ultrasonic assisted lipoplast

[wickedturbo]

one surgeon states this

The best method of treating this type of tissue is ultrasonic assisted lipoplasty. Ultrasonic energy will “melt” the fibrous fatty tissue of the chest and produce the best contour. This is then fine tuned by using suction assisted liposuction.

is this considered incision?

[Litlriki]

No.  I used Ultrasonic Assisted Liposuction (UAL) in my practice up until a few years ago.  I stopped using it when the device met it's demise, and it was decided that the benefit didn't justify the cost of replacement.  What I found, however, was that the ultrasound DOES NOT melt the fibrous tissue, only the fatty tissue, and incision is still necessary to adequately resect the fibro-fatty mass under the nipple.  The reference you're citing seems to be recommending UAL to treat gynecomastia without the incision around the areola. There was a paper by Dr. Rohrich and his colleagues a few years back, which recommended UAL for treatment of gynecomastia, and some of his post-op photos look like some of my "puffy nipple" pre-op patients--Not an adequate result, in my opinion. 

Rick Silverman

[George Pope, M.D.]

I agree with Dr. Silverman.  UAL was pretty popular when it first came out in the mid to late 90's, but it's pretty much fallen out of favor.  The heat generated by the ultrasonic energy can cause prolonged swelling, and a lot of the remaining fat is damaged, thus the problem with long term swelling and induration or hardness. 

Dr. Pope, MD

[Dr. Elliot Jacobs]

I agree with my colleagues.  UAL only melts fat --it has no effect on solid gland or fibrous tissue.  It also has some very definite downsides -- there have been reports of skin burns (a burn from the undersurface of the skin when the instrument came too close to the skin) and of prolonged swelling and pain.  And at best, it does no better than regular suction assisted liposuction.  I do not understand doctors hyping it as "better" for gyne surgery, when it clearly is not better.  Perhaps they are just trying to pay off these very expensive machines.

Dr Jacobs