Operative techniques

[tbb82]

Hi. I am due surgery for some v.mild gynecomastia. My surgeon says I need excision and lipo, but insists on doing it via an incision in the areola, not under the armpit. Why would this be? (He says the armpit is too far away but other people here have had it). What are the disadvantages of an incision under the armpit - sounds better to me - right?

thanks

tim

[Finrod]

The difference is that the gland MUST be cut, and you can't do that from under the armpit.
Liposuction is only for fat, and it can be done from under the armpit.

[DrBermant]

Hi. I am due surgery for some v.mild gynecomastia. My surgeon says I need excision and lipo, but insists on doing it via an incision in the areola, not under the armpit. Why would this be? (He says the armpit is too far away but other people here have had it). What are the disadvantages of an incision under the armpit - sounds better to me - right?

thanks

tim

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

The problem is that gynecomastia comes in so many different forms.  I prefer to let what I find during surgery help guide what needs to be done.  An incision at the edge of the areola opens up for me an artist's palette of tools not available when using the armpit approach.  That is why I prefer my Dynamic Technique.

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.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  

The areola chest skin interface is a great place to hide a scar.  Check out the many before after pictures of this Areola / Nipple Gallery here, here, and here.  These results are typical for my sculpture of my patients.

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

[jc71]

tbb82, you have a great question in the "Local US" section.  Move that question to "Gynecomastia Talk" and i think you'll get great feedback.  Question is about taking too much out.