Micro-cannula or vaser liposuction

[wh1000]

Hello Doctors,

I'm 20 and have decided to get treatment for my gynecomastia problem. I am fit and healthy, but have had the problem for a number of years. Perhaps this is due to lifting weights/swimming at too young an age. Even when I have had very low body fat, I still have pronounced man-boobs so I feel its impossible to loose them with exercise now.

I have had a consultation for what I thought would be vaser treatment, but it turns out the clinic uses micro-cannula instead. It was explained to me that instead of melting the fat they use a liquid to loosen it before being sucked out. I get the impression that it may be a less effective method, but may be cheaper and heal more easily. I was told I wouldn't need the lymphatic massage for micro-cannula that I would for vaser treatment.

Do you think I should go for the micro-cannula or would vaser be better? I don't think I've got that extreme a case of gynecomastia, and the consultant said that the fat may be underneath the chest muscle, in which case they couldn't remove it using micro-cannula. What would be the best solution for me if this is the case?

Thank you

[Dr. Elliot Jacobs]

I am afraid you are being handed a lot of BS.

Vaser is no better in removing breast tissue than anything else. 

Adding liquid to the tissues is a standard procedure -- called tumescent liposuction -- that is performed by 100% of surgeons world wide.

Using micro cannulas does not add to the ability to remove solid breast tissue.

Finally, there is no fat beneath the chest wall muscle -- period.

Best recommendation:  go to an experienced gyne surgeon who knows what he is talking about.

Dr Jacobs

[wh1000]

I am afraid you are being handed a lot of BS.

Vaser is no better in removing breast tissue than anything else. 

Adding liquid to the tissues is a standard procedure -- called tumescent liposuction -- that is performed by 100% of surgeons world wide.

Using micro cannulas does not add to the ability to remove solid breast tissue.

Finally, there is no fat beneath the chest wall muscle -- period.

Best recommendation:  go to an experienced gyne surgeon who knows what he is talking about.

Dr Jacobs

Thanks for your advice. My initial consultation was not with the surgeon, I am hopeing to have a consultation with him tomorrow. It was the woman who consulted me initially who suggested fat could be behind the chest muscle, but she isn't a surgeon. I'm glad to find out this isn't possible!

I'm mainly looking to figure out whether micro cannula will be good enough to deal with my problem, as I see if is particularly useful in dealing with hard to reach areas suuch as underneath the chin etc. Will I be able to have as much fat removed using micro-cannulas as I would with vaser? Also she mentioned vaser-high def, which would cost a lot more, in which you actually have the muscle shaped to improve the look of the chest. Is this a big difference to standard vaser and micro-cannula treatment?

Would it be ok for me to send you pictures if this would help?

Thanks a lot

[DrBermant]

Hello Doctors,

I'm 20 and have decided to get treatment for my gynecomastia problem. I am fit and healthy, but have had the problem for a number of years. Perhaps this is due to lifting weights/swimming at too young an age. Even when I have had very low body fat, I still have pronounced man-boobs so I feel its impossible to loose them with exercise now.

I have had a consultation for what I thought would be vaser treatment, but it turns out the clinic uses micro-cannula instead. It was explained to me that instead of melting the fat they use a liquid to loosen it before being sucked out. I get the impression that it may be a less effective method, but may be cheaper and heal more easily. I was told I wouldn't need the lymphatic massage for micro-cannula that I would for vaser treatment.

Do you think I should go for the micro-cannula or would vaser be better? I don't think I've got that extreme a case of gynecomastia, and the consultant said that the fat may be underneath the chest muscle, in which case they couldn't remove it using micro-cannula. What would be the best solution for me if this is the case?

Thank you

Sorry, they do not work well at all. The questions have been asked here many times before. Use the search function on the forum and look up "Vaser Liposuction."  Check the option show as messages to see the answers better. Look for good documentation that any one method actually works before having surgery.

I have used micro cannula and a prow based cannula as a component of my sculpture for years and I have evaluated the material in what comes out. I have yet to see gland elements in the liposuction component nor a doctor being able to prove that they can get the gland out with such methods. I have also removed many gland elements from patients unhappy with surgery done elsewhere and have verified the removed gland component with pathology. I have published many such examples to demonstrate the issue.

Try using my Standard Gynecomastia Pictures if you want others to better understand your contour concerns. There are careful instructions on how to take this documentation.

As far as the Anatomy of Gynecomastia, I found there were so many poor descriptions of that in the literature, that I did my own drawings and published them. The drawings are dynamic permitting interaction. There little fat behind the majority of the pectoral muscles being adherent against the chest wall. As the muscle fibers condense to attach to the arms, there can be some fat there, but that region does not contribute to the contour of the chest.

Hope this helps,

Michael Bermant, M.D.

[Dr. Elliot Jacobs]

I'm mainly looking to figure out whether micro cannula will be good enough to deal with my problem, as I see if is particularly useful in dealing with hard to reach areas suuch as underneath the chin etc. Will I be able to have as much fat removed using micro-cannulas as I would with vaser? Also she mentioned vaser-high def, which would cost a lot more, in which you actually have the muscle shaped to improve the look of the chest. Is this a big difference to standard vaser and micro-cannula treatment?

I understand the confusion you have.  Unfortunately, some doctors buy expensive machines (ie Vaser or Vaser hi-def, "laser" lipo, the now mostly discredited "ultrasonic lipo", etc) and then market it to the public so that they can pay off the purchase price of the machine.  The bottom line is that none of these machines offers any advantage (and some offer disadvantages) over traditional liposuction and excision. 

Another concept for you to understand is that the results of surgery have more to do with the surgeon's experience and skill than with the instrument he uses.

Finally, the "hi-def" idea of vaser has to do with removing a lot of tissue above and surrounding the muscle -- it does not and cannot enhance the muscle in any way.  The essence of gyne surgery is not to add muscle but to reveal the muscle that you already have.  If you want more muscle, you will have to build it yourself.

Dr Jacobs

[wh1000]

Thanks for the replies,

I believe that the problem I have is because of a build up of fat, as I have seen both a GP in the past and the consultant recently, and both said that the gland seemed not to be the issue. But I will not know for sure until seeing a surgeon.

You have both mentioned that these methods are not effective for removing breast tissue, but if I don't have actual breast tissue that needs to be removed, then the liposuction will only be for removing the fat will it not?

Do you suggest then that micro-cannula is not effective for removing fat from the male chest area, or that it is not useful for either breast tissue removal or fat removal? Is vaser treatment better?

Thanks again

[Litlriki]

The tissue in gynecomastia is a mix of fat and "gland", which in many cases can not be distinguished by physical exam.  If someone is obese, it's likely that more fat is involved, but if someone is normal weight with significant gynecomastia, there will be some fat and some gland, and the gland can actually be quite extensive.  Only fat can be removed with liposuction.  It doesn't really matter what sort of liposuction is used, as long as the operator knows how to use it properly.  Most of the bells and whistles of new liposuction machines are designed to make the process more effective with less operator effort.  In other words, ultrasonic assisted (Vaser and others), laser assisted (Slim-lipo and Smart-lipo), and power assisted liposuction involve modifications that make the process go easier for the surgeon.  The marketing hype to the public mostly proclaims that each of these options is invariably "less invasive" with "less down time," "less bruising" and so on.  There may be some other benefits (thermal effect in helping to tighten skin with ultrasonic and laser, for example), which are beneficial in some specific cases, but for the most part, liposuction is liposuction is liposuction. 

So I love reading Dr. Jacob's replies, which are spot on.  It doesn't matter which machine the surgeon is using, as long as he or she is competent with the device, and is capable of correcting your condition.  A well-executed procedure followed by an uneventful recovery should get you a good result, whether Vaser or laser or plain old elbow grease is used. 

Feel free to post photos. In the meantime, you may want to consult with a surgeon and not a liposuction machine marketing agent.

Rick Silverman

[wh1000]

The tissue in gynecomastia is a mix of fat and "gland", which in many cases can not be distinguished by physical exam.  If someone is obese, it's likely that more fat is involved, but if someone is normal weight with significant gynecomastia, there will be some fat and some gland, and the gland can actually be quite extensive.  Only fat can be removed with liposuction.  It doesn't really matter what sort of liposuction is used, as long as the operator knows how to use it properly.  Most of the bells and whistles of new liposuction machines are designed to make the process more effective with less operator effort.  In other words, ultrasonic assisted (Vaser and others), laser assisted (Slim-lipo and Smart-lipo), and power assisted liposuction involve modifications that make the process go easier for the surgeon.  The marketing hype to the public mostly proclaims that each of these options is invariably "less invasive" with "less down time," "less bruising" and so on.  There may be some other benefits (thermal effect in helping to tighten skin with ultrasonic and laser, for example), which are beneficial in some specific cases, but for the most part, liposuction is liposuction is liposuction. 

So I love reading Dr. Jacob's replies, which are spot on.  It doesn't matter which machine the surgeon is using, as long as he or she is competent with the device, and is capable of correcting your condition.  A well-executed procedure followed by an uneventful recovery should get you a good result, whether Vaser or laser or plain old elbow grease is used. 

Feel free to post photos. In the meantime, you may want to consult with a surgeon and not a liposuction machine marketing agent.

Rick Silverman

thanks for the reply,

I have consulted with 2 surgeons since my last post. I have decided to go ahead with the surgeon I had my most recent consultation with. She did an ultrasound and said there is both fat and breast tissue there. She then said that in the procedure she can first remove the fat using vaser-liposuction and then we can both see if there is any 'puffy nipple' noticeable due to the gland, if so she can remove that as well surgically.

This seems to match all of your suggestions perfectally, as since I am in OK shape but with the pronounced gynecomastia I agree that there must be breast tissue there as well, which she said is also why there is fat. This is apparently normally the case for patients who notice gynecomastia during their teens, like myself.

One question I do still have, is that I enjoy playing sports that I feel would be significantly impared by the operation, i.e. golf and tennis. How long after the operation would you reccomend me being able to playing both of these sports? I would be happy to wear the compression vest whilst doing so if this would help.

Also one other thing I was wondering is, what colour compression garment do you normally give to your patients after surgery? Th surgeon said it's normally black so that any leaking is not as noticeable. But I will be working a week after the operation in a job that requires wearing a white shirt, so a black vest would look a bit strange. Would a white one be ok?

thanks again doctors for all your help.

[Litlriki]

Regarding exercise after surgery, you should speak with your surgeon to get her recommendations, since we all approach this differently.  I ask that my patients minimize strenuous activity for the first week after surgery, at which point I allow them to resume cardio.  After two weeks, I allow them to start resistance training but I discourage overhead maneuvers, and they can't do chest exercises.  After three weeks, I allow the overhead maneuvers, and after four weeks, they can do chest as well.  They are instructed to wear compression at all times.  Taking this approach, I've had no late complications related to activity.  (This is detailed on my website under "Getting Back to Training.")  Golf and tennis impact the chest during the swing, so I would discourage those activities until 3 to 4 weeks post-op to allow for improved flexibility and to minimize any potential problems related to motion at the operative site.

As for garment color, I've seen black, white, and "champagne" or flesh colored.  If you get a black vest, you can always put a white t-shirt over it under your white shirt.  I allow my patients to switch to UnderArmor after a week, and those come in white.

Good luck,

Rick Silverman

[DrBermant]

One question I do still have, is that I enjoy playing sports that I feel would be significantly impared by the operation, i.e. golf and tennis. How long after the operation would you reccomend me being able to playing both of these sports? I would be happy to wear the compression vest whilst doing so if this would help.

Also one other thing I was wondering is, what colour compression garment do you normally give to your patients after surgery? Th surgeon said it's normally black so that any leaking is not as noticeable. But I will be working a week after the operation in a job that requires wearing a white shirt, so a black vest would look a bit strange. Would a white one be ok?

thanks again doctors for all your help.

We fit each of our patients before surgery with both a stage 1 and a stage 2 garment. Both come in black and white but I only have been using the white first stage garments. Some patients use the white or black second stage garments some purchase both for camouflage depending on what they want to wear. Years ago I evolved my surgery to have a sealed dressing for typical gynecomastia surgery. It has been quite some time since any patient had a blood stain on the white garment while the dressing was in place. The exception is the long incision for a skin reduction chest lift. Those patients do have some drainage since the occlusive dressing makes it too difficult to take deep breaths. If a patient wanted a black first stage garment, that would need to be ordered ahead of surgery but for the many years I have been doing this, I do not remember a single patient asking for that garment.

For my patients, I advise them that recovery time for this surgery is something like a sprain.  Planning timing after surgery is like planning how long someone is out with a sprain.

This is real surgery and tissues need a chance to heal before stressed.  Time to return to activities depends on the problem to be treated, what needs to be done, surgical technique, stress that activity creates on the healing tissues, after surgery care, and many other factors.  Some doctors advocate quick return to activity but then new swelling typically means new injury. While pushing injured tissues in hand surgery can help tendons and joints from sticking, with cosmetic male chest surgery that further injury seems to  offer little advantage. Why push a sprain injury early?  Getting a World Series pitcher back on the mound may win a game, but will there be permanent damage? Take a cut finger and open a jar too soon, the jar may get opened but you may just tear open the healing wound.

My patients are typically back to thinking the day after surgery. Being able to think clearly requires being comfortable and not needing strong pain medications. Comfort After Gynecomastia Surgery is an art form. This varies from doctor to doctor. Although my patients are given a strong pain medication, almost all tell us that plain Tylenol is more than enough. They typically relate their comfort to having a heavy chest workout.

Hope this helps,

Michael Bermant, M.D.

[DrPensler]

I do not like the sound of your note. The advice you received seems a bit disingenuous. Tumescent solution with liposuction has been widely used since the late 80's. Vaser is a type of UAL ( Ultrasonic Liposuction ) and deals only with the fatty component of the breast tissue. Glandular tissue would be minimally responsive to any type of liposuction.