I have Grade 2 Gynecomastia. My situation warrants the removal of glandular tissue through a small incision in addition to some fat via lipo. However, I fear that gland removal will not be aesthetically attractive since it will result in a flat chest. Therefore I'm contemplating performing either a Vaser procedure or the Radio frequency Assisted Lipo and not removing the gland. Is this a common approach? How much reduction can I expect? Will the results be satisfying? Is RFAL superior to vaser?
Will Results Be Satisfying if I Keep the Gland Tissue and Only Remove Fat?
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Gynecomastia repair using liposuction without Gland excision
Generally excision of the gland is important in treating real Gynecomastia(unlike pseudogynecomastia). Vaser is as good as many other liposuctions instruments.The surgeon's experience with this surgery can make the difference.
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Liposuction Only for Gynecomastia?
An experienced plastic surgeon in gynecomastia will know the correct amount of fat and breast tissue to remove to leave a well sculpted chest. If you have only fat removed you will not be happy. You will find that breast tissue without the support of fat around it will be even more obvious. The only patient that does well with liposuction alone is the patient that has "pseudo-gynecomastia", which means he has only excess fat in the breast, not excess breast tissue. Men who come to me for gynecomastia redo surgery that only had fat removed represents about 30% of my gynecomastia cases.
Is it worth not removing the glandular tissue for treatment of gynecomastia?
Definitely NOT. You really need to get the glandular tissue removed. This is where the real problem is. If you don't you will be left with residual fullness that may even look worse after all the surrounding fat has been removed. When done properly the results should leave you with a smooth chest, not one which is overly flat or caved in. Find someone who knows what they're doing.
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Gynecomastia revision surgery
The best surgical solution for your “problem area” is best determined by direct physical examination. In my experience, for most patients with true gynecomastia, partial glandular resection along with peripheral liposuction surgery tends to achieve the best results.
On the other hand, patients who have a significant “excess” of adipose tissue without a dominant gland may benefit from liposuction alone. This is assuming of course that significant excess skin (or poor quality skin elasticity) is not an issue.
My best advice to you: pick a well-trained/experience plastic surgeon for consultation and go from there. Best wishes.
Gynecomastia and gland removal vs fat removal
Most plastic surgeons who specialize in this operation will tell you that they usually have to remove both fat and gland to get a proper result. Occasionally I will see a very thin early adolescent with either one side or both where it is pure gland tissue but that is the exception. I do the operation using the "Scarless" approach, with a tiny excision in the axilla and the liposuction is performed and the gland is also removed from the same incision using an instrument that mechanically grinds up and liquefies the hard gland tissue. This leaves no scar on the front of the chest around the areola. The final decision has to be left to an experienced who deals in this all the time. Hope this is of some help
Male breast reduction
Although liposuction can remove the fatty tissue around the periphery of the breast in men who have gynecomastia, even Vaser assisted liposuction may not adequately remove dense central breast glandular tissue. You are correct that in some cases, if all the central glandular tissue is removed, it can result in a flat chest or even a central depression. therefore, it is important to tailor this central glandular tissue and not necessarily remove all of it, when performing the surgery.
Glandular Tissue Should Be Removed In Gynecomastia
I think that you may be disappointed if you have glandular tissue present and do not have it excised at the time of your gynecomastectomy. I do not feel that there is a significant advantage in using Vaser or radio frequency assisted lipo over regular liposuction if a tumescent technique is employed. If you have your surgery performed by an experienced (in gynecomastia) plastic surgeon, it is not likely that you will have a depression under your areola.
True gynecomastia requires glandular removal. Fat around the gland can be feathered for a final result. Ive performed several hundred male chest and schools axilla combos and the chest needs to be sculpted, not just "operated on"..have a great day! Dr Jeneby