Question to dr.bermant/members

[nothingworse]

I am most likely going to get my surgery done by dr.lowenstein in Milwaukee. He does many cases of gynecomastia and womens breast reduction. My question is about his technique. I have mostly gland to be removed and though he would excision it. He said he would use ultrasound to break it up since my tissue isn't that hard and suck it up through the canula. Then suck out an excess remaining fat in the surrounding area. I am just worried that that might not work out that well. I want all the tissue out and hope that method would work right. I don't care about the fat because if there is an excess it would be very little.

[nothingworse]

Dr. Bermant I need your input on this I am concerned and need to know from another proffesional.

[jc71]

Dr. Bermant will probably say each surgeon has his/her own techinques.  I think this is very true.  

There's been a few guys on these boards who like you were mostly gland and they used Bermant with excellent results.

I'd look around Milwaukee for a 2nd or 3rd opinion.  If you're still not happy and don't mind the traveling, go see Bermant.

Personally, from everything I've read about that technique, it doesn't work too good.  

I think for best results, your PS needs to cut around the areola and excise the glandular tissue.  

I'd hate to see you have to go back for revision surgery.  

[DrBermant]

I am most likely going to get my surgery done by dr.lowenstein in Milwaukee. He does many cases of gynecomastia and womens breast reduction. My question is about his technique. I have mostly gland to be removed and though he would excision it. He said he would use ultrasound to break it up since my tissue isn't that hard and suck it up through the canula. Then suck out an excess remaining fat in the surrounding area. I am just worried that that might not work out that well. I want all the tissue out and hope that method would work right. I don't care about the fat because if there is an excess it would be very little.

Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like.  The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques.  

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture