Scars and lipo entry site

[Waterman]

I am debating  between 2 surgeons who use different approaches for  lipo.  One inserts cannula thru areola so that no other scars are necessary.  I like this, but I am not sure why all surgeons Would not use this approach.  For instance, Dr. Jacobs is one of the most respected gyro surgeons but it looks like that he enters on the side of the chest for lipo as all of his pics show a scar below the armpits.  Is there a reason for this?  Possibly better results from entering on the side of the chest?  Just not sure why all surgeons would not insert the cannula thru the aerola and avoid having a scar on the side of the chest below the armpit?

[ms123]

Often surgeons use the armpit incision for drains. It is my understanding that this scar usually heals pretty well.

[Waterman]

I understand about the possibility of a drain coming out in the armpit.  However, what I am referring to is something different where the surgeon inserts the lipo cannula under the armpit ( in line with the aerola where it is not concealed by the armpit ).  Some surgeons insert the cannula thru the aerola and avoid an additional scar on each side, and I am wondering why some surgeons ( Dr. Jacobs for example ) seems to opt for a scar on each side when they could insert the lipo cannula thru the aerola?  There must be a reason???  Dr. Jacobs please feel free to respond.

[Dr. Elliot Jacobs]

Excellent question.  But first understand one thing:  surgeons evolve in their techniques and eventually settle on methods that work best in their hands.  Such is the case for a lipo incision at the edge of the areola vs a lateral chest access incision that I use.

I use special, sharp custom cannulas to perform this operation.  In fact, the cannula that I use was one which I designed myself.  It is very aggressive and many times I am able to remove both fat and breast tissue with it without the need for a gland excision directly. In these situations, there is no visible scar on the breast at all -- and the lateral chest scar is hidden by the arm when it is at one's side. Further, using the lateral chest access incision allows me to make broad, even, powerful strokes across the entire chest and I am thus able to achieve a smooth and uniform result. And, from an ergonomic point of view, it is very efficient.

I have at times tried the areolar access incision, but I find it is very difficult to work through. Imagine the contortions one would have to go through, while standing in one position only, if one tried to push a pencil-like metal tube in a complete circle (like spokes on a wheel).  And most important, it would be difficult to remove the tissue just below the areola.  

Remember, all this has to be done in a sterile environment, with sterile drapes that occasionally get in the way.  The arm position is also important -- it cannot be raised too high for fear of stretching major nerves.

Lastly, the lateral chest scar does tend to heal very well and fade to a slight blemish in 6-12 months.  The photos of my patients, though, are taken at 3-6 months and the scars are generally more visible at that time.  I take photos at this time because it is difficult to coax patients to make a return trip to my office simply to have post op pix taken at one year.

Bottom line:  there is no right or wrong way to do this operation.  What counts are the results -- not the means by which one achieved those results.

Dr Jacobs

[Waterman]

Thanks Dr. Jacobs.  I really appreciate your response.  You are the most open and honest surgeon I have experienced.  Many surgeons do not want to discuss the specifics of their procedure with patients.  Their attitude is that they are the doctor and they know best.  You are a breath of fresh air for patients trying to understand the procedure before we go "under the knife".  I am going to be scheduling a consultation with you in the near future.  Thanks again!

[Delivered]

So true. I wish we had a Dr Jacobs in Mumbai.

[Dr. Elliot Jacobs]

Waterman and Delivered -- thanks for the kind words -- much appreciated.

Dr Jacobs