To the PS on the board here...
How effective is UL on glandular tissue at minimizing, or destroying the mass?? I have been in contact with a PS in my area who uses UL alone on gynecomastia patients, with a %90 success rate (claimed) at eliminating glandular tissue with the UL technique. Is this possible to not need manual excision? WHat are the long term outcomes? Pro's vs con's??
I am under the belief that UL was not a stand alone procedure for gland removal and fat removal.
Also i am concerned with some information i have read which points to UL as somewhat dangerous....
"Avoid Ultrasonic Assisted Liposuction (UAL)
Ultrasonic liposuction is much more dangerous than most patients and many surgeons realize. There have been major complications including potential infections, complete loss of overlying skin as a result of burns caused by heat generated by the ultrasound device, and even deaths that are the direct result of UAL. The initial published reports and descriptions of the benefits of UAL were overly optimistic and inaccurate. Subsequent to these publications, some patients of the authors of these articles encountered severe complications as the direct result of UAL. By failing to publish these unfavorable results, the authors have contributed to an unrealistic and overly optimistic reputation of UAL. In fact, because the is insufficient evidence that UAL is safe, the U.S. Food and Drug Administration (FDA) has refused to permit any company to sell an ultrasonic devise to be used for liposuction."
Each surgeon used 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
Topic: Ultrasonic Liposuction efficasy on Glandular Tissu (Read 2564 times)
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