The Percentage that direct incision is used

[steelhead]

To all the doctors here on this site about what percentage is direct used ?
I have read here that some doctors use a special canula to remove the gland
but you can see how alot of us here are skeptical ? I would prefer that a doctor
do the direct incision but it not the technique but the end result that counts.

[Litlriki]

Up to 50% of my patients present with steroid or pro-hormone induced gynecomastia, and all of those patients get a small peri-areolar incision.  Additionally, I treat any patient who has "puffy nipples" with a peri-areolar incision, since in my hands, that's the only way to get at the sub-areolar tissue effectively (I don't use a cutting cannula--Just personal preference).  The only patients in my practice who avoid the peri-areolar incision are those with purely fatty breast tissue, but some of these will get a circumareolar incision to remove skin and reduce the areolar size.  Despite the resulting high percentage of my patients with a peri-areolar incision, I have had a total of 5 or 6 patients in 19 years of practice who have developed a thick or visible scar, all of which responded to scar management. 

Rick Silverman

[Dr. Elliot Jacobs]

I probably end up with about 60% (average) of my patients having a peri-areolar incision.  I never hesitate to do so if I feel it is necessary -- but on the other hand, there are roughly 40% of patients who get a nice result without a peri-areolar incision.

When puffy nipples are present, then it is virtually 100% of patients who receive a peri-areolar incision -- that is the only way to treat this condition (IMHO).

In general, younger patients oftentimes need a peri-areolar incision while older men seem to need this incision only rarely.

Dr Jacobs

[DrBermant]

To all the doctors here on this site about what percentage is direct used ?
I have read here that some doctors use a special canula to remove the gland
but you can see how alot of us here are skeptical ? I would prefer that a doctor
do the direct incision but it not the technique but the end result that counts.

100%

I prefer one small incision for each side and the nipple areola chest skin junction is a great place to fool the eye and hide a scar. This incision now is typically under 1.6 cm (0.6 inch) for my primary cases and much better in my opinion than needing remote incisions that do not hide well except in photographs taken with the arms down. This becomes even more relevant when that "special" liposuction cannula does not "remove the gland" and the patient ends up with both the remote and areola incisions.

I have seen so many patients unhappy with liposuction techniques that I have been working on publishing a subset of a collection of over 500  (just over the past few years) requests for help after liposuction done elsewhere. Complaints have been for Puffy Nipple Complication deformity, scarring between the remote incision and the region needing sculpture, the actual scars of the remote sites, and many other issues.

You are right on target looking for the end result, but the question is what result? The result seen in one or two still pictures with the arms at the sides? For my patients, I am looking for results that look good living life, playing sports, swimming, flexing muscles, and being not embarrassed with their chest exposed. That is why I evolved my standard pictures to include arms up overhead, the view from around the body, and views relaxing / flexing muscles. Other views become critical for revision surgery and loose skin issues. More critical for evaluating of results are the movies before and after surgery. We may not walk around with our arms up over our head, but it is hard to play volleyball or basket ball without exposing our sides with the arms up. If the results are good, then they should be able to be so documented.

In evaluating so many unhappy patients done elsewhere and revising them, I do not consider the sharp cutting cannula effective for gynecomastia gland and have seen unhappy patients from most of the "special" cannula techniques even when the surgery was done by the designing doctor themselves. I have yet to see satisfactory proof that these cannula work removing actual gland. When scar gland tissue is compressed, it does not compress like fat, and that is why I have been able to revise patients by removing this residual gland / scar and replacing it with nearby fat. Such compression issues become more evident on animation, flexing, and other activities which is why I added those views and videos to my documentation of results. I have documented and published such contour issues in the past and continue to publish more.

So in understanding just what a technique offers, its scars, you need to be able to evaluate how the tissue looks when moving, flexing, and living life. The scar is not just the access point from the surface, but extends throughout the entire sculpted region. The best surgery should be transparent and not show that it has been there.

Hope this helps,

Michael Bermant, M.D.

[steelhead]

Thanks to you all doctors I agree that I prefer direct incision 100 % of the time but ultimately I will live it up to the doctor.

[Miguel Delgado MD]

I would estimate that 95% of my patients recieve a peri-areolar incision.  The length may vary greatly.  Men rarely complain of the incision.  They do complain of a low placed liposuction incision or drain site.  For men with pseudogynecomastia i give them a choice.  However, i still perfer to open the area to scult the tissue sharply.

[DrPensler]

About 99% of my patients require a periareolar incision it is the very  unusual individual who does not. I typically combine the periareolar incision with a 1mm stab incision near the pectoralis insertion.
Jay Pensler,MD