I just read this in a post "LIPO ONLY DOES NOT WORK"

[anon1234]

Lipo only can work -- if done by the right surgeon with the right instruments and with the right experience!  I have designed my own set of custom cannulas specifically to treat gyne -- they are sharp!  With them, I am able to remove both fat and gland in many patients -- but not all.  In about 50% of my patients, after doing the lipo, I find there is very dense gland remaining which my instruments cannot deal with.  It is then -- during surgery -- that I make the decision to do an excision and I never hesitate to do so if I feel it is indicated. 

There is no all or none in surgery -- every case is individual and one cannot tell by any type of physical examination (by the patient or by the surgeon) prior to surgery if lipo only will suffice or whether lipo and excision will be the answer.

The nice part of using my instruments is that in about 50% of the cases, I can perform the entire procedure with only a nick in the skin, which will heal to be a white blemish in six months or so.  If you can avoid a scar around the edge of the nipple, why not??

If you don't believe me, I have over 700 satisfied patients who will happily attest that it can be done!

Elliot Jacobs, MD

Hi Dr Jacobs,

I have made a previous post and got no reply so if can find the time to respond to my below question it would really be appreciated.

Have you ever seen any patients for gyne that have cellulite I believe I may have this as I have been told by a Dr after a scan that I mainly have fatty tissue, I am no overweight at the moment although have carried extra weight in the past. I feel hard lumps they are up to a couple of inches away from my nipple it seems they are not gland only thing I can think is that it is cellulite.

If you have seen this can the cellulite also be removed in any way?

Thanks

[Dr. Elliot Jacobs]

Cellulite is a non-medical term.  Some people term ANY fat deposit anywhere on the body as cellulite.  Others refer to the cottage cheese-like dimpling of the skin (usually the thighs on women) as cellulite.  I have never seen any man, thin or obese, with dimpling on the chest.  So I never use the term cellulite.

On any male chest, there can only be fat or breast tissue (and usually both in varying ratios).  I never send routine patients for a scan because it is the volume of tissue on the chest which bothers the patient. So it really doesn't matter whether you have fat, breast tissue or both -- we are going to remove everything in any case!  Let's face it, what counts is the final result and the goal of surgery is to provide a firm, flat, contoured, masculine chest.  In order to achieve this, I perform lipo, with or without nipple incision as needed, with the ultimate goal being a very thin and uniform pinch of skin and fat extending from the collar bone down to the rib cage below the breast.  I do not leave the operating room until I have achieved this goal!

To return to your question, obviously I haven't examined you so I can't tell what your "hard lumps" are.  But the bottom line is that with appropriate surgery, everything  (lumps and all) would be removed.

Elliot Jacobs, MD, FACS

[anon1234]

Cellulite is a non-medical term.  Some people term ANY fat deposit anywhere on the body as cellulite.  Others refer to the cottage cheese-like dimpling of the skin (usually the thighs on women) as cellulite.  I have never seen any man, thin or obese, with dimpling on the chest.  So I never use the term cellulite.

On any male chest, there can only be fat or breast tissue (and usually both in varying ratios).  I never send routine patients for a scan because it is the volume of tissue on the chest which bothers the patient. So it really doesn't matter whether you have fat, breast tissue or both -- we are going to remove everything in any case!  Let's face it, what counts is the final result and the goal of surgery is to provide a firm, flat, contoured, masculine chest.  In order to achieve this, I perform lipo, with or without nipple incision as needed, with the ultimate goal being a very thin and uniform pinch of skin and fat extending from the collar bone down to the rib cage below the breast.  I do not leave the operating room until I have achieved this goal!

To return to your question, obviously I haven't examined you so I can't tell what your "hard lumps" are.  But the bottom line is that with appropriate surgery, everything  (lumps and all) would be removed.

Elliot Jacobs, MD, FACS

Thanks for the quick response Doc.

I suppose I incorrectly used the term cellulite there as I don't have the dimpled skin appearance, I was actually referring to what feels like hard fat lumps that I understand from some internet research are what unltimately create the dimpled affect of cellulite.

A lot of what I have read indicates these lumps of fat(the ones that cause cellulite) are at layer 1 underneath the skin not layers 2 and 3 where liposuction works on. Therefore as liposuction does not work for cellulite I came to the conclusion that it would also not work on the lumps in my chest believing these are the same lumps that are the underlying cause for the dimpling affect of cellulite that is evident for some women.

Does that make any sense or am I jumping to conclusions?

Thanks again.

[Dr. Elliot Jacobs]

You are jumping to conclusions.  Lay people may talk about layer 1 or 2 in the skin -- this does not make medical sense.  Each layer of the skin, fat, etc has specific names.

Yes, it is true that sometimes fat can feel firm, but I do not know why you are so concerned about your lumps!  Fat of any type can be suctioned and fat on the chest is no exception.  Again, I haven't examined you but I think your conclusions are erroneous and your fears unjustified.  Just go to an experienced surgeon and I think you will have a fine outcome from surgery!

Elliot Jacobs, MD, FACS

[mmaman]

Hello Dr. Jacobs.  I have a few questions.  You say that you design your own set of cannulas.  Do you do that yourself?  If so...how?  I can see where the dispersed bits or strings of gland could be sucked through.  Are you making some sort of twisting circular motion or stabbing many tiny pieces and then sucking them through?  I am curious to know if you are aware of any other PS's who do this.  If not, would you say that lipo-only doesn't work unless you go to Dr. Jacobs?  Does it only work on people who seem to have large, fatty breasts?  It is very interesting because a small incision near the armpit would be much better than the half moon on the areola.       

[Dr. Elliot Jacobs]

Yes, I designed the cannulas myself and they are able to remove a fair amount of firm gland -- but not all the time.  Sometimes the tissue is just too dense and hard -- then I do have to make an incision around the edge of the areola.  My cannulas are available for sale by a medical company -- I own no patents and earn no royalties on the sale of the instruments.  I have donated the design so that any PS can buy them.  I wanted to make them available to help as many gyne patients as possible.  Therefore, I am not the only PS who can do lipo only.

However, and this is a big however, you can buy Picasso's paintbrush set but not be able to paint like Picasso.  There is talent, experience, skill, artistry, judgement and technique in the hands that wield the cannula -- and not all hands are alike.

Elliot Jacobs, MD, FACS

[mmaman]

thanks for clearing that up. i wonder why more surgeons don't use them. 

[anon1234]

You are jumping to conclusions.  Lay people may talk about layer 1 or 2 in the skin -- this does not make medical sense.  Each layer of the skin, fat, etc has specific names.

Yes, it is true that sometimes fat can feel firm, but I do not know why you are so concerned about your lumps!  Fat of any type can be suctioned and fat on the chest is no exception.  Again, I haven't examined you but I think your conclusions are erroneous and your fears unjustified.  Just go to an experienced surgeon and I think you will have a fine outcome from surgery!

Elliot Jacobs, MD, FACS

Thanks again for the response.

I have been to see a surgeon yesterday. He did not really seem to know exactly what the fat lumps a couple of inches away from the nipple were suggesting it was possibly breast tissue but did not seem to concerned about it. He said the way forward would be liposuction to get the fat and gland with some cutting at the end of the procedure from behind the nipple if required.

He did say however that there would be some lumps remaining and that he would approximate being able to remove 50% of the tissue on my chest advising maybe more maybe a bit less. He said the main goal was to reduce to peak and roundness to a more normal level. Whilst I agree with him and can understand exactly what he means by saying this I would have thought that all lumps and the required amount of fat could be removed, is this the case or is what he saying accurate?

Sorry to continue asking questions I don't live in a large city and access to a surgeon with your experience in gynecomastia surgery is not possible, to get a second opinion here I am having to wait until the end of May for my appointment. This surgeon does a lot of female breast reconstructive surgery and advised he does about 6 gynecomastia surgeries a year although that number he said was increasing.

Thanks again

[Dr. Elliot Jacobs]

The ultimate goal of gyne surgery is to provide a trim, contoured chest which reflects the size and shape of the underlying chest muscles.  Usually this requires there be only a thin layer of skin and fat covering the muscle.  Pinch the skin/fat layer just below the collar bone.  That is my goal for surgery:  the same uniform layer from the collarbone down to the lower rib cage (obviously including the nipple area) -- and I don't leave the operating room until I have accomplished this. 

However, this goal must be tempered with artistry -- this same thin layer would not look good on someone who is very heavy everywhere else.  In other words, the surgeon must match the results of the gyne surgery to the surrounding areas of the body.  This requires artistry and judgement and it should be discussed in detail with the patient prior to surgery.  In fact, it is very important that you discuss with your surgeon what can and cannot be accomplished through the proposed operation.  This, in essence, will avoid disappointment if you have been given a realistic idea of what to expect for the final outcome.

Elliot Jacobs, MD, FACS

[anon1234]

You are jumping to conclusions.  Lay people may talk about layer 1 or 2 in the skin -- this does not make medical sense.  Each layer of the skin, fat, etc has specific names.

Yes, it is true that sometimes fat can feel firm, but I do not know why you are so concerned about your lumps!  Fat of any type can be suctioned and fat on the chest is no exception.  Again, I haven't examined you but I think your conclusions are erroneous and your fears unjustified.  Just go to an experienced surgeon and I think you will have a fine outcome from surgery!

Elliot Jacobs, MD, FACS

Hi again Dr Jacobs,

You mentioned that any fat can be suctioned this being the case how come lipo is not an effective way to reduce the appearance of cellulite? My understanding it is ultimately fat that causes this look.

Thanks yet again

[Dr. Elliot Jacobs]

Your understanding is incorrect.

Cellulite, as reflected in the dimpled, cottage cheese appearance of the skin (frequently on women's thighs), is not due to the fat that is there but due to fibrous connections between the deeper tissues and the skin. These fibrous connections pull the skin down and create the "mattress button" type of appearance.  The fat between the fibrous connections is like any other fat and it can be suctioned out by any means but the fibrous connections remain.

There is a treatment for cellulite but it gets very technical and really doesn't pertain to gynecomastia.

Elliot Jacobs, MD, FACS

[GynO_DuDe]

Ive had lipo only and it worked ... but as the doc clearly said, it was using the 'special' cannula that also removes gland after its been broken up. Dr Levick performed this technique on me and im chuffed although just 80% but the other 20% of being unhappy is balanced out considering I have no permanent scars and in the future if it really, really bothers me, I can go back for a free revision but I doubt it.

[anon1234]

Thanks for the responses Dr Elliot they have really been appreciated, if I only I could get to North America to visit you for the surgery, being over here is Australia it would be just a little too expensive for me.