new types of surgery?

[Fgyne]

hi all, i was wondering if the incision done under the armpit is considered the most advance and less scar inducing type of surgery available now. Are their any Doctors that are well know for this technique b/c i really want to get surgery done at the beginning of summer but not deal with the nipple scars...so if anyone has info on specific doctors or if u had this type of surgery performed on u, please help me out...thanks

[phantom]

In my opinion, it's not a question of the 'most advanced' method of male chest reduction.  It comes down to the skill, experience and confidence of the surgeon and the expectation and ability to heal by the patient.

Armpit incision (or rather the crease near to the armpit) is a newer and less practiced method, but there are still excellent results to be had by some surgeons that go via the areola.

I had surgery via a stab wound near the armpit.  This was carried out by Mr Paul Levick in Birmingham, UK (see link below).  He has a very high caseload for male chest reduction and actually had the treatment performed on himself via the same technique around ten years ago by a colleague from Los Angeles (I don't know who).

As for the scarring, it is only noticeable if the arm is raised.  At the moment it is a 2cm purple line (now three months old) and I anticipate this to fade to virtually nothing over the coming months.

[Fgyne]

thanks for replying and your results look really good... does anyone know of any good drs in the US that perform this type? thanks

[Paa_Paw]

Male breast reduction surgery has been around for barely over 20 years. Individual surgeons each refine their methods and as phantom pointed out, the skill and experience of the surgeon is more important than the route taken.

[infinity123]

I had surgery recently and spent a great deal of time researching this issue. In my opinion -- and this is just my opinion, I'm no expert -- doing the procedure in an area outside of the nipple IS a somewhat new and improved way of doing gynecomastia surgery. I had surgery with a plastic surgeon at the Mayo Clinic in Minnesota (liposuction + excision), who invented his own way of doing it. It is similar to the abstract I'm citing below by Prado and Castillo. I also had a consultation with the new president of the American Society of Plastic Surgeons, who assured me that he could do liposuction and excision via the armpit.  Also, Dr. Lista of Canada, who gets high marks on these boards, has come up with his own method, also cited below. --So, I would recommend that you do some serious research and come up with a decision that you're comfortable with.
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Prado AC, Castillo PF.  Minimal surgical access to treat gynecomastia with the use of a power-assisted arthroscopic-endoscopic cartilage shaver.  Plast Reconstr Surg. 2005 Mar;115(3):939-42.

The authors present a new method of treatment for gynecomastia that combines traditional liposuction in conjunction with a shaver technique to effectively remove the fibrofatty and the glandular tissues of the male breast and avoid areolar incisions. Twenty-five patients were treated in this fashion, and each patient demonstrated a smooth, masculine breast contour with well-concealed scars in the inframammary folds, eliminating the stigma of breast surgery. The procedure is technically straightforward and provides consistent results.
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Lista:  http://www.theplasticsurgeryclinic.com/malebreast_reduction.html

The standard technique for correction of gynecomastia involves a small incision around the nipple. The problem with this procedure is that it leaves a "tell-tale" scar which looks like a half moon around the lower half of the nipple. Usually this scar looks acceptable, but in some patients the scar is obvious and visible. Some men are disappointed that after surgery they are embarrased to expose their chests because of the nipple scar. Because of these concerns, Dr Lista has developed a new technique which eliminates this embarrasing tell-tale scar. In Dr Lista's procedure he places the Power Assisted Liposuction scar in the outside area of the chest. This scar is about 3 mm (or a quarter of an inch) and looks just like a scar after the removal of a small mole. At the completion of the liposuction he inserts a specially designed instrument through the liposuction incision to remove glandular tissue. This revolutionary technique allows the removal of both fatty tissue and glandular tissue through the same small incision while avoiding the embarrasing incision around the nipple….Dr Lista is preparing to present this new technique to several national plastic surgery conferences

[DrBermant]

hi all, i was wondering if the incision done under the armpit is considered the most advance and less scar inducing type of surgery available now. Are their any Doctors that are well know for this technique b/c i really want to get surgery done at the beginning of summer but not deal with the nipple scars...so if anyone has info on specific doctors or if u had this type of surgery performed on u, please help me out...thanks

Armpit access for gynecomastia has been around for quite some time.  Each surgeon used the tools and techniques he / she prefers.

The problem is that gynecomastia comes in so many different forms.  I prefer to let what I find during surgery help guide what needs to be done.  An incision at the edge of the areola opens up for me an artist's palette of tools not available when using the armpit approach.  That is why I prefer my Dynamic Technique.

I have also seen patients from other doctors 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 flexion here to see what I mean.  

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  

The areola chest skin interface is a great place to hide a scar.  Check out the many before after pictures of this Areola / Nipple Gallery here, here, and here.  These results are typical for my sculpture of my patients.

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.  Limited view demonstrations can pick the best angle to hide deformities and problems.  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 About Gynecomastia and Chest Sculpture

[Fgyne]

thanks for all the help infinity...just wondering how long the recovery generally is with the armpit incision, as in how long until ur comfortable taking ur shirt off?