Tumescent Lipo & excision under General or local anesthesia

[kaps]

Dear Docs ,

I have been reading your advices and success stories on this website , this has encouraged me to opt for a surgery though i do no have very significant gyno problem but i dont feel very comfortable without my shirt on the beach .........

I live in India , and after reading a lot on this site , spoke to few doctors here have short listed two ...now my delima is they are both talking about doing Tumescent Lipo & excision both ....

One doctor is MBBS and MS and has been running his own clinic on plastic surgery from last 16 years and is Member American Academy Of Cosmetic Surgery & Association of Surgeons of India. he claims to have done several gyno surgeries over the years and also has a video of such surgery on his website .

he is saying that he will do this in his clinic under local anesthesia and i can go home in 4-5 hrs.he will not use drainge pipes .

The other doctor is MS (General Surgery), MCh (Plastic Surgery), F.R.C.S (Plastic Surgery)
Board certified in Plastic Surgery - UK and he is saying that i will perfer to do this under general anesthesia in one of the hospitals and will also put drainge pipes for 24 to 48 hrs and wants me to stay in the hospital for that duration that is 2 days .

Now i am very confused to go with which option  .... can you pls guide me

[Litlriki]

To begin, I would say that the most important decision you'll make is the choice of surgeon, rather than the choice of anesthetic option. 

For the first eight years I practiced, I did the majority of my gynecomastia procedures in an outpatient setting with tumescent anesthesia and intravenous conscious sedation using Demerol and Versed administered under my direction by a nurse.  I did this because I had the facility to do it, and it saved the patients money, since there was a lower hospital cost and no anesthesia fee. My patients did very well, including patients as young as 13 years old.

Since I moved my practice to Boston, I do not have that facility available, so there is no cost benefit to the patients in being awake or asleep.  As a result, most of my patients opt to go to sleep. That certainly makes the procedure easier for me, since I don't have to oversee administration of sedation, and I also don't have to worry about patient discomfort during the operation. When the occasional patient requests intravenous conscious sedation (in other words, if he wants to be awake for the surgery), I can oblige him with that, but it's a very different sort of sedation than what I did in the past using more effective and sedating medicines, which are administered by the anesthetist.

You may find that many of the surgeons on this site prefer general anesthesia, since it really allows us to do whatever is necessary to get the best result without worrying about the patient's level of discomfort, and we all have a facility that allows for administration of general anesthesia.  Personally, it sounds like your second surgeon is particularly conservative in his approach (a 24 - 48 hour hospital stay is unheard of in the US for this sort of procedure), but if that is his practice, and if he gets good results that way, then so be it. It also sounds like he may be better qualified as a plastic surgeon with board certification in the UK, which is a tough board.  Membership in the American Academy of Cosmetic Surgery does not tell me much, other than that the first surgeon has paid dues to be a member of the society. 

You may want to check a few more options.  At least look at some photos and if possible, speak to a patient or two.

Good luck,

Rick Silverman

[kaps]

Thanks a lot Dr Rick for your inputs , it surely has helped.i feel more confident of the Plastic surgen with UK board membership.... and the fact that he will operate me in a big hospital so i am more safe with anesthesia and othet things ..... and also i am very scared of surgery cuts and needles so i think opting for general anesthesia sounds like a better option...... I think i will try and convience this doc to relive me from the hospital by next day max 24 hrs .... thru this forum only i got to know about this doc and the results he has given .... but that paitent was discharged the same day .... i am enclosing the results of that paitent .... pls let me know what you think .

http://picasaweb.google.co.in/mumbai.experience/PreOperation?feat=directlink

http://picasaweb.google.co.in/mumbai.experience/PostOperative?feat=directlink

http://picasaweb.google.com/mumbai.experience/23DaysPostOperation?feat=directlink

http://picasaweb.google.com/mumbai.experience/55ApproxDaysPostOp?feat=directlink

[DrBermant]

Dear Docs ,

I have been reading your advices and success stories on this website , this has encouraged me to opt for a surgery though i do no have very significant gyno problem but i dont feel very comfortable without my shirt on the beach .........

I live in India , and after reading a lot on this site , spoke to few doctors here have short listed two ...now my delima is they are both talking about doing Tumescent Lipo & excision both ....

One doctor is MBBS and MS and has been running his own clinic on plastic surgery from last 16 years and is Member American Academy Of Cosmetic Surgery & Association of Surgeons of India. he claims to have done several gyno surgeries over the years and also has a video of such surgery on his website .

he is saying that he will do this in his clinic under local anesthesia and i can go home in 4-5 hrs.he will not use drainge pipes .

The other doctor is MS (General Surgery), MCh (Plastic Surgery), F.R.C.S (Plastic Surgery)
Board certified in Plastic Surgery - UK and he is saying that i will perfer to do this under general anesthesia in one of the hospitals and will also put drainge pipes for 24 to 48 hrs and wants me to stay in the hospital for that duration that is 2 days .

Now i am very confused to go with which option  .... can you pls guide me

Selecting a gynecomastia surgeon  for this type of contouring should include seeing specific before and after pictures and how  the tissues move before and after surgery. Here is a section I posted on how to pick a male chest surgeon  here:

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

Local anesthesia alone is not enough to maximize comfort for good chest contouring. Plastic Surgery Anesthesia is an art form.  Sedation manages the patients conscious level.  Local and Tumescent Anesthesia manage the numbness and comfort.  For almost all of my gynecomastia surgery, local anesthesia with heavy sedation provides a safer much more comfortable method.  The patient starts with medication from an IV given by my Anesthetist.  He is an artist who blends various medications that gently drift each patients off to sleep.  We have been working as a team for many years.  By the end of the operation the patient awakes, comfortable, with no nausea, and unaware of the time that has transpired.  My local anesthesia and tumescence is given after the patient is asleep. 

I prefer local anesthesia alone for long nipple reduction gynecomastia. For almost all other gynecomastia surgery, local anesthesia with sedation provides a safer much more comfortable method.  When 2 stages are needed, as with this problem of enlarged nipples of gland and nipple tissue, I perform the first stage with local sedation, and the second with local alone.  For my upper body lift surgery, when I have to operate all around the chest - front / back, I need Light General Anesthesia.  This is still my Tumescent Technique, but adds the safety of airway protection while the patient is in the prone position.

I perform many revision gynecomastia surgery on patients first done elsewhere.  Many have told me how unpleasant their first doctor's experiences were under local anesthesia alone or General Anesthesia for liposuction and gynecomastia surgery.

You can find an extensive individual patients' experience with comfort and my Tumescent Technique Anesthesia for gynecomastia here.

If you prefer direct links to each of those discussions:

• anesthesia and comfort in gynecomastia patient from California
• anesthesia and comfort after revision gynecomastia surgery in patient from Hong Kong China
• comfort and anesthesia in physician's son with gynecomastia
• comfort and anesthesia in gynecomastia patient from Florida
• comfort and anesthesia in gynecomastia patient from Illinois
• comfort and anesthesia with gynecomastia patient from Texas
• comfort after gynecomastia surgery with patient from Colorado
• comparing comfort and anesthesia of my revision surgery with prior gynecomastia surgery in Florida
• comfort and anesthesia in patient 4 hours from Richmond with gynecomastia
• parent of teenage gynecomastia patient commenting about comfort after surgery
• comfort after gynecomastia revision surgery on patient from the United Kingdom
• comparing comfort of my revision surgery to prior gynecomastia surgery done in New York

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia Surgery

[Dr. Cruise]

I cannot comment on the abilities of your plastic surgeon.  Gynecomastia can be treated several differnet ways.  Your final results will be based on the experience of the surgeon not necessarily the technique used.  My recommendation would be to get a personal referral from a previous patient.  At the very least, look at his before and after photos prior to making a decision.