The Wilcox Gynecomastia Technique


Gynecomastia is an overgrowth of the tissue of that male chest, which in combination of fatty tissue, as well as the normal glandular tissue found in men and women. Obesity can lease to a predominance of the fatty portion of gynecomastia whereas causes can lead to an overgrowth of the normal glandular breath tissues found in both genders. There are numerous cases of gynecomastia. Anabolic steroid use including those found over the counter without a prescription and legally sold in health food stores such as GNC, multiple prescription medications for unrelated conditions, marijuana usage, but most commonly there is no identifiable cause. Heavy alcohol use and liver conditions can also lead to gynecomastia. Gynecomastia is extremely common at onset of puberty, the majority of cases reverse themselves within a year and half. 

When gynecomastia has been present for two years of longer, it is extremely unlikely to reverse itself. In this situation, surgery is indicated to relieve the unsatisfactory appearance as well as the, sometimes, encountered painful cases of gynecomastia.

Surgery for this condition formerly was not very satisfactory for one for either the surgeon or the patient. This required an incision around the border of the areolae from the 3 to 9 o'clock positions with direct excision of the tissue under direct vision by the surgeon with scissors often leading to an irregular or lumpy final result. It also required drainage tubes coming out of the sides of the torso. Most of all, however, was the appearance of two half moon scars on the chest which no man care the display for the rest of his life. Most surgeon performed gynecomastia surgery the same way it has been performed for the last 75 years.

It occurred to me that there must be a better way. With the advent of ultrasonic liposuction some 10 years ago, I came to realize there was a better way to perform this surgery using the new technology. Traditional liposuction is ineffective in removing any of the glandular components of this condition. Remember, there are two components that need to be reduced and that is the fatty tissue as well as the glandular tissue. Whereas traditional liposuction may be able to remove a portion of the fatty tissue, it take the power of ultrasonic liposuction to have a appreciable effect.

Ultrasonic liposuction involves the use of a cannula made of titanium whose tip vibrates over 20,000 times per second. The tissue that encounter this leading probe cannot tolerate the rapid positive and negative pressure waves, and the resulting cavitiation effects causes breakdown of the tissues. This allows far more breakdown of the fatty and glandular tissue of the chest wall. Nevertheless, even ultrasonic liposuction cannot remove all of the tissue, and this is where we have multi-joined cutting instrument that can be inserted through the small incision under the arm to remove the rest of the glandular tissue.

Having said all this, the result is we can offer most patient and operation with no scar or incision on the chest, no drainage tubes and only a small 1.5 cm incision under each arm to remove this tissue and result in a flatter, more masculine torso. Since the fatty tissue and the glandular tissue are removed, the chances of recurrence are extremely unlikely and would theoretically depend upon continued stimulation from some source such as described above. Just as important as getting a flat torso is not removing too much tissue. Certainly, some glandular tissue in a small amount has to be left behind by the nipple and areola so that a depression is not left behind.

I hope this has been helpful to you. 

Robert D. Wilcox, M.D.

Article by
Dallas Plastic Surgeon