Lypo and Excision VS. Just Excision

[mannyman742]

The PS I saw today said he'd do lypo and excision, but the first surgeon I met with said he'd just do excision.  I'm torn here because I really liked the first surgeon, and he had more experience and does this procedure more frequently, and his price point is lower because he will just be performing gland removal.
I feel very good about both surgeons, but the one who wants lypo and excision only does one gynecomastia surgery per month. 
Should I get a third opinion?
Take a look at my pics, I don't know if you can evaluate from those if I need both lypo and excision.

[kanzoe23]

From my experience in doing the surgery and my own research i would go with lypo and excision. You can be smart and ask why would i need lypo wouldnt excision just be enough? . I dont know but i think you would need lypo with excision so you can contour the chest the right way .

[ellington7]

Your exactly right kanzo...

[MSJ108]

From my research, most are happy with incision and lypo.  However, you could ask the first ps "After you do the incision if you feel necessary would you be willing to do some lypo?"

[headheldhigh01]

lipo without excision doesn't work for some because a few docs think it's enough when it leaves too much tissue behind.  excision without lipo works well especially for denser gland cases, but as dr bermant pointed out recently the lipo might let you do a little extra reshaping. 

it's always going to be case by case for the individual. 

[DrBermant]

The PS I saw today said he'd do lypo and excision, but the first surgeon I met with said he'd just do excision.  I'm torn here because I really liked the first surgeon, and he had more experience and does this procedure more frequently, and his price point is lower because he will just be performing gland removal.
I feel very good about both surgeons, but the one who wants lypo and excision only does one gynecomastia surgery per month. 
Should I get a third opinion?
Take a look at my pics, I don't know if you can evaluate from those if I need both lypo and excision.

Experience can be a major factor in results.  I can work with up to 8 gynecomastia patients  a day.  Defining the problem with photographs sometimes can help.  However, it is impossible to tell from photographs if the deformity is from fat or gland. The dynamic images, of my standard set of images can show a region that compresses differently.  Even clinical examination differentiation can be difficult.

Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this Drawing of Gynecomastia Anatomy and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

I have seen many Crater Deformities After Gynecomastia Surgery from doctors who remove gland and not sculpt the remaining tissue. 

Very Large Glands can be removed from tiny incisions at the edge of the areola.  I have taken much larger glands from incisions that are typically less than 2 cm long. 

Gland left behind is firm unlike normal fat and does not compress like fat.  With my Dynamic Technique Male Chest Sculpture, I prefer to target this firmer gland first.  I then select from an Artist's Pallet of Surgical Tools Techniques to contour the remaining tissues.

Hope this helps,

Michael Bermant, MD
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