Questions about different gland removal techniques

[Jrad]

Hello, I'm hoping some doctors can give me some insight into the pros and cons of the different gland removal techniques. I've noticed most doctors remove the glands through a incision under the areola, however, I read that Dr. Schuster performs this through a 1/2" incisions on the side of the chest. What are the reasons for this other than different scar locations? Are certain techniques more conducive to the degree of the gynecomastia?

It also seems to me that most doctors leave a bit of gland to prevent an indentation but, in a video I watched Dr. Robert Caridi states that he removes all of the gland. He also states he uses a "internal flap" method which is suppose to prevent indentation as well. Why do some doctors choose to leave some gland in while others remove it all? 


I'm considering surgery for puffy nipples but still researching the best surgeon/technique for me. I'm a 35 year old male with a naturally muscular build and have always been lean and active. I had a doctor confirm that I have glandular gynecomastia when I was 18 and it has not changed in size since then. 

Any information would be greatly appreciated, thanks you. 

[Dr. Elliot Jacobs]

Every surgeon  has his own method of performing gyne surgery.  What counts is the final and reproducible result.

I am aware that many docs favor leaving a little gland under the areola.  That may work -- but it leaves some gland which may, in the future, decide to grow.

My technique is to remove as much visible gland as possible, leaving only the thin areolar skin behind.  In virtually every case, I will then perform primary fat flaps to support the areola and provide a "gliding plane" for the skin to move over the underlying fat.

If you have puffy nipples, the ONLY cause is breast tissue beneath the areola.  Fat alone does not cause puffy nipples.  Proper surgery is to remove that glandular tissue but replace it with fat to prevent a post op crater deformity.

If properly performed, surgery for puffy nipples should provide you with areolas which are smaller in diameter and which lie flat and flush with the surrounding skin all the time  -- from day one post surgery and well into the future.  Choose your surgeon wisely -- don't rush into surgery until you are sure.

Good luck

Dr Jacobs