Different Type of Surgery?

[hitman200x]

One of the most fascinating parts of this site is looking at the before/after pictures so I can see where I'll stand in the coming month or two. However, these pictures have led me to wonder if I'm on a different time-table. The reason I ask is because all the pictures I see involve a scar on the actual nipple, which appears to be the point of entry for removing the tissue/gland/whatever.

That didn't happen to me, because the surgeon said there was a new tool that allowed him to remove the tissue without scarring me. Instead I have scars right around my armpit, where the lipo and other tool was used. Is there a difference between having the surgery done with the actual nipple as the entry point and what I had? My surgery was specifically for puffy nipples.

[DeeDubStyle619]

Its still gynecomastia surgery, just a different technique.
An incision at the nipple allows the doctor to remove the glandular tissue directly behind the nipple. Some of the tissue can be so firm, that lipo alone is not good enough.

[Dr. Elliot Jacobs]

What counts is the final result!!

Yes, there are instruments available which can remove fat AND breast tissue from a distance.  I, in fact, designed my own cannula which can do just that.  Other doctors have their own preferred instruments.

But all instruments and techniques have their limitations.  With my technique, for example, I start off trying to remove everything through a single 1/8 inch incision just below the armpit.  Many times this is successful and I do not have to make an areolar incision.  At other times, my instrument may not be able to remove extremely thick, dense breast tissue directly under the nipple.  (Imagine trying to drive a pencil into a golf ball!!).  It is at those times that I will make a peri-areolar incision to enable me to complete the removal of breast tissue and achieve a smooth, flat contour to the chest.

Again, if your puffy nipples are now flat, then your (remote) surgery was a success -- congratulations!  Proof positive that a surgeon need not make a peri-areolar incision for every single case.

Dr Jacobs

[DrBermant]

One of the most fascinating parts of this site is looking at the before/after pictures so I can see where I'll stand in the coming month or two. However, these pictures have led me to wonder if I'm on a different time-table. The reason I ask is because all the pictures I see involve a scar on the actual nipple, which appears to be the point of entry for removing the tissue/gland/whatever.

That didn't happen to me, because the surgeon said there was a new tool that allowed him to remove the tissue without scarring me. Instead I have scars right around my armpit, where the lipo and other tool was used. Is there a difference between having the surgery done with the actual nipple as the entry point and what I had? My surgery was specifically for puffy nipples.

All injuries result in scars, it the way the body heals itself. It is a process that you have experienced anytime you have cut yourself. Such scars are both on the surface and deeper where ever the injury takes place. That is why seeing how tissues move after surgery to evaluate such possible scarring is so critical.

Remote access for gynecomastia attempts have been available for quite some time. Patients complain about the under arm scars, their length, and how they show especially with the arms up playing basketball or volleyball.

Under Arm Incisions Require Sculpture from a remote location and depending on either liposuction or long fine cutting tools.  Some doctors may try the remote location first and then add additional scars by the areola.  I prefer to limit the scars on the surface and internally.  Two surface scars are much better than 4 or more. The color interface of the areola and chest is a great place to hide a scar. My typical at the edge of the areola is now typically 1.6 cm (0.6 inch) long. I can sometimes even improve another surgeon's scar by moving it to this interface as in this  Revision Gynecomastia Surgery.

I have seen just too many unhappy patients with Puffy Nipple Complication After Gynecomastia Surgery remaining after axilla or armpit attempts alone using sharp cutting cannula or other such instruments by other doctors.

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.

For a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used special remote instruments to remove gland, that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

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 prefer to avoid this unnecessary additional scar.  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.  Scars to be considered include the sculpted tissues, yes the entire zone operated on.  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
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