different doctors techniques

[graywelf]

Can anyone tell me what techniques Dr. Delgado and Dr. Bermant use?  Do they use the same techniques, if not then how do they differ?

[DrBermant]

Can anyone tell me what techniques Dr. Delgado and Dr. Bermant use?  Do they use the same techniques, if not then how do they differ?

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. The hallmark of this method is targeting the gland first, not the fat. The other critical feature and why I call this Dynamic is that the technique is designed for sculpture to look good in motion (dynamically) and at rest. How the body moves is even more important for someone who wants to live life playing basketball, swimming. Results should not just be just a few still pictures with limited angles and views.

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.  

Liposuction is fine for fat.  However, all forms of liposuction

• sharp cutting cannula
• ultrasonic
• vasor
• power assisted
• "smart"

all preferentially remove fat over gland.  Check out the Normal Anatomy of Gynecomastia.  When fingers of fat are between fingers of gland, liposuction alone tends to suck out the fat condensing  the gland behind making a mess.  

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. I also use Excision, Microliposuciton, Nipple Sculpture, Mastopexy 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. Then to see this in action I have started posting much more detailed but Graphic Gynecomastia Surgery Video (actual movie of me performing this sculpture). This is but one version of this sculpture. I am currently editing another example video. That is 13 minutes of movie showing both the surgery and how the results move. Done 7 years ago, my methodology has continued to evolve. This is part of the fun of such extraordinary documentation, going back to see what I have done and what I am now doing. The next video I am working on is in HD wide screen from 4 years ago on someone primarily fat with little gland.

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 a Puffy Nipple Complication After Gynecomastia Surgery that can look bad when the areola muscle relaxes and on animation.

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

Revision Gynecomastia After Partial Gland Excision

there are many more examples of this technique on my website.  Gland targeted first and almost all removed, the surrounding fat replacing that gland.  I have never seen a crater deformity from my sculpture.  

The 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

[Dr. Elliot Jacobs]

To be brief, every doctor, including myself is a highly trained surgeon.  There are a multitude of techniques which can be used on any particular patient.  However, there are no "standard" patients -- each is different and requires different techniques and approaches for their surgery.  And sometimes, the surgeon has to adopt a different technique during the operation in order to deal with an unexpected situation.

That is why the "technique" is only one aspect of a procedure.  What counts even more is the manual dexterity of the surgeon and his experience in meeting all operative challenges.  As I frequently tell my OR team, there are no "routine" cases -- ever!

Dr Jacobs

[deja911]

edited