The doctor I'm considering is using Vasar to do the surgery and I'm unsure of its effectiveness, apparently its a pretty new procedure. I just wanted to ask the great doctors on here if this would be effective in clearing up my case, can I request he just keep it old school and do lipo and gland excision or should I put off surgery and save up and head to NYC from Texas. Thanks in advance for the solid advice.
PS, has anyone on here had their surgery done with Vasar and if so, how did it go? Let me know.
Liposuction Is Great for Sculpting FatSharp cutting cannula have been around since the beginning of liposuction. There have been many variations on sharp cutting liposuction cannula for decades. Various types of ultrasonic and power assisted liposuction (UAL and PAL) have also been around for quite some time. Newer hyped techniques include VASER and "Smart Liposuction." Each surgeon uses the tools and techniques he / she prefers.
In evaluating any particular technique, it is a question of what the final results looks like and the path needed to get there. Swelling, bruising,
comfort after surgery, also can be important factors in choice of surgical technique. Results should look good while living life, not just in a still photograph.
Liposuction is great for fat, but does not do well for gland at all. I have yet to find any literature where the removed tissue was analyzed for gland component in the liposuction aspirate. This material is thrown away. As shown in the
Anatomy of Gynecomastia,, gland tends to exist under the nipple areola region. When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind. On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.
Puffy Nipple Contour After Gynecomastia Surgery ComplicationLiposuction no matter what technique (sharp cutting cannula, specially designed cannula, ultrasonic, laser, or "smart") targets the fat first. Remove the fat and the gland remains behind condensing the fingers making a firm mass. Even if the doctor achieves a flatter chest, that firm mass does not look like fat, move like fat, or compress like fat. Condensed remaining gland dug into a hole of the fat just does not move like the surrounding fat. That is why few doctors will show results with chest muscles tightened or arms up over the head or movies showing the tissues in motion. Check how each result looks from multiple angles. Be especially careful when only one or 2 views are shown for a patient and the particular view changes from example to example. Residual gland can also show up as puffy nipple contour problems when the areola muscle relaxes in warm temperatures.
When gynecomastia is from fat, liposuction works very well for contouring the chest. I have seen many patients for
Revision Gynecomastia Chest Surgery unhappy after other doctors tried to use liposuction alone techniques that left gland behind that the patients just did not like. Here are examples of some of the many patients I have seen who came to me complaining of:
all after other surgeons' work. I have recently reviewed over 600 requests for help after gynecomastia surgery done elsewhere over the past few years. I have seen many many other patients unhappy after contouring from other doctors who claimed that their liposuction alone was enough to manage the gynecomastia.
Gland removal by any technique can still leave a depression when a major part of the problem is from gland. For gland removal, I prefer the greater precision of removal under direct visualization and feel. The problem is picking the right method for what actually is that patient's problem. That is why I prefer my
Dynamic Technique that permits what I find during surgery to guide my sculpture. The tiny incision at the edge of the areola opens up my entire spectrum of artist's pallet of tools for my sculpture. The hallmark of this technique is to start with the firmer gland first, not the fat. The fat then remains as a potential resource for shaping a natural looking chest. This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat with my artistic palette of surgical sculpture.
A remote incision robs me of many options and just does not looks as nice.Under Arm Incisions Require Sculpture from a remote location and depending on either liposuction or long fine cutting tools. Some doctors may try the remote location first and then add additional scars by the areola. One small scar hidden at the edge of the areola is better than longer scars or having 2 or more incisions on each side. I prefer to limit the scars on the surface and internally. I have also seen patients with channel problems between remote access sites and the areola / nipple. Scars, adhesion, and depressions can look terrible. Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexing
Revision Gynecomastia Complication to see what I mean.
For a liposuction cannula or remote cutting instrument to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars. I have seen so many patients who were unhappy from doctors that used special cannula to remove gland, that I just prefer to go directly to the problem itself. Primary surgery is usually better than needing a revision. All male breasts have gland. With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour. This is how I achieve such limited
Bruising and Swelling After Gynecomastia Surgery. Not all doctors will show such early results, but you can find some here in this forum.
As any artist, I take my cannula selection
very seriously and have evolved what permits me to achieve my results. I have considered and evaluated many, many technologies. The many different types of cannula I use have their own advantages and qualities. I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see. I like the much better control I get with my cannula selection and personally I do not like either ultrasonic, power assisted, nor sharp cutting cannula techniques. None of the cases on my website used either PAL, Ultrasonic, nor sharp cutting cannula techniques.
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. 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
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