Lipo or removal

[jizz]

I wanted to ask that, considering surgery, which is better Liposuction, or complete gland removal???

Also which one is cheaper option???

[Litlriki]

Surgery to correct gynecomastia must address the condition, which is different from patient to patient.  In some individuals, the problem is only fat, and in those patients, liposuction alone is effective.  In many patients, however, there is also a glandular component, and the condition will not be adequately treated if only liposuction is used.  In such instances, the nipple will still appear prominent, possibly puffy, and the result will be incomplete.  Many times, it's possible to tell from the initial evaluation or from the history if gland removal will be required.  Patients with puffy nipples, steroid users, and patients in whom a lump can be felt will require a combination of liposuction and excision of the gland.  In patients where there is uncertainty, it becomes obvious after the initial liposuction is performed, and then a short incision can be made along the edge of the areola to remove the residual fibro-fatty "gland" that can't be suctioned out. 

I'm not sure how other surgeons structure their charges, but in my practice, there is no price difference for the surgery, except in patients where skin removal is also required, in which case the charge may be slightly higher.

Rick Silverman

[DrBermant]

I wanted to ask that, considering surgery, which is better Liposuction, or complete gland removal???

Also which one is cheaper option???

Each doctor has the technique they prefer. No surgery can offer complete gland removal. Shreds of gland can remain behind even with disfiguring radical removal methods.  Gland removal alone without other contouring methods can result in a Crater Deformity Defect after Gynecomastia Surgery.

Many doctors prefer to start with the fat. However, I see just too many patients unhappy with such methods that I reversed the order of the surgery to target the gland first.

My sculpture has evolved over the years. Although a normal male chest will have a tiny amount of gland, it should not show when the areola muscles relax and in motion. A chest should look good beyond just a few still pictures. How it moves when playing sports, exercising, flexing are critical.  It does not take much gland to distort the male chest. Residual gland and scar move like gland and scar, fat moves like fat. Check out this Video of Residual Gland After Gynecomastia Surgery and how this firmer tissue moves.  Watch how the chest then moves when this large chunk of gland / scar is replaced by fat.

I prefer my Dynamic Technique where, what I find during surgery helps guide what needs to be done.

When gland is present, and it usually is, I prefer to start with and target the gland first. By concentrating on gland, I target the tissue that compresses the least and reserve the remaining fat as a potential tool for my reconstruction. 

When the gland component is very small / trivial, liposuction alone can handle the contouring. Liposuction is fine for fat.  However, all forms of liposuction

• sharp cutting cannula (and there are many different ones out there)
• ultrasonic
• vasor
• power assisted

all preferentially remove fat over gland.  Check out the Normal Anatomy of Gynecomastia.  When fingers of fat are between fingers of gland, liposuction preferentially goes after the fat, it is the softer structure, and condenses  the gland behind making a firmer mass. 

When significant gland is present, I start at the edge of the chest skin areola interface. That is a great place to fool the eye about a scar. Typically for normal gynecomastia, I need only one small incision on each side often about 1.6 cm (a little over 1/2 inch). This is much better than needing 4 incisions.  Direct access to the gland gives me direct access to controlling hemostasis (bleeding). This is a major factor in minimizing Bruising and Swelling with my Gynecomastia Surgery and why I can post such Early Healing After Gynecomastia Surgery Pictures.  Less swelling and bruising often results in greater Comfort After Gynecomastia Surgery.

Liposuction is but one of many tools of my artist's palette for surgical sculpture of the male chest and gynecomastia.

• Excision,
• Liposuction,
• Microliposuction,
• Nipple Sculpture,
• Mastopexy Male Chest Lift,
• Skin Reduction,
• and other techniques.

Fat Flaps can bring fat into a defect left by targeting gland first.  A flap is tissue moved with a blood supply.  Adjacent fat transferred with a blood supply tends to survive, much better than a graft.  When carefully done, fat flaps tend to look like normal fat, feel like normal fat, and move like normal fat.  There are limitations to what fat flaps offer since fat still connected to its blood vessels will move only so far.

When liposuction is used first, a hole is often dug in the fat making a "flat" contour.  But the firmer gland does not compress like the fat causing distortion. In addition, techniques that target the gland remotely need to come at the gland from the gland edges and often leave residual puffy nipples: a layer of gland under the areola that can look bad when the areola muscle relaxes and on animation.

Here are just a few of the many examples I have seen and treated:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

A surgeon's technique does not stop in the operating room.  Patient education, after surgery care, Compression Garments, Scar Care are but a few of the attention of detail that permits patients to have maximum swelling at the time of surgery, quick recovery, and move on with their lives. 

But in the end, each surgeon has the methods he / she prefers. It is the result that counts. But that should be a result

• that a patient does not need to keep his arms down or not flex his muscles to hide deformity,
• a result that looks good from many different views and looks good even on animation while living life no longer hiding the chest with clothing,
• and a result that does not typically need so much bruising, swelling, and discomfort to get to the other side.

Hope this helps,

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

[Dr. Elliot Jacobs]

I wanted to ask that, considering surgery, which is better Liposuction, or complete gland removal???

Also which one is cheaper option???

Why go for cheap?  That doesn't make sense. If you do go in for surgery, your should pick and choose your surgeon carefully.  And any surgeon worth his socks will be prepared to do anything necessary, lipo, excision or usually both, to obtain the very best result during your operation.

I never break down my fees for lipo only or excision only -- I provide a fee for my patients which reflects all the surgery necessary to get the very best result possible.

You should only go to a surgeon who promises to do the same -- otherwise you are setting yourself up for a potential second operation to clean up the first one.

BTW, there are various methods, techniques, surgical approaches to treat this problem -- they all work.  Do not be swayed to think that there is only one way to do the procedure.  What counts is the final result -- not the road by which the result was obtained.

Dr Jacobs