Puffy Nipples - Surgeon said that lipo only will work

[jon1234]

Hi All
      I went for a consultation the other day and the surgeon told me that the lipo only procedure would work. I have a moderate case of gyno- more so on my left side then right, and my aerola stick out to the point there is very little nipple definition.   From doing a bit of research here it appears theres many very unhappy people that have had lipo only- and I've read more then a few cases of guys having to get revisions to resolve "puffy nipples". What are your suggestions? Go to a different surgeon? I was quoted a price of around $5,000 for the whole procedure. I'm concerned that lipo only will not take care of my entire problem. Is there anyone who had lipo only for gyno and puffy nipples that is happy with the result?
thanks so much for any advice - this is a great forum.
Jon   

[wilsjwilson]

Jon,
I had the same experience.  I saw 3 plastic surgeons and they all told me the same thing.  After reading input from others on this board, I became nervous.  Had my pre-op appt this morning with the surgeon who will do the work this Friday and I grilled him on the gland excision issue.  He examined me again, and came to the same conclusion.  he said my gyne was fatty tissue, not gland.  So we are moving forward with lipo only.
I can't speak for anyone else on the Board, only about my experience.  I suppose I'll find out in a few months if it took care of the problem.
Best of luck to you.
JW

[RyanMace]

How can u decide whether it's gland or not before the ps has cut u open ?

[wilsjwilson]

You ask a good question, one I can't answer.  of course I'm not a PS, and I suppose my approach is that 3 of them told me the same and they know better than i do. 

[RyanMace]

I might be wrong, but I think that DrBermant posted somewhere that he doesn't really know what he's dealing with before he's actually "in there". It's a vague memory that I have, and might aswell be awfully wrong, so don't take my words for granted.

[jon1234]

I'll have to get a few different opinions - I'm a little leery after reading some threads on this site, that this doctor is comfortable with performing anything other then lipo.

[snycs10]

I'm going in for my procedure in 2 weeks and my doc made it clear to me that he's going to first tey and remove the breast tissue by lipo but if the tissue is too dense he'll need to make an incision on my nipple to cut out the tissue. He said this is something he won't know for sure until he actually is in me. Not sure if there's really any pros or cons to having it done either way.

[DrBermant]

Hi All
      I went for a consultation the other day and the surgeon told me that the lipo only procedure would work. I have a moderate case of gyno- more so on my left side then right, and my aerola stick out to the point there is very little nipple definition.   From doing a bit of research here it appears theres many very unhappy people that have had lipo only- and I've read more then a few cases of guys having to get revisions to resolve "puffy nipples". What are your suggestions? Go to a different surgeon? I was quoted a price of around $5,000 for the whole procedure. I'm concerned that lipo only will not take care of my entire problem. Is there anyone who had lipo only for gyno and puffy nipples that is happy with the result?
thanks so much for any advice - this is a great forum.
Jon   

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.  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 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

[asap4500]

The first consultation I went to  Doc. A told me he could remove gland w/ ultrasonic lipo.  He was very adamant about this.  A few consultations later, I asked a Doc. B about this without using the other surgeons name, and he told me that some of them went through school at the same time when this was being taught.  Doc. B told me that if he does lipo only, he will be doing a free revision.  Which is lost income for him, a bad rep and will definitely  piss me off.  He also said that ultrasonic lipo can burn skin and knowing that he would be doing excision anyway, there is no benefit to ultra sonic.  The best way for both of us to be happy is excision and lipo. according to Doc. B.  Studies are studies.  Real experience and a rep to protect is better.

 It's not the Gospel, just my experience.

[jon1234]

For what it's worth I went to another PS and he's going to perform Excision along with LiPo. He said that he's done lipo only in the past and most of the time the patient isn't happy. I'm glad I went and got a second opinion - thanks for the help and advice.

[manic91m9]

For what it's worth I went to another PS and he's going to perform Excision along with LiPo. He said that he's done lipo only in the past and most of the time the patient isn't happy. I'm glad I went and got a second opinion - thanks for the help and advice.

yeah im glad u are coz although its probably possible for some doctors to get a result with lipo only (or a specific technique of) the majority of people on this site with lipo only seem to have been unhappy. if your going to go through the down time and cost of surgery its best to go with the option that has frequently produced better results imo.

[latediagnosis]

i have puffy nipples and my PS said that she will be doing an excision only as there is no fat (my chest looks fine when im cold and nipples are erect).. she had plenty of previous photos with successful results with excision only.. almost all people who arent happy with the surgery are the ones who get lipo only.

[mmaman]

Do not get lipo only if you have puffy nipples.  Can you feel those hard lumps behind your nips.  That is mammary gland that will not fit through a cannula. 

IF you decide to continue with the lipo only, you will get what you deserve, which is a failed surgery. 

If you do not heed these words you will regret them.

Peace

[MSJ108]

I'm going in for my procedure in 2 weeks and my doc made it clear to me that he's going to first tey and remove the breast tissue by lipo but if the tissue is too dense he'll need to make an incision on my nipple to cut out the tissue. He said this is something he won't know for sure until he actually is in me. Not sure if there's really any pros or cons to having it done either way.

The last surgeon I spoke with said the same thing. I have a problem with puffy nipples (areolas). However, my chest looks fine when the nipple/areola is cold or stimulated by touch. He said I have very very little gland that he could feel. However, he said once he starts working and gets rid of some of the fat he might some small gland that will need to be removed. He is going to first remove the fat then IF NECESSARY create an incision and remove gland. Makes sense to me.