I've just started to seriously look at surgery as a possibility and I read about gland removal versus lipo? I have really puffy nipples and I don't think I'm really overweight, so maybe I could go with just gland removal? I know I need to talk to a surgeon, but could someone give me some opinions how if and how bad I have gynecomastia.
You have subtle
Puffy Nipple Gynecomastia, the sculpture of which is an art form. Look for a surgeon with specific examples to find out their skill level with this art form.
Gland excision alone can result in a crater deformity. Many 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
- "smart"
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.
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: Gland removal or lipo? (Read 5855 times)
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