Possible alternative to the current surgical strategy

[Struggle]

I am no surgeon, but I have an idea for a different possible surgical procedure. In the case of a gynecomastia per se (i.e., glandular gynecomastia), the gland is maintained alive by one or many blood vessel(s) nourishing it. Thus, cutting this or these blood vessel(s) would cause the gland to starve to death and dry, so to say, which would probably decrease its size back to the size of undeveloped mammary glands. Cutting the blood vessel would require an incision much smaller than the actual incision under the aerola. In fact, it would require, I believe, an incision no wider than a centimeter. And in cases where the gynecomastia is accompanied with a fat build-up, the same incision could be used to insert the liposuction tool. I think the reason why most guys hesitate to undergo the surgery (besides money) is because they are afraid the scar will show and they will be identified as someone who had man boobs, but if such a procedure were possible there would be no significant scaring. I would be very interested in hearing feedback from a surgeon about this.

[Paa_Paw]

I would be afraid that the necrotic (dead) tissue would simply be filled in with scar tissue which would actually be more firm than the pre-existing gland. There is also the possibility of killing off more tissue than would be desired creating a cavity deformity. Either way the result would not be very satisfactory.

That is just a guess though and I too would be interested in what the surgeons might have to say about this.

[Struggle]

I found a representation of a mammary gland with the veins connecting it the circulatory system, and if the image represents things accurately there seems to be too many ramifications for my previous idea to be possible.

http://www.scielo.cl/fbpe/img/ijmorphol/v24n4/fig30-05.jpg

This raises the question of what happens with these veins in the case of the standard procedure.

[headheldhigh01]

nice try, but almost certainly not.  first, i think necrotic tissue would be vulnerable to internal infection.  second, i don't think it's going to dry up in an osmotically pressured environment.  third, any mass reduction would not be significant.  fourth, the small incision's all you'd need for a lipo or pal anyway.  but most important, see #1. 

[KE25]

I am no surgeon, but I have an idea for a different possible surgical procedure. In the case of a gynecomastia per se (i.e., glandular gynecomastia), the gland is maintained alive by one or many blood vessel(s) nourishing it. Thus, cutting this or these blood vessel(s) would cause the gland to starve to death and dry, so to say, which would probably decrease its size back to the size of undeveloped mammary glands. Cutting the blood vessel would require an incision much smaller than the actual incision under the aerola. In fact, it would require, I believe, an incision no wider than a centimeter. And in cases where the gynecomastia is accompanied with a fat build-up, the same incision could be used to insert the liposuction tool. I think the reason why most guys hesitate to undergo the surgery (besides money) is because they are afraid the scar will show and they will be identified as someone who had man boobs, but if such a procedure were possible there would be no significant scaring. I would be very interested in hearing feedback from a surgeon about this.

I never finished med school but I guess there are several issues with the idea. Starting with the simple question on how to find the appropriate blood vessels. That is highly individual and would probably create more of a mess that a simple incision to get the gland and fatty tissue out cleanly.

However, alternative surgical approaches sound interesting to me. Whatever happened to the idea of an endoscopic intervention coming in from under the arm pits? I think this was tried somewhere. Was it in Israel?

[postiey]

just wanted to add my bit! i truely cant believe the only means to fixin this problem was this type of surgery. i know sounds dumb but what about some special formula injeted into the gland wich would shrink it. there must be some sort of drug formula . but i know, i know! side effects! side effects!
as u can tell i am no doctor hahah. surgery it is then  >:

[Struggle]

Good idea Postiey. They use drugs now in alternative cancer therapy, such as Temozolomide (Temodar) and Caesium Chloride, to shrink certain cancer tumors. Both compounds, apparently, have the property of fragmenting the DNA of the tissue in which they are injected. Could such drug, or a similar compound, be injected (once or a certain number times) in the gland to shrink it in an analogous fashion?

One seemingly possible challenge would be to limit its effect to the gland and to prevent it from being efficient on the surrounding muscles. But if this is not a problem with tumors, then this shouldn't be a problem with the glands neither (I guess). Mammary glands and tumors seem to have a similar structure, at least at the mesoscopic/phenomenal level. Compare the inner structure of mammary glands with:

http://www.pathology.washington.edu/about/education/gallery/jpgs575/spd/img0037.jpg

http://www.math.princeton.edu/~jgevertz/tumor_originalCA.jpg

From what I have read, it takes an average of two weeks for the above mentioned compounds to do all the reduction they can do. Perhaps some draining would be necessary after that time and the liposuction could be done together with the draining (another guess). On Caesium Chloride and Temozolomide, see:

http://en.wikipedia.org/wiki/Caesium_chloride

http://en.wikipedia.org/wiki/Temozolomide

Of course, this would no more be surgery, but would fall under the heading of chemotherapy in the wide sense of the word. So I guess that a surgeon would not be entirely qualified to evaluate the idea. Someone more qualified perhaps would be a chemotherapist specialized in breast cancer.

[Dr. Elliot Jacobs]

Intriguing idea -- except it won't work.  There are just too many blood vessels to consider.  Chemo is a bit over the top for a simple, benign condition.  And dead tissue may shrink but not disappear -- you will have residual scar tissue and possible infections.

Finally, the one centimeter scar is actually larger than the 3millimeter incision that I use on the side of the chest.  If indeed a peri-areolar incision is needed to complete the removal of dense breast tissue, then only a slightly larger two centimeter incision is used -- and if it is stitched right, it will heal to be virtually invisible.

Gyne surgery has come a long way and is now safer and more effective than ever before.  Why try to make it less safe and more complicated?

Dr Jacobs

[DrBermant]

I am no surgeon, but I have an idea for a different possible surgical procedure. In the case of a gynecomastia per se (i.e., glandular gynecomastia), the gland is maintained alive by one or many blood vessel(s) nourishing it. Thus, cutting this or these blood vessel(s) would cause the gland to starve to death and dry, so to say, which would probably decrease its size back to the size of undeveloped mammary glands. Cutting the blood vessel would require an incision much smaller than the actual incision under the aerola. In fact, it would require, I believe, an incision no wider than a centimeter. And in cases where the gynecomastia is accompanied with a fat build-up, the same incision could be used to insert the liposuction tool. I think the reason why most guys hesitate to undergo the surgery (besides money) is because they are afraid the scar will show and they will be identified as someone who had man boobs, but if such a procedure were possible there would be no significant scaring. I would be very interested in hearing feedback from a surgeon about this.

I would be afraid that the necrotic (dead) tissue would simply be filled in with scar tissue which would actually be more firm than the pre-existing gland. There is also the possibility of killing off more tissue than would be desired creating a cavity deformity. Either way the result would not be very satisfactory.

That is just a guess though and I too would be interested in what the surgeons might have to say about this.

Paa_Paw, you are right on target.  The blood supply to the gland is quite diffuse, vessels attach from all around.  This includes the skin, sides, and bottom.  By the time you reached all the vessels, the dissection would resemble what I currently do during my Gland Dissection which is usually through an incision at the edge of the areola less than 1.6 cm in length (one incision not 2 for each side).

Leaving the dead tissue behind means that the body would need to deal with it.  Infection, scarring, Crater Deformity Complication are among the many possible messes that would ensue.

Scars at the edge of the areola hide very well as you can see in the many Before And After Gynecomastia Surgery Picture Galleries posted on my website. My patients often tell me that they cannot see the scar. I used to tell each patient that I could see the scar for every one of my patients, but now sometimes I cannot even find it!

Some surgeons offer breast augmentation through an incision by the belly button just to avoid a scar on the surface near the breast.  However, the tissues between the remote access site and the breast are just not acceptable, especially on animation.  Just because it can be done, does not mean it should be done that way.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[KE25]

Good idea Postiey. They use drugs now in alternative cancer therapy, such as Temozolomide (Temodar) and Caesium Chloride, to shrink certain cancer tumors. Both compounds, apparently, have the property of fragmenting the DNA of the tissue in which they are injected. Could such drug, or a similar compound, be injected (once or a certain number times) in the gland to shrink it in an analogous fashion?

One seemingly possible challenge would be to limit its effect to the gland and to prevent it from being efficient on the surrounding muscles. But if this is not a problem with tumors, then this shouldn't be a problem with the glands neither (I guess). Mammary glands and tumors seem to have a similar structure, at least at the mesoscopic/phenomenal level. Compare the inner structure of mammary glands with:

http://www.pathology.washington.edu/about/education/gallery/jpgs575/spd/img0037.jpg

http://www.math.princeton.edu/~jgevertz/tumor_originalCA.jpg

From what I have read, it takes an average of two weeks for the above mentioned compounds to do all the reduction they can do. Perhaps some draining would be necessary after that time and the liposuction could be done together with the draining (another guess). On Caesium Chloride and Temozolomide, see:

http://en.wikipedia.org/wiki/Caesium_chloride

http://en.wikipedia.org/wiki/Temozolomide

Of course, this would no more be surgery, but would fall under the heading of chemotherapy in the wide sense of the word. So I guess that a surgeon would not be entirely qualified to evaluate the idea. Someone more qualified perhaps would be a chemotherapist specialized in breast cancer.

And as some one who works for a cancer treatment facility I may add that such drugs tend to be extremely expensive. And this would also enter deeply into the realm of off-label use for which you would probably not find any ine to actually administer it even if it worked.