Dr. Jacobs side chest method vs Bermant under areola or under armpit

[johnsmithreturns]

Dr Jacobs does a good job correcting the problem but why does he cut in the side of your chest leaving a visible scar instead of under the areola( such as Dr. Bermant) or under the armpit( like others do) to hide the scar better?

[DrBermant]

Dr Jacobs does a good job correcting the problem but why does he cut in the side of your chest leaving a visible scar instead of under the areola( such as Dr. Bermant) or under the armpit( like others do) to hide the scar better?

Each surgeon has his / her own methods.  Check out many before and after surgery pictures to see what that particular sugeon offers.  Such pictures should be from many different angles to best understand what happened with that surgery. 

Liposuction techniques traditionally suggested that at least 2 access sites for each region minimized cross hatching from the cannula tracks.  Remote incisions permit faster liposuction, shorter operating time, more cases in a day.  The center chest incision was abandoned by many since the scar is quite visible and the central chest is the worst place on the body for scarring.  The armpit incision is favored by some.

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.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.  I also feel that one incisions for each breast is much better than 2.  For both sides, that is four scars vs. two scars.  The extra incisions are just not worth the faster operating time.

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.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia

[johnsmithreturns]

The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.  I also feel that one incisions for each breast is much better than 2.  For both sides, that is four scars vs. two scars.  The extra incisions are just not worth the faster operating time.

The scar in the side seem to really stand out in the after pictures. The chest is nice and flat after surgery but I can't help but wonder if the side incision is absolutely necessary since he ends up cutting at the edge of the areola anyway at the end of the procedure to remove the breast tissue.

Why not simple perform the liposuction  from the same incision point at the edge of the areola to prevent the additional scaring on the side? I would gladly pay for the extra time required in order to avoid 2 large scars to either side of my chest.

6:14 in the video, he cuts around the areola. He does the same thing on the other video surgery. ( warning, this is a surgery video)
http://www.youtube.com/watch?v=2DVSO75Xk3E&feature=channel_page.

That is just my initial impression from comparing the video and pictures on the 2 sites.
That is one of the things that I am most confused about the contrasting methods I have seen to correct the same problem from the top doctors on the subject.

Thanks.

[Dr. Elliot Jacobs]

I have tried, over the years, to find the best place to put an access incision.  High in the armpit requires the arms to be stretched too high and too much during surgery -- and could potentially and theoretically lead to stretch injuries of the arm nerves.  Placing an incision at the edge of the areola makes liposuction awkward and ineffective in my hands -- one has to manipulate the cannula like spokes of a wheel -- and I cannot generate enough power. 

I place the access incision in the mid armpit line so that when the arm is at the side, the scar is hidden.  This location allows for the needed powerful lipo strokes which enable my special instruments to remove both fat and breast tissue together.  It provides total access to the entire chest.  And since I am able to remove all tissue (fat and breast tissue) in about 50% of cases without the need for a peri-areolar incision at all, this enables me to make one remote incision and provide virtually scar-less surgery in many cases.

One important note:  all scars fade away in time.  My photos are usually taken at a patient's visit between 3 and 4 months post op -- the scars are still pink at this time.  It takes about 6-12 months for a scar to fade completely to white.  Unfortunately, I have difficulty getting some of my patients back to see me in one year -- they have better things to do than to return to their surgeon for a photo.

Ultimately, every doctor has a method and system which works best in his own hands -- what counts is the final result on the patient -- one year out.

Dr Jacobs