anyone had success with liposuction only

[april24th2007]

anyone had success with liposuction only
no gland excision?
anyone with puffy nipple type gynecomastia

[Dr. Elliot Jacobs]

Puffy nipples is actually a solid area of tissue directly beneath the areola.  Liposuction can only remove fat.  I have designed my own cannula which can remove fat as well as some breat tissue.  But it too has limits.  when faced with solid tissue beneath the areola, even my cannula will not be totally satisfactory.

That is why whenever I see puffy nipples on one of my patients, I always inform them that most likely a per-areolar incision will be needed.

There are some surgeons who can/try to remove this solid tissue from a remote, small access incision in the armpit or side of the chest. I do have those instruments and have tried to do the surgery in this manner.  Unfortunately, I have not had great success with it.  I much prefer to open the areolar edge and visually remove all the solid tissue so that it is smooth and even.  I can also place one finger underneath the areola and one on top and feel the tissue inbetween, thereby assuring myself that everything is as smooth and even as possible. The resultant scar, if sutured properly, is negligible.

Th peri-areolar incision also allows me to perform any minor improvements of the underlying chest contour, using sutures, fat flaps, etc.  Therefore, I know when I am completed that the underllying tissues are smooth and even and the overlyoing skin is smooth and even.  Net result is a smooth and even chest.

Dr Jacobs

[april24th2007]

Thank you for your comments and input.
How does one differentiate between breast tissue fat?
I feel no lump below my nipples, but I do feel it on the side of my nipple leading all the way till arm pits.
I'm 5'9" & 150 lbs.

[april24th2007]

Also, I've read from many surgeons on this web forum that lipo doesn't really take out the breast tissue gland.  Similarly, from most patients I've read the same info backing the surgeons' point of view.  But how come there are so many websites out there promoting vasar and other similar lip methods which are openly stating their product can remove the breast tissue?

[Dr. Elliot Jacobs]

How does one differentiate between breast tissue fat?
I feel no lump below my nipples, but I do feel it on the side of my nipple leading all the way till arm pits.

IT is virtually impossible for an even an experienced surgeon's hands to determine fat vs gland -- much less a lay person.  Trust me, there is virtually always some ratio of gland and breast tissue in every guy who has gynecomastia.  It is a fool's errand to try to determine how much of each one has -- and it truly doesn't matter because any excess of both types of tissue must be removed.  Remember, for most gyne, except for the tissue just directly beneath the areola, the remainder of the excess tissue is really fingers of gland interspersed with fingers of fat.

But how come there are so many websites out there promoting vasar and other similar lip methods which are openly stating their product can remove the breast tissue?

Vaser is pulsed ultrasonic liposuction.  At best, it can remove fat.  It absolutely does not melt fibrous tissue or gland.  That is why many guys who have written on this forum, after having had vaser, then have to go back for direct excision. 

Dr Jacobs

[april24th2007]

Thanks for your answers.
I appreciate you taking the time to respond (and so promptly too).
Thank you.