ultrasonic lipo vs. excision

[mephistopholes]

Why is that based on what I am reading, the INFORMED gyne guys seem to be wary about ultrasonic lipo than excision?

Does ultrasonic lipo carry more risk of failure in surgery?

[flex1appeal]

LOl...I think it's more wary for the simple fact that ultra lipo by itself is not as successful as excision by itself. However, most don't get just excision done. They would also get lipo done as well. I had ultra lipo done only the first time around and it worked fairly good but not as well as my second surgery when I insisted he remove the gland as well as perform ultra lipo. The combination was awesome!

[headheldhigh01]

lipo alone is probably fine for guys with less dense tissue, he problem arises when a ps decides to play it on the conservative side of what he leaves in.  afaik, if yours is a denser case and gland material is left in, maybe in the name of not leaving a concavity, you might either be unhappy or it might be more prone to regrow some. 

[Hypo-is-here]

lipo alone is probably fine for guys with less dense tissue

This is factually incorrect.

Liposuction does NOT remove diffuse glandular gynecomastia, excision is required to remove glandular gynecomastia whether it be dense or diffuse.

Also re-growth is dependent upon the aetiology of the gynecomastia and its root cause not upon whether it is dense or diffuse. 

E.g

A man with an underlying causative factor such as untreated or pooprly treated hypogonadism, hyperthyroidism, liver disease etc is more likely to see re-development of gynecomastia post surgery, even if diffuse, than say;

A man with idiopathic pubertal gynecomastia that is dense with no permanent underlying causative factor.



 

[DrBermant]

Why is that based on what I am reading, the INFORMED gyne guys seem to be wary about ultrasonic lipo than excision?

Does ultrasonic lipo carry more risk of failure in surgery?

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses 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, VASER, 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 for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

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