I've recently found a doctor who is very experienced in breast surgeries, is listed by Castle Connolly as a top doctor, and seems to be the ideal surgeon for my condition (puffy nipples only since puberty).
Doing research on him, I found a paper he co-authored called "Combined Use of Ultrasonic Liposuction with the Pull-Through Technique for the Treatment of Gynecomastia." It's located at . I tried to include a direct link but it is not allowed on this forum.
This is the technique he described to me in his office. Can any of the doctors here comment on this technique? Thank you.
In this years Castle Connolly America's Top Doctors there are only 194 Plastic Surgeons throughout the United States. Some get selected and then no longer make the current year's guide. That doctor is indeed in this years guide for ATD. I have been so honored to be in this guide now consecutively for 9 years. Being listed for Gynecomastia is another matter. Until recently, I was the only current guide doctor listed for Gynecomastia. Now there is another one, not the one you are mentioning. Breast surgery is different than gynecomastia, being good at one does not make that surgeon good at both.
A gland pull through technique has been a hallmark of many surgeons' methods for quite some time for those of us interested in smaller scars. You can find both still photos of that method on my site, and videos of me performing the operation. I even feature a Gynecomastia Gland Gallery that then can be matched to the patient, the problem, the solution, and the scars.
What is good about the article is admitting that liposuction does not remove gland, which it does not. I also agree that the lower incision they started their series with results in suboptimal scars. However, I never subjected my gynecomastia patients to that lower incision starting out at the edge of the areola as a better place from the beginning. Their incision is only 1 cm which is smaller than what I am currently using. My current incision is typically about 1.6 cm: the size I can fit my smallest finger in to feel that I have targeted the firmer tissues first. At the time of that article, my incisions were longer about 1.8 cm or so. The smaller incision forces the gland to removed in pieces (not a critical issue) and at the time of the article I weighed making my incision even smaller, but scar analysis led me to discard that smaller incision as not worth the targeting gland first.
What I do not agree with is the order of the surgery. I prefer to target the gland first and then approach the fat. When liposuction is done first, some gland may need to be left behind to keep the areola supported. The issue is in the documentation of the problem and the result. When only a front and side picture are used, more subtle issues can go unrecognized. You should take the time to evaluate my resource designed to demonstrate how limited views can miss a monster deformity and disfigurement. See the flexing photos views and if you want to really become unsettled, watch the video on how the tissues move. That is the key issue, looking good in real life, playing sports, swimming and enjoying our shirts off. When patients come to me unhappy with surgery done elsewhere too many had a Puffy Nipple Complication that particularly shows up when the muscle flexes compressing the tissue over it. Firmer gland and scar tissue just do not compress like fat. This deformity can also show up when the areola muscle relaxes. I also do not use the ultrasonic cannula since I do not like the injury that method causes on my patients' tissue. Something also that shows up on animation views, but this time as adhesion scars.
So if you are going to evaluate that method, or for that matter, any other surgeon's method look beyond just one or two views if you want to see just what that method achieves. That surgeon should have a passion for this particular subspecialty of male chest contouring and have many examples of their work for you to become comfortable with their methods and results. Even better, that doctor should have so many examples of their gynecomastia that they have sub sections dedicated to such issues as puffy nipple gynecomastia.
Hope this helps,
Michael Bermant, M.D.
Topic: Question about this technique (Read 2361 times)
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