Gynecomastia surgery - is Smart Lipo safe? Should I be concerned about scarring?

Question

I am about to sign to do gynecomastia surgery. The surgeon wanted to do smart lipo originally. After research I am concerned about scarring. The other option is incision with traditional lipo. He already stated he will make extra incisions for the lipo, although I’ve seen a lot of procedures go through the areola. I also have very pale skin and wounds heal Slowly. What are recommendations for the best procedure? Is smart lipo safe and scarring rare or no? Thank you

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Smart lipo is a great option in my opinion.  Because it's laser assisted it helps with the skin retraction component of the procedure.  I would suggest speaking with your Surgeon in depth about your concerns and then make your decision.

Daniel Barrett, MD · Answer

Dear dmcc73,
it is hard to tell for sure without an examination. Generally speaking, liposuction can help with extra fat under the areola but if you have glandular tissue then excision is a better option. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

In the end there are two variables that determine the potential outcome for an aesthetic procedure. The first is the candidacy of the patient and the second is the skill and experience of the surgeon.

Notice I didn’t include what equipment they used as an important variable.

For gynecomastia there are three tissue components as well as age that need to be assessed independently. These are the amount of excess subcutaneous fat, the amount of glandular breast tissue and lastly skin laxity. Skin laxity typically comes with age though that is more a lack of elasticity than true laxity but it can be both. Men who have had significant weight fluctuations for example often have skin laxity and don’t get the same results as those who have tight skin.

If there’s a substantial amount of glandular tissue then direct excision with an incision around the areola is needed and the amount of glandular tissue that needs to be removed falls under the category of skill and experience on behalf of the provider.

When doing Liposuction the incision point should not be right over where the work is being done. It’s much better to come in from about 10 inches away and approached area in different angles.

Fair skinned people typically do not have significant visible scars after liposuction. These incisions are generally very small and most people use cannula‘s that are 3 mm in diameter.

Skin incisions take 12 to 18 months before they stop changing and this is true for everyone. It’s better to add a small incision away from the chest and not compromise the liposuction results when doing these procedures.

Gynecomastia surgery is tricky both and making a good assessment and the technical part of the procedure. If to much glandular tissue is removed patients are left with a permanent indentation and if not enough is removed patients only get a partial improvement.

The type of Liposuction is completely irrelevant.

Smart Liposuction adds absolutely no advantage to traditional Liposuction and all experienced providers of used modality will tell you so behind closed doors.

Still, the word laser seems to have magical connotations and does sell well when it comes to the general public.

The most important two variables for you is to get an accurate assessment so you have a good understanding of what can or cannot be achieved in regards to the above stated variables.  Secondly finding the most experienced and talented provider in your community. Do that by having multiple in person consultations. During consultations ask each provider to show their entire collection of before and after pictures.

And experienced provider should have no difficulty showing you 25 or more sets up before and after pictures. Highly experienced providers will have hundreds.

Plastic surgeons who are inherently talented and have done this procedure many times and do them regularly will have the most consistent and best results.

When it comes to getting a good result this also means making an accurate and honest assessment so patients have been clear understanding of a can and cannot be delivered from the procedure.

One easy way to differentiate skin laxity and get a clear understanding of what glandular tissue represents is by stretching one hour minute time behind your head putting the pectoralis muscle under full tension as well as removing all skin laxity.

Doing this usually shows the impact of skin laxity with the arm and a down position and clearly demarcates glandular tissue. Typically after a well-done gynecomastia procedure the contour it should look just slightly indented with the arm stretched up behind the head. This may still leave patients having slight excessive fullness with the arm and a down position because most patients don’t have ideal skin for ideal outcomes. A history of a B city or true gynecomastia often has stretched a skin to some degree and this can sometimes make the results look slightly less than perfect even after a while performed the procedure.

If you’re comfortable with your provider then move forward with the surgery. If you’re not then I would encourage you and everyone else to always schedule multiple procedures to help find the most talented provider.

These are not the easiest procedures to do and get consistent high-quality results.

Best,

Mats Hagstrom MD

David E. Berman, MD (retired) · Answer

I am a huge fan of Smartlipo. It is one of the most common procedures that I do. I have done over 1,300 Smartlipos (we stopped counting at that point!) because it does an excellent job and I do them all in the office under local with oral sedation. You can return to work the next day.

however, I almost never do Smartlipo for gynecomastia!!! The reason is that the breast fullness is almost never due to fat alone,. It is almost always due to a mixture of fat and glandular/fibrous tissue. the latter will not be affect by any type of liposuction. Almost all of the men that i treat for gynecomastia, are very self conscious and will not (or if they take their shirts off and if they do, they hate it) take their shirts off in public. They need an aggressive treatment. The smartlipo will only give a minor improvement and they will not be satisfied. This is why for a general chest fullness, I almost always take them to the OR and under general anesthesia, using a periareolar incision, will directly excise most of the fibrous/glandular and fatty tissue.

the scars from surgery, usually heals extremely well, with a very hidden scar that gets better over time.

make sure you see a board certified plastic surgeon and not some wannabee plastic surgeon that calls himself a "cosmetic surgeon.". They are not at all the same.

best of luck
david berman md, frcsc

Gynecomastia surgery - is Smart Lipo safe? Should I be concerned about scarring?

Answers (4)

Answer: I am a huge fan of Smartlipo but NOT for gynecomastia

Answer: I am a huge fan of Smartlipo but NOT for gynecomastia

Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Gynecomastia surgery - is Smart Lipo safe? Should I be concerned about scarring?

Answers (4)

Answer: I am a huge fan of Smartlipo but NOT for gynecomastia

Answer: I am a huge fan of Smartlipo but NOT for gynecomastia

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Recommended reading

Everything you need to know about Gynecomastia Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.