Liposuction and gland

[ddrop]

I had a liposuction and the doctor told me he managed to remove gland too with lipo only. Is this possible?? He told me he first inserted some liquid in the breast to make the gland softer and easier to get out with lipo?

[DrBermant]

I had a liposuction and the doctor told me he managed to remove gland too with lipo only. Is this possible?? He told me he first inserted some liquid in the breast to make the gland softer and easier to get out with lipo?

Tumescent Solution is for anesthesia and does not help remove gland.

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, power assisted, and sharp cutting cannula preferentially remove fat over gland.  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.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

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 incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients 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 flexing here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques. 

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.

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.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  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
Learn More About Gynecomastia and Male Breast Reduction

[ddrop]

Thx, so basicly it is possible to remove some gland with some techniques?
Because he claimed he did remove some of it. enough so it wouldnt cause an indent

[ddrop]

This is what my doctor basicly said on the lipo thing:

"The breast is first marked,then injected with a specia fluid which hardens the area and closes the blood vessels,then through two small incisions the excess tissue is removed with probes under negative pressure . It is necessary to use probes with a special type of opening,sometimes sharp,so harder glandular tissue can be removed too"
 
Care to comment??

[MSJ108]

My doc told me the same thing. "was able to remove gland with lipo only". I won't be able to confirm this until I recover a bit more. I had surgery Tuesday.

I hope it worked!!

[MSJ108]

My doc used lipo with saline to decrease bleeding. This common Doc?

[Dr. Elliot Jacobs]

Yes, in some circumstances, it is possible to remove gland tissue using liposuction instruments.  I have developed my own custom lipo instruments (cannulas) which are sharp and capable of removing gland in some, but not all, cases.

Thus, I start my cases with lipo and if successful, the patient has only a small nick in the skin.  If the tissue is much to dense, then I will perform excision in the standard way (through a small incision at the edge of the areola).

The solution that is injected is called tumescent fluid and consists of saline plus dilute adrenaline (to minimize bleeding) and lidocaine (to numb the tissues).  This is a standard procedure with any liposuction case, including gyne surgery.

Elliot Jacobs, MD, FACS

[MSJ108]

Yes, in some circumstances, it is possible to remove gland tissue using liposuction instruments.  I have developed my own custom lipo instruments (cannulas) which are sharp and capable of removing gland in some, but not all, cases.

Thus, I start my cases with lipo and if successful, the patient has only a small nick in the skin.  If the tissue is much to dense, then I will perform excision in the standard way (through a small incision at the edge of the areola).

The solution that is injected is called tumescent fluid and consists of saline plus dilute adrenaline (to minimize bleeding) and lidocaine (to numb the tissues).  This is a standard procedure with any liposuction case, including gyne surgery.

Elliot Jacobs, MD, FACS

Thanks Doc! You're the man!

[MSJ108]

Ok thanks Doctor Jacobs.. Well too bad my old doctor was a dumbass

I should have researched the subject a little more.. oh well
Hopefully my recent surgery will produce better results than the first one.

Good luck and keep us posted!

[lugg47]

It appears my surgeon did the same technique to me as Dr. Jacobs uses. I'm 5 weeks post op, and while the results are better, things still look pointy/puffy.

I know I'm at only 5 weeks, but with this technique, which did leave me with virtually no scar, will the pointy nipples evolve into a flat chest in the end?

I was told to wear tighter compression to speed the healing process. Dr. Jacobs has such successful results by looking at his before and after pictures. If he uses this technique and it works for him, maybe I can trust what my surgeon did. I thought I would be having excision only, but my surgeon changed his mind on the day of surgery to perform it by lipo fist, excision if needed.

Dr. Jacobs, when performing the liposuction only technique, do you see the puffiness remain for a while and then flatten out in your patients, or do you typically see a general flatness that gets better in time with the healing process?

[Dr. Elliot Jacobs]

Every patient is variable -- I have seen everything you have described is many of my patients. 

Best thing to do is trust your original surgeon and give it plenty of time to heal.  If, after a number of months, there are still concerns, then it should be addressed with your surgeon.

Many patients are impatient -- they want to see perfect results -- immediately.  That does not happen in the real world.  Therefore, best thing to do is choose your surgeon with care (make sure he has lots of experience with gyne surgery),  stick with him (or her), carefully follow your post op instructions, and be patient, patient and patient!

Dr Jacobs

[MSJ108]

Amen to what Dr. Jacobs said. I am 5 week post op and still feel hard tissue in small areas of my chest. Most of it has smoothed out but still some hard tissue which I assume is scar tissue and swelling. Hang in there and give it time.