel problems between remote access sites and the areola / nipple. Scars, adhesion, and depression 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.
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 aboutGynecomastia and Chest Sculpture
Topic: Gland Removal with Vaser Lipo? (Read 19131 times)
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