I had my consult with doctor #3 today - the first two confirmed that excision is needed to remove the breast tissue, while #3 says he does ultrasound lipo, first removing the fat then breaking down and removing tissue with the lipo. He would only decide to cut if the lipo didn't remove enough of the tissue. I'm concerned that if he removes all the fat first, then goes after the tissue, I'll have nothing covering the muscle, and be flat or cratered. Any thoughts?
Here is a post I put here on how to pick a gynecomastia surgeon:
http://www.gynecomastia.org/smf/index.php?topic=16474.0Many doctors still start with the fat, dig a hole for the gland which they then may remove some of the firmer tissue. However, I see just too many patients unhappy with such methods that I reversed the order of the surgery to target the gland first.
My sculpture has evolved over the years. Although a normal male chest will have a tiny amount of gland, it should not show when the areola muscles relax and in motion. A chest should look good beyond just a few still pictures. How it moves when playing sports, exercising, flexing are critical. It does not take much gland to distort the male chest. Residual gland and scar move like gland and scar, fat moves like fat. Check out this
Video of Residual Gland After Gynecomastia Surgery and how this firmer tissue moves. Watch how the chest then moves when this
large chunk of gland / scar is replaced by fat.
I prefer my
Dynamic Technique where, what I find during surgery helps guide what needs to be done.
When gland is present, and it usually is, I prefer to start with and target the gland first. By concentrating on gland, I target the tissue that compresses the least and reserve the remaining fat as a potential tool for my reconstruction.
Liposuction is fine for fat. However, all forms of liposuction
- sharp cutting cannula
- ultrasonic
- vasor
- power assisted
all preferentially remove fat over gland. Check out the
Normal Anatomy of Gynecomastia. When fingers of fat are between fingers of gland, liposuction alone tends to suck out the fat condensing the gland behind making a mess.
When significant gland is present, I start at the edge of the chest skin areola interface. That is a great place to fool the eye about a scar. Typically for normal gynecomastia, I need only one small incision on each side often about 1.6 cm (a little over 1/2 inch). This is much better than needing 4 incisions. Direct access to the gland gives me direct access to controlling hemostasis (bleeding). This is a major factor in minimizing
Bruising and Swelling with my Gynecomastia Surgery and why I can post such
Early Healing After Gynecomastia Surgery Pictures. Less swelling and bruising often results in greater
Comfort After Gynecomastia Surgery.
Liposuction is but one of many tools of my artist's palette for surgical sculpture of the male chest and gynecomastia.
My
Fat Flaps can bring fat into a defect left by targeting gland first. A flap is tissue moved
with a blood supply. Adjacent fat transferred with a blood supply tends to survive, much better than a graft. When carefully done, fat flaps tend to look like normal fat, feel like normal fat, and move like normal fat. There are limitations to what fat flaps offer since fat still connected to its blood vessels will move only so far.
Try to go through the entire section about male chest sculpture on my site to learn what my techniques of surgery have to offer.
When liposuction is used first, a hole is often dug in the fat making a "flat" contour. But the firmer gland does not compress like the fat causing distortion. In addition, techniques that target the gland remotely need to come at the gland from the gland edges and often leave
residual puffy nipples: a layer of gland under the areola that can look bad when the areola muscle relaxes and on animation.
Here are just a few of the many examples I have seen and treated:
Yes, there are many more examples of this technique on my website. Gland targeted first and almost all removed, the surrounding fat replacing that gland. I have never seen a crater deformity from my sculpture.
The technique does not stop in the operating room. Patient education, after surgery care,
Compression Garments,
Scar Care are but a few of the attention of detail that permits our patients to have maximum swelling at the time of surgery, quick recovery, and move on with their lives.
You will not find many of my patients on the forums to answer your questions. A few post but then disappear putting their gynecomastia behind them. However, there are many patients who have been willing to share
their gynecomastia surgery experiences on many pages of my website and in this forum. (Start at the first page and then follow the arrows).
But in the end, each surgeon has the methods he / she prefers. It is the result that counts. But that should be a result
- that a patient does not need to keep his arms down or not flex his muscles to hide deformity,
- a result that looks good from many different views and looks good even on animation while living life no longer hiding the chest with clothing,
- and a result that does not typically need so much bruising, swelling, and discomfort to get to the other side.
Hope this helps,
Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction
Topic: Ultrasound Lipo? (Read 2708 times)
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