Microdebrider vs "pull through" method

[Andgy]

I have been reading up on gynecomastia surgery lately. I realise different surgeons have different preferences for the removal of breast discs/glands.

A common way to remove the breast gland is using the "pull through" method. As the name implies, the surgeon simply pulls out, via an incision, whatever fibrous gland that can be seen and cuts it off. The disadvantage of this method is that a larger incision has to be made in the periareolar, which could leave a prominent scar after healing.

A less common method discussed is the use of a microdebrider which "chomps" down the breast gland into smaller pieces and sucks them out via a relatively small incision. Not many surgeons seem to use this technique. The advantage of this method is that it leaves a much smaller scar. However, the disadvantage is that there could be bleeding as the doctor is not able to see exactly the amount of gland to be removed. In addition, there is a slight possibility that not all the gland is completely removed which would require a revision surgery later.

I wonder if any doctor here would kindly comment on the above 2 methods of gland removal? Which would you prefer in your practice?

[Dr. Schuster]

The Lateral Pull Through technique uses a very small incision on the side of the chest. It usually includes liposuction, ultrasonic liposuction and then direct excision of the remaining gland by pulling the remaining gland out through the side and cutting it out under direct vision. This is the technique I use in over 90% of patients. It works very well. The majority of surgeons utilize an incision at the lower border of the areola. They can also combine this with liposuction but will directly excise the glandular tissue through this opening. This is NOT generally referred to as a Pull Through technique as far as I know. The microdebrider ahs been described in the literature but I have not used it. It is basically taking an orthopedic cartilage debrider to cut away the breast tissue. I suppose in experienced hands it can do a good job. I suspect there is a higher chance of hematoma because there is so much more "cutting".

[Andgy]

Thank you, Dr Schuster, for the clarification.

I notice there are some surgeons who will make an incision near the armpit area to do liposuction first. They then cut the lower border of the areola to do the Pull Through technique.

Is there a reason why the lower border of the areola cannot be used for liposuction and removal of breast gland? I suppose this could minimize any possible scarring (however little) near the armpit?

[Dr. Schuster]

I use the Lateral Pull Through technique routinely. What you have described is not accurate. The Lateral Pull Through technique uses a very small incision on the side of the chest. It measures less than a half inch. Through that incision, liposuction, Ultrasonic Assisted liposuction and direct excision of the remaining gland is performed. I believe that when performed correctly it not only eliminates a potentially visible areolar scar but also reduces the risks of irregularities and retractions. just my opinion.

I have never used the microbraders.