power-assisted arthroscopic-endoscopic cartilage shaver

[CK]

Has anyone heard of this technique? From what I understand it doesn't call for cutting around the areolar.  Gynecomastia is the most common benign condition of the male breast. The authors present a new method of treatment for gynecomastia that combines traditional liposuction in conjunction with a shaver technique to effectively remove the fibrofatty and the glandular tissues of the male breast and avoid areolar incisions. Twenty-five patients were treated in this fashion, and each patient demonstrated a smooth, masculine breast contour with well-concealed scars in the inframammary folds, eliminating the stigma of breast surgery. The procedure is technically straightforward and provides consistent results. It is offered as an additional option for the treatment of gynecomastia.

[Dr. Elliot Jacobs]

There are a number of techniques and instruments (my own included) which are quite capable of removing breast tissue from under the nipple through a distant entry point.  Sometimes it is the instrument that works -- and many times it is the skill of the surgeon manipulating the instrument which is the determining factor.

There are many techniques that will yield excellent results -- not just one.  Each technique has its pros and cons -- speak about these at length wit your surgeon.  Oftentimes a surgeon who espouses only one incision around the areola has to make additional tiny cuts to facilitate liposuction of the chest.

Check your surgeon out carefully.

Dr Jacobs

[DrBermant]

Has anyone heard of this technique? From what I understand it doesn't call for cutting around the areolar.  Gynecomastia is the most common benign condition of the male breast. The authors present a new method of treatment for gynecomastia that combines traditional liposuction in conjunction with a shaver technique to effectively remove the fibrofatty and the glandular tissues of the male breast and avoid areolar incisions. Twenty-five patients were treated in this fashion, and each patient demonstrated a smooth, masculine breast contour with well-concealed scars in the inframammary folds, eliminating the stigma of breast surgery. The procedure is technically straightforward and provides consistent results. It is offered as an additional option for the treatment of gynecomastia.

Remote access for gynecomastia attempts have been available for quite some time. Endoscopic access requires a fairly long incision to get the scope / instruments into the patient. Patients complain about the under arm scars, their length, and how they show especially with the arms up playing basketball or volleyball.

Under Arm Incisions Require Sculpture from a remote location and depending on either liposuction or long fine cutting tools.  Some doctors may try the remote location first and then add additional scars by the areola.  I prefer to limit the scars on the surface and internally.  Two surface scars are much better than 4 or more. The color interface of the areola and chest is a great place to hide a scar. My typical at the edge of the areola is now typically 1.6 cm (0.6 inch) long. I can sometimes even improve another surgeon's scar by moving it to this interface as in this  Revision Gynecomastia Surgery.

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.

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.

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 remote instruments 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.

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.  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.  Scars to be considered include the sculpted tissues, yes the entire zone operated on.  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 Chest Sculpture