Anyone heard of a special cannula that makes traditional excision obsolete?

[Raider Fan]

The following message is on the website of a doctor in my area.  He has been on CNN and Oprah, and is supposed to be a well respected plastic surgeon in the Dallas, TX area.  See here...

http://www.yourlooks.com/more_about.html

Just wondering what the other doctors think about this "special cannula" Dr. Hamas and another Dr. in Australia developed.  I know traditional excision is preferred by the doctors here, but have you heard of this special cannula and how successful is it?  Is it best to stay away from someone that doesn't use traditional tissue excision?  He says surgical excision is essentially old hat and rarely used today.  Why would a leading plastic surgeon say such a thing? 

Here's the website...

http://www.yourlooks.com/breast_reduction_men.html

And here's the part talking about the special cannula.....

How are men’s breasts reduced?

In the past, prominent breasts were usually treated by surgical excision. An incision around the lower edge of the areola (the pigmented area around the nipple) was sometimes extended onto the chest. Because of the nature of this method, often there were irregularities and noticeable scars. It is rarely used today.

A typical blunt-tipped liposuction cannula is effective for thinning body fat layers, but not men’s breasts. This is because the blunt tip cannot penetrate dense, fibrous breast tissue. If a man’s breasts are mostly composed of fatty tissues, this technique may be somewhat effective, but it can not remove the fibrous glandular tissue component.

Ultrasonic liposuction (UAL) destroys fat cells within fibrous glandular tissue, but it is not very effective for removing the fibrous glandular tissue itself. This technique has the potential risks of skin burns and fluid accumulations and needs a larger incision.

A new liposuction technique involves a special sharp cannula specifically designed for reducing men’s prominent breasts. It is far more effective than a blunt cannula and does not have the risks and limitations of ultrasonic liposuction.

I developed this new gynecomastia cannula a few years ago with a plastic surgeon in Australia. It is now used by a large number of plastic surgeons and our technique was recently selected for inclusion in The Year Book of Plastic, Reconstructive and Aesthetic Surgery.

Through tiny incisions, this special liposuction cannula easily removes the dense, fibrous glandular tissue, along with the breast fat, to fully reduce all components of the prominent breast tissue. During the procedure, care is taken to be sure that the resulting contours are as smooth, even and symmetrical as humanly possible.

[Dr. Elliot Jacobs]

Yes, there are special, sharper cannulas around -- which DO remove both fat AND gland.  I designed my own such cannula about ten years ago and it works extremely well -- often allowing me to perform the entire procedure through a small 1/8 inch incision on the side of the chest near the armpit.  However, sometimes, even my cannula will not work -- when I encounter extremely dense breast tissue.

It is at those times that I proceed to perform an excision.  This staged technique allows me to perform many gyne procedures with just a small hidden nick in the lateral chest skin and no areolar incision.  For those instances when I do encounter very dense breast tissue, I will then proceed to make a peri-areolar incision. 

I am sure the doctors in Texas do it the same way.

Dr Jacobs

[DrBermant]

Just wondering what the other doctors think about this "special cannula" Dr. Hamas and another Dr. in Australia developed.  I know traditional excision is preferred by the doctors here, but have you heard of this special cannula and how successful is it?  Is it best to stay away from someone that doesn't use traditional tissue excision?  He says surgical excision is essentially old hat and rarely used today.  Why would a leading plastic surgeon say such a thing? 

You can Search this forum this forum to find other patients experiences with a particular doctor. Put that name in the search field.

Liposuction Is Great for Sculpting Fat
Sharp cutting cannula have been around since the beginning of liposuction. There have been many variations on sharp cutting liposuction cannula for decades. Various types of ultrasonic and power assisted liposuction (UAL and PAL) have also been around for quite some time.  Newer hyped techniques include VASER and "Smart Liposuction." Each surgeon uses the tools and techniques he / she prefers.

In evaluating any particular technique, it is a question of what the final results looks like and the path needed to get there. Swelling, bruising, comfort after surgery, also can be important factors in choice of surgical technique. Results should look good while living life, not just in a still photograph.

Liposuction is great for fat, but does not do well for gland at all.  As shown in the Anatomy of Gynecomastia,, 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. Liposuction no matter what technique (sharp cutting cannula, specially designed cannula, ultrasonic, laser, or "smart") targets the fat first.  Remove the fat and the gland remains behind condensing the fingers making a firm mass.  Even if the doctor achieves a flatter chest, that firm mass does not look like fat, move like fat, or compress like fat. Condensed remaining gland dug into a hole of the fat just does not move like the surrounding fat. That is why few doctors will show results with chest muscles tightened or arms up over the head or movies showing the tissues in motion.  Check how each result looks from multiple angles. Be especially careful when only one or 2 views are shown for a patient and the particular view changes from example to example. Residual gland can also show up as puffy nipple contour problems when the areola muscle relaxes in warm temperatures.

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 Surgery. Here are examples of some of the many patients I have seen who came to me complaining of:

• Residual Gynecomastia after Liposuction Alone
• Revision Puffy Nipples after Liposuction Alone
• Redo Surgery for Remaining Gland after Liposuction

all after other surgeons' work. I have seen many many other patients unhappy after contouring from other doctors who claimed that their liposuction alone was enough to manage the gynecomastia.

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. 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 tiny incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture. The hallmark of this technique is to start with the firmer gland first, not the fat. The fat then remains as a potential resource for shaping a natural looking chest. This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat with my artistic palette of surgical sculpture.

A remote incision robs me of many options and just does not looks as nice.
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. One small scar hidden at the edge of the areola is better than longer scars or having 2 or more incisions on each side. I prefer to limit the scars on the surface and internally. I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesion, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexing Revision Gynecomastia Complication to see what I mean.

For a liposuction cannula or remote cutting instrument 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.  This is how I achieve such limited Bruising and Swelling After Gynecomastia Surgery. Not all doctors will show such early results, but you can find some here in this forum.

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. I like the much better control I get with my cannula selection and personally I do not like either ultrasonic, power assisted, nor sharp cutting cannula techniques.  None of the cases on my website used either PAL, Ultrasonic, nor sharp cutting cannula techniques. 

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 About Gynecomastia and Male Breast Reduction