Vaser Gynecomastia surgery

[rex]

Hello,

I am wondering if anyone has had the gynecomastia surgery using the vaser technique?
I have done extensive research on the topic and just came across this technique.  I have seen a couple of videos on
youtube demonstrating the procedure and it promises to be a scar less procedure.  There is a video of a doctor explaining
that with this vaser technique there is no need to do an incision under the nipple.  All of the fatty and glandular tissue can
be removed from the same incision, which is usually done under the pec, not nipple.   Also, the advantages of this procedure
are said to be:  less recovery time, more of a sculpting/definition end feel, and no scars.  Also it can be done via local anasthetic.
Has anyone had this done in Chicago?  if so, can you recommend a surgeon who uses this technique.
Also, if there are doctors reading this, can I get your opinion on this?
A bit about my self:
In mid twenties, am 5'8" and weigh approx 142 lbs.  so im in pretty good shape.
I work out at least 3 times a week, and keep very active, have tone and definition all around, but the chest area.
On a scale of one to ten, (ten being the most severe case) i would probably say im a 4 on one side and a 3 on the other and
i dont have puffy nips or large nips.  they are fairly small/normal, which is one reason I do not want to have an incision on the lower
side of my nipple.  I have read too many iffy stories about nipples being damaged or unsightly.  Thank you and i really look forward to replies!

[headheldhigh01]

use the site search engine, you'll find some stuff.  

right now i think you're headed in the direction of the many who've been seriously disappointed by not having the excision option.  think of gyne as a thick balloon.  if you deflate it, even if it goes down by 80-90%, you're still going to have a mass left over that's going to make you unsatisfied, AND you'll probably have more extensive scarring that won't go away soon.  some salesman sells a ps who doesn't do that many cases a month or year a system that requires less skill, and they believe the marketing hype themselves, but it never takes out as much gland as they claim.  ask him if he so stands behind this that he swears if you have to do it again at YOUR option that he will pay everything and you won't have to pay one single cent, and watch the hedging begin.  

don't be sold by fancy-a** marketing names that sound like laser, or technical like p.a.l., because they're not going to do enough vaporizing to leave you happy with the results.  an incision on the areola won't leave a really visible scar and will give you far better results.   find somebody who's capable of better than just waving a cannula around.  

[desi]

lipo alone cannot suck the gland out, in fact, the gland has to cut (excised) out, you need to go for excision + liposuction .... all lipo techniques target fat, not the gland!

[DrBermant]

Hello,

I am wondering if anyone has had the gynecomastia surgery using the vaser technique?
I have done extensive research on the topic and just came across this technique.  I have seen a couple of videos on
youtube demonstrating the procedure and it promises to be a scar less procedure.  There is a video of a doctor explaining
that with this vaser technique there is no need to do an incision under the nipple.  All of the fatty and glandular tissue can
be removed from the same incision, which is usually done under the pec, not nipple.   Also, the advantages of this procedure
are said to be:  less recovery time, more of a sculpting/definition end feel, and no scars.  Also it can be done via local anasthetic.
Has anyone had this done in Chicago?  if so, can you recommend a surgeon who uses this technique.
Also, if there are doctors reading this, can I get your opinion on this?
A bit about my self:
In mid twenties, am 5'8" and weigh approx 142 lbs.  so im in pretty good shape.
I work out at least 3 times a week, and keep very active, have tone and definition all around, but the chest area.
On a scale of one to ten, (ten being the most severe case) i would probably say im a 4 on one side and a 3 on the other and
i dont have puffy nips or large nips.  they are fairly small/normal, which is one reason I do not want to have an incision on the lower
side of my nipple.  I have read too many iffy stories about nipples being damaged or unsightly.  Thank you and i really look forward to replies!

I have seen patients unhappy from many doctors who used Vaser for male breast reduction. Some of these patients were even from doctors who wrote some of literature that Vaser works for gynecomastia!  It is interesting how using only a few select photographic angles, suboptimal results can be hidden. 

As for the periareola scars, the areola chest skin junction is a great place to hide a scar.  What is on my website are typical examples of my patients' scars. I used to tell my patients, I could see the scars for each of my patients (although patients have told me they cannot see the scars.) For the last few years, some of the patients have come back that even I cannot see the scars.

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite some 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 tumescent 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.

I have seen just too many unhappy patients with puffy nipples remaining after axilla or armpit attempts alone using sharp cutting cannula or other such instruments by other doctors.  Check out this drawing of Puffy Nipple Anatomy after Remote Gland Removal Drawing.

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 prefer to avoid this unnecessary additional scar.

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 flexion 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 a liposuction cannula 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.

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, Ultrasonic, nor sharp cutting cannula 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 aboutGynecomastia and Chest Sculpture

[Dr. Elliot Jacobs]

Quite simply, vaser liposuction is marketed to make liposuction (removal of FAT) better/easier/faster/safer.  I don't agree with all of that.  But nowhere is vaser purported to remove breast (gland) tissue.

If you have gyne, I'll bet a certain proportion of it is gland -- and if vaser is used alone, you may join the line of men seeking a revision operation.

I have no problem, however, if the vaser is used in conjunction with direct gland excision.

As far as scar location, agree with Dr Bermant -- the scar at the edge of the areola heals extremely well and in some cases, can become undetectable.

Dr Jacobs

[DrBermant]

Unfortunately some do claim Vaser and ultrasonic liposuction will manage the gland component. Just perform a search in google:

http://www.google.com/#hl=en&source=hp&q=vaser+gynecomastia

A search in the medical literature also unfortunately shows those advocating Vaser alone techniques.  I have actually seen several unhappy patients from authors of such articles and many patients unhappy with liposuction alone techniques.

Hope this helps,

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

[rex]

Thank you for all of the great Info!

I still have a couple of questions...

From all that i have read on this forum and elsewhere, I get the sense that most men have and can feel
hard, glandular tissue right behind the nipples, that is not my case really.  I dont seem to have a localized feel
of a gland(s) on either side.  but at the same time, im pretty thin, so i dont really have much fat either...
from videos i have seen of the procedure, when the doctor takes out the glandular tissue, it seems like a small
ball shaped gland that happens to be right behind the nipple.   i feel like i have a thin layer of gland evenly throughout
the pecs, not just behind the nipple.  how would the doctors perform that? 

what would be your recommendation?

Is there anywhere else the incision can go aside from below/around the nipple and still have the same effects?
Im still a bit skeptical about the incision going around the nipple.

Thank you to all

[Dr. Elliot Jacobs]

The shape and amount and firmness of gland tissue varies from man to man.  Some gland may be firm -- or it may be soft.  And vice versa for fat.  Even experienced hands like my own can sometimes not be sure.  And many times the gland will spread beyond the areolar margin itself.

Self-diagnosis is never a good idea.

Best advice:  consult an experienced gynecomastia surgeon and let him guide you as to the right coure of treatment.

And as for a scar at the edge of the areola -- believe me, it can heal extremely well -- so much so that at times, I cannot find the scars I have left on my own patients.  Be reassured.

Dr Jacobs

[DrBermant]

Thank you for all of the great Info!

I still have a couple of questions...

From all that i have read on this forum and elsewhere, I get the sense that most men have and can feel
hard, glandular tissue right behind the nipples, that is not my case really.  I dont seem to have a localized feel
of a gland(s) on either side.  but at the same time, im pretty thin, so i dont really have much fat either...
from videos i have seen of the procedure, when the doctor takes out the glandular tissue, it seems like a small
ball shaped gland that happens to be right behind the nipple.   i feel like i have a thin layer of gland evenly throughout
the pecs, not just behind the nipple.  how would the doctors perform that? 

what would be your recommendation?

Is there anywhere else the incision can go aside from below/around the nipple and still have the same effects?
Im still a bit skeptical about the incision going around the nipple.

Thank you to all

All male mammals have some gland in their breasts.  It is a function of the definition of being a mammal.  For almost all, the amount of gland is very small.  Gynecomastia comes in different degrees: from a tiny puffy nipple to a massive breasts. It does not take much to interfere with the cut look of a bodybuilder or athlete.   The shape of the Gland of Gynecomastia can vary widely from patient to patient and even from side to side.  This is in a slide show format.  You can slow down, speed up, and activate a navigation panel. Each image links to pages of further details about that patient, his problem, and his surgery. 

Gynecomastia Examination by feeling alone can be misleading. Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this Puffy Nipple 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.

That is why I evolved my Dynamic Technique, to target the Gland First and then use remaining tissues to sculpt the chest.

Gynecomastia comes in many different forms.  Check out my Gynecomastia Gallery where you can view before and after pictures of gynecomastia and the changes with surgery.

Take your time to view the various degrees of male breast enlargement. There are additional Gynecomastia Gallery Links on that page.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture