Question for Dr. Pope

[EdmondDantes]

Dr. Pope,

There have been some bad experiences here where the gynecomastia surgery was performed and looked fairly normal when the chest was in the resting position but when the chest/upper body muscles are flexed dimpling and distortion appear. Can you touch on how your approach prevents this from happening, ensuring the chest has normal contours no matter where the arms/muscles are be they tensed or relaxed?

Dr. Jacobs, If you happen to read this, would you mind responding as well? Thanks to both in advance!

[Dr. Elliot Jacobs]

As I have stated many times, it is incumbent on the surgeon to remove enough tissue to do the job yet leave enough tissue so that there is no dimpling or adherence to the underlying muscle.  That is the "art" of this operation -- knowing how much to take and how much to leave.  It is like an artist working on a piece of art -- you have to know when the work is "done."

The surgery is accomplished by very careful and artful liposuction as well as appropriate removal of any solid breast tissue directly beneath the nipple.  Fat flaps are used as need -- this is routine.  My mantra to my patients is that I will spend the extra 5, 10, or 15 minutes at the end of the operation to make sure that the result is as good as it can be.  Reason:  if it doesn't look good on the OR table at the end of surgery, it will not magically improve during the healing phase.  That is why I have a near 0% personal revision rate.

Dr Jacobs

[George Pope, M.D.]

Edmond,

I agree with Dr. Jacobs, who is obviously a master at this operation.  Fat in the chest wall serves a definite purpose.  It provides a soft cushion between the skin and chest wall or pec muscle.  If you "skeletonize" the chest wall, meaning remove all tissue between the skin and pec muscle, then any movement of the arm/shoulder can potentially cause an abnormal tethering or pulling of the skin against the muscle - a very abnormal appearance.  If there is sufficient fat left in place, this distortion is minimized.

I hope this answers your question.

Dr. Pope, MD

[EdmondDantes]

Thanks to both of you for your thoughtful answers. As a follow up....and you may not have the answer to this....are each of you at all familiar with the techniques of the other? Do you know if you use a similar/same technique?

[George Pope, M.D.]

Dr. Jacobs and I try to get together at national meetings, and we have discussed technique.  I feel that our surgical techniques for this procedure are pretty similar; I even own a couple of the liposuction cannulas that he has designed specifically for gynecomastia surgery.  He's certainly a great mentor for this procedure.

Dr. Pope, MD