How much do you remove?

[combatwombat]

How much of the gland do you remove duing surgery? all of it? or enough to make it look natural? And typically do you do both a lipo and gland removal? or is it more of a lipo or gland removal?

[Dr. Elliot Jacobs]

Most men require a combination of lipo and direct excision of the gland.  Every man is different and indeed every breast is different -- therefore, what is removed is determined individually at the time of surgery.

what counts is not what was removed -- but what it looks like after surgery is completed.

Dr Jacobs

[DrBermant]

How much of the gland do you remove duing surgery? all of it? or enough to make it look natural? And typically do you do both a lipo and gland removal? or is it more of a lipo or gland removal?

I prefer my Dynamic Technique which Targets the Gland First. Going after the gland first is the hallmark of my methodology. By concentrating on gland, I target the tissue that compresses the least and reserve the remaining fat as a potential tool for my reconstruction. This is not a cancer operation, but a contouring sculpture. However, the results should look good more than with the arms down and only a limited set of after surgery pictures that change for each patient example. Contour results should look good with arms up, flexing muscles, sports, and living life. Without targeting gland first, a Puffy Nipple Complication of Gynecomastia can ruin the male chest contour.

However, no technique can remove all gland. The Anatomy of Gynecomastia normally has fingers of fat coursing through fingers of gland.

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.

I then select from 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.

My 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.

Try to go through the entire section about male chest sculpture on my site to learn what my techniques of surgery have to offer.

This 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 our 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