Dr Jacobs' Technique

[gyno1234]

I like the sound of Dr Jacobs' technique (canula to remove fat AND breast tissue from an incision on the side) and then a second incision (if necessary) at the areola to remove hard breast tissue.

My question: By jabbing away at the gland with his sharpened canula, is there any chance bits of gland could be left behind and make the chest lumpy? Isn't this a rough approach to take in comparison to a clean excision of the gland and then fat sculpting? I say this in reference to this guy's experience with Dr Jacobs:

(THREE WEEKS Post-Op)
"One thing I have noticed is that when I'm out of the binder my chest isn't super smooth, it almost looks like cellulite" - he didn't elaborate further and is no longer active.

Could somebody settle my concerns? Dr Jacobs - you're a master - I just want to understand your technique better!

[Dr. Elliot Jacobs]

First, you have to understand the problem.  Breast (or gland) tissue is thickest directly under the areola.  It then spreads out across the chest, usually occupying the lower half of the chest in the rough outline of a horizontal football pattern.  As it spreads out, it intertwines and disperses with the chest fat -- it resembles fingers intertwined.

All standard lipo cannulas remove fat -- but cannot remove the denser, tougher gland tissue.  Consider Vaser, laser, ultrasound, water-assisted lipo (Body Jet) -- they all remove ONLY fat.  In fact, they are hyped as "safer" for standard lipo because they ONLY remove fat and leave the other structures intact.  Therefore, how can they be used for both standard lipo (on the thighs, for instance) and then be effective for gyne, which has gland interspersed.  It is a setup for an incomplete removal of the gland tissue.

When I originally confronted the problem of gyne, I knew one had to be aggressive to be able to remove both fat AND gland tissue.  I designed my own cannula and had it manufactured.  It is very effective in removing both types of tissue.  BTW, that cannula is available to any surgeon who wishes to buy it -- I don't make a penny on any sale.

As for my technique -- it has evolved over time and it works.  Other docs have their own techniques -- and their techniques work for them.  What actually counts is the final result -- not the means by which you arrived at the result.  In essence, who cares how the doc got the result -- as long as the result is what one wants.

I do not know the poster who wrote about bumps -- but that is quite new to me.  My patients always talk about how smooth and even their contours are. And, there is no way to do a "clean" excision of tissue since it extends outward in all directions.

As for leaving bits of gland -- yes, there is always some gland left behind -- by every surgeon.  Remember, this is not a cancer operation -- it is a contouring operation.  If one wanted to remove virtually every cell of breast tissue, it would almost mutilate the chest. Just check out some bad results of women who have had mastectomies and you will see that.  The goal of properly performed gyne surgery is to leave a normal looking chest -- and in particular, normal for that particular body.  If a guy is skinny, then a lot of tissue is removed.  If a guy is heavy-set, then one must leave some tissue in order for the chest to appear normal on that guy.  That is the "art" of doing this operation -- one should tailor the operation to the physical needs of the individual patient.

With my technique, I start with what I call "aggressive" liposuction.  I work from the periphery surrounding the nipple and then "lipo" the nipple itself.  In some cases, I am able to remove everything through a single, 3mm incision on the side of the chest.  If, however, there is any evidence of firm breast tissue directly beneath the areola which my cannula cannot remove, then I will open the areola and remove it under direct vision.  This allows me to assure a smooth, flat areola on a smooth chest.  I find this "graduated" approach to gyne surgery to work best for me -- as I said, others may do it differently and also get good results.

I do hope this has helped you to understand some of my techniques.

Dr Jacobs

[Viking75]

I had surgery with Dr Jacobs. I was left with good lean contour. I later had problems with scar tissue. We will fix this! regarding lumps, I think as long as they do not bother the contour, do not worry about it.
No surgery can ever be made without some scar tissue or perhaps minor tradeoffs.
If you have a tru and real problem after surgery due to the surgery with bumps caused by scar or dead fat cells etc Dr Jacobs would never leave you hanging!
He will take care of you. However you must ask yourself if this problem is realy there, or if it is in your mind.
Healing is not only a physical thing!

jUST MY THOUGHTS

[gyno1234]

Thanks for your VERY informative reply, Dr Jacobs. Very much appreciated!!

[xelnaga13]

One thing my surgeon pointed out to me is that it's the mirror that counts. You may be able to feel little pieces of scar or left over gyne tissue... but you really need to focus on the appearance rather than what you can or cant feel.

[Dr. Elliot Jacobs]

Xelnaga -- amen to that.

Many post op patients mention to me that they can "feel" something after surgery.  Right -- that is scar tissue and the location and extent of scar tissue is extra-ordinarily variable -- and totally beyond the control of the patient or the surgeon.  Everyone heals differently!

What counts is the contour -- does it look smooth?  Are there any dents or dings or contour irregularities?  Patients need to understand that many of the feelable lumps are scar tissue -- which will disappear slowly with time.  Unfortunately, many patients are impatient and want a perfect result (both to appearance and to feel) within weeks after the surgery -- that simply doesn't happen. 

Beyond that, even if there is a small area of residual feelable scar tissue, it does not detract from the appearance -- and that is the ultimate goal of the operation. 

The mirror, the mirror is what counts.

Dr Jacobs