Liposuction Question and revision

[Ganesh]

Hello doctors..

I have a question on liposution done..

I have seen soo many doctors saying that by doing liposuction itself they will be able to remove the glands...


If soo y do we go for the excision and aerola cuts..?

If the glands are of very small size can it be removed along with liposuction itself...without doing excision...


In my case.. i had a consultation with my doctor for my revision surgery...i stressed him that if excision is required..he can do it...

but the doctor told that..my case required just lipo..since the 1st surgeon removed the glands well..

He just confirmed this with manual examination of my breasts....


Im not sure about wts exactly required for my case....

I have taken some pictures on my mobile..posting that will be of providing better idea...i need to buy a datacable and wil soon post in this forum...



Thanks in advance...

[DrBermant]

Hello doctors..

I have a question on liposution done..
I have seen soo many doctors saying that by doing liposuction itself they will be able to remove the glands...

If soo y do we go for the excision and aerola cuts..?
If the glands are of very small size can it be removed along with liposuction itself...without doing excision...

In my case.. i had a consultation with my doctor for my revision surgery...i stressed him that if excision is required..he can do it...
but the doctor told that..my case required just lipo..since the 1st surgeon removed the glands well..
He just confirmed this with manual examination of my breasts....

Im not sure about wts exactly required for my case....
I have taken some pictures on my mobile..posting that will be of providing better idea...i need to buy a datacable and wil soon post in this forum...

Thanks in advance...

Standard After Gynecomastia Surgery Pictures can help others better understand your concerns.

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic 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 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.

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, 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.

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.

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.

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 flexing 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 a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used "special cannula to remove gland," that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

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, Ultrasonic, nor sharp cutting cannula 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 aboutGynecomastia and Chest Sculpture

[Dr. Cruise]

Hi Ganesh,
It is ideal to go to a plastic surgeon that does gynecomastia correction often. Plastic surgeons who do not have significant experience in gynecomastia correction will often look at the excess tissue of the chest like other areas of the body (ie stomach, love handles). Liposuction is a technique they are comfortable with. As Dr. Bermant so aptly pointed out, the male chest is different. While in some cases liposuction alone can adequately treat the problem it is rare. I say this because I often see unhappy liposuction only patients coming to me for revision after being treated elsewhere. The incision used for the excision heals amazingly well and is virtually never a concern. For this reason, I routinely utilize BOTH liposuction and gland excision.

[Ganesh]

hello doctors,

i hv posted my recent pictures..

http://www.flickr.com/photos/43520544@N06/?saved=1


I had liposuction + excision 9 months before


plz help me out on these questions.

1.do i need revision?

2.is still glands are left in mr breast or it is only fat?

3.do i need lipo only or both lipo and excision?

4.wt will be the outcome of the revision... flat chest is possible?

5.my revision surgeon told that there are no glands left so lipo alone is enough..
he is confident tht i will get a flat chest.The doctor told that if he is not comfortable under local anes.. he will switch to general anes.. at time of surgery..

6.the surgeon was very casual...but eventhough i choosed him sice his profile is good in his area.

below are few of his profile infos.

National Seceratory :  International Society of Aesthetic Plastic Surgery (ISAPS)

Total Experience
Plastic Surgery 20 Years
General Surgery 3 years
Anatomy 6 Months
Teaching Experience 8 years


please advice me..

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thanks
ganesh

[Dr. Elliot Jacobs]

Ganesh

Your photos ( assume they are post op) reveal that you are overweight.  Many overweight men seek gyne surgery with the idea that post op their chest will be smooth, flat, contoured and very thin over the muscles.  That is not realistic.  The idea of gyne surgery is to reduce the size of the chest so that it is compatible and consistent with the surrounding areas of the body.  I usually will try to achieve a uniform pinch of skin and fat from the collarbone down to the lower ribs.  But even when this is achieved, the result on an overweight man will still be a smaller breast -- not a ripped, muscular, contoured chest.  The latter is only possible if you lose substantial weight as well.

This may not be the answer you would like to hear -- but it is an honest one.

Dr Jacobs

[Ganesh]

Thanks for ur reply Dr jacobs,


i agree with u doctor,

though i am a bit overweight... if i reduce my weight there is no means by which my gyne is also going to be reduced...

so wn i get lean it will create more problems...


My question is may be the person is overweight or normal.. if fat and glands are there in the breast unless it is completely removed.. it doesnt make a person completely gyne free...

From my pics do you see that i have  glands or only fat(due to overweight)..?

Do you say that my initial surgery made be completely gyne free and now due to overweight my chest look like this..?


Thanks
E.Jaiganesh

[DrBermant]

though i am a bit overweight... if i reduce my weight there is no means by which my gyne is also going to be reduced...

so wn i get lean it will create more problems...


My question is may be the person is overweight or normal.. if fat and glands are there in the breast unless it is completely removed.. it doesnt make a person completely gyne free...

From my pics do you see that i have  glands or only fat(due to overweight)..?

Do you say that my initial surgery made be completely gyne free and now due to overweight my chest look like this..?


Thanks
E.Jaiganesh

Wearing extra fat is not healthy.  Check out your risks with a BMI Calculator (Body Mass Index)

Unfortunately, BMI does not take into account muscle mass vs. fat.  Body Fat Analyzers can help define that issue.

Plastic surgery is better after weight loss, losing weight is a coarse tool. Plastic surgery is better used for refinement.

Weight Loss, Dealing With Excess Skin of the Chest and Body is also a major emotional issue. 

We have many patients, family members, and parents who have raved how a compression garment can really help while waiting for surgery or until stabilization of a problem.  However, I have found not all compression garments work as well.

Body shaping garments are a good temporary contouring solution.  They do not help remove or treat gynecomastia.  When the garment is removed, the gynecomastia is still there.  They can provide an emotional band-aid for the stress of contour issues and bouncing tissues.

Non-Surgical Body Shaping for Gynecomastia

Check out the multiple views for each patient. Clink on the links to see other views of the garment and features of this design I prefer.  We have tried many other brands and none seem to come close to what this one offers.

Rate My Gynecomastia - is a frequent question.

Unfortunately, it can be difficult to distinguish just what is causing the problem.  Gynecomastia male breasts can be fat, gland, or most commonly a combination of both.  Sometimes skin and sagging tissues can be a factor.  Pseudo Gynecomastia (pseudogynecomastia) is supposed to be fat only gynecomastia.  The problem with that "classification" is that in almost every case of gynecomastia I have seen there is some component of gland.  This gland can be very small, but it is present almost all the time.  So do you have Pseudo gynecomastia when there is a 1%, 10%, 50%, or 90% deformity from fat?  Reality just does not work that way.

Defining the problem with photographs sometimes can help.  However, it is impossible to tell from photographs if the deformity is from fat or gland. The dynamic images, of my standard set of images can show a region that compresses differently.  Even clinical examination differentiation can be difficult.

Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this drawing and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

Men with excessive fat do tend to have certain contour issues.  Check out this link about Sumo Wrestlers.  Men tend to carry excessive weight in their chest and stomach.

Losing weight first, to something you are comfortable with and can maintain is typically a much better option.  Weight loss is a coarse tool.  Unfortunately, you cannot pick where weight comes from - nor can you pick where weight goes back on to.  Gland that contributes to the breast shape is not helped with weight loss.  Fingers of fat in the gland can become smaller, but the contour problem from gland does not go away.  After losing weight plastic surgery can help with localized fat, gland, and extra skin.  After surgery remaining fat cells can put on more weight.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Ganesh]

That was a great explaination..


I would like to take this oppurtunity to thank all doctors of this forum for providing their valuable insights..


Big Thanks to you all doctors.