Gynecomastia Surgery, I had this problem from my early 20’s, need recommendations for doctors.

Considering that gynecomastia involves growth of male breast tissue, Veser or other techniques of liposuction can NOT remove the actual breast gland. it might remove excess chest fat but it can not melt away or remove excess breast gland.

VASER can be a good option for patients that minimal skin excess, predominantly fatty tissue in the cheat and minimal to moderate glandular tissue. Following VASER liposuction, if glandular tissue remains, an incision around the areolar can be used to remove excess glandular tissue and skin to give the optimal contour.

I perform this procedure using a combination of Vaser Liposuction and surgical removal of the glandular tissue which produces great results. The recovery itself is not incredibly painful. You can expect some swelling and bruising in the area and will need to wear a compression garment for a minimum of 6 weeks.

Thank you for your question.There are three main surgical options for #gynecomastia #treatment: #liposuction, #excision of excess skin and #glandular tissue, and the combination of the two.  #Results are usually #permanent.  You need to contact a #boardcertified #plasticsurgeon for an in-person consultation to discuss the best plan of action for your specific case.

Vaser is a good instrument for gynecomastia if it is INCLUDED with glandular excision.  Glandular tissue is unlike fat.  It won't "melt" like fat melts.  While Vaser alone will help with reducing volume in the chest, it won't completely alone fix gynecomastia.

                  The
surgical management of gynecomastia varies from patient to patient. This
variation depends on the severity of the problem and the type of gynecomastia
present.

                  When
glandular tissue is present surgical excision is usually necessary. This is
usually accomplished through a peri-areolar incision. The breast tissue is
first separated from the skin and subcutaneous tissue. Once this is
accomplished the breast tissue is separated from the underlying muscles and
removed as a single unit.

                  When
the breast tissue is predominately made of fat, liposuction can be utilized.
This technique involves passing a canula through the breast tissue repeatedly
while suction is applied to the canula. Cores of fat are removed and the area
is effectively sculpted.

                  In
some cases glandular and fatty components are present, and
combination procedures are necessary. Following surgery patients wear a
compression garment for four to six weeks. This helps remodel the tissue and
minimize complications.

                  It’s
important to realize that no two patients are alike and treatment should be
individualized. If you’re concerned about gynecomastia, consultation with a
board certified plastic surgeon would be appropriate. 

Gynecomastia is NOT just Liposuction (but it can be). Know who is doing it and what is involved.

Most important is not the technology but the surgeon:

• Verify Board Certification by American Board of Plastic Surgery (do this online)

• Member of American Society of Plastic Surgery (requirements beyond Board Certification)
• Member of American Society of Aesthetic Plastic Surgery (indicates extensive experience in aesthetic surgery - see below link)
• Look at online review sites - like RealSelf, Health Grades,RateMDs, Google, etc
• Look at Before and After photos
• What is my instinct or "gut reaction" as to who I relate to better, answers my questions more fully and who I basically trust the most.
• Finally ask yourself - if I was to have a complication, who would be the best to take care of me.

Procedure Description
General, Intravenous or local anesthesia are used for this procedure depending on the severity and type of procedure(s) selected by your plastic surgeon. It is performed on an outpatient basis.  For males with very large breasts staged procedures (more than one procedure) may be required. For example, the first procedure may be liposuction, then several weeks to months later after skin contraction has occurred, a separate procedure is done to remove excess skin. By doing a staged procedure, often the final scars are less.

Oftentimes, specific types of liposuction cannulas are used and often in conjunction with direct removal of excess breast glandular tissue through small incisions for mild to moderate gynecomastia. This can be the Vaser, Ultrasonic liposuction, or Power Assisted liposuction devices for better results. I prefer the Power Assisted liposuction device by Microaire. Other specific techniques can reduce the areola when needed or reposition the nipple to create the appearance of a more natural contour.

Larry Nichter, MD, FACS

With the introduction of liposuction in the 1970’s, the treatment of gynecomastia has also evolved to utilize liposuction techniques. Through small incisions located at the periphery of the breast tissue, liposuction cannulas are introduced and traditional liposuction or ultrasound-assisted liposuction (click here to learn about Liposuction) is performed to remove excess fatty breast tissue. Because fibrous, glandular breast tissue is stronger and more compact than fatty breast tissue, the fatty breast tissue is easily removed with liposuction while the denser glandular tissue remains. This often produces the appearance of a “puffy nipple” with underlying fibrous breast tissue surrounded by a flaccid, abnormally flat, or even “rippled” chest wall where liposuction has been performed aggressively.
 

You are on the right track to consult with a plastic surgeon (or a few) with experience treating gynecomastia who can show you results and discuss all risks, consequences and expectations.  VASER liposuction can be a very effective method of removing at least some of the excess (fatty) tissue, however it is usually not suficient alone. 

There is often a combination of fatty and glandular breast tissue which is more dense and tough. Sufficient removal can require a small incision to open the breast (a small scar along the lower border of the areola) and surgically remove this tissue in combination with the liposuction component.  

IF your gynecomastia condition is primarily due to fat then Vaser liposuction alone may be avery good option. However, in my experience the vast majority of patients have a glandular and fatty composition that is best treated with BOTH liposuction and direct excision. I believe most plastic surgeons do this because they want satisfied patients and not because they are credit card machines. However, if you are unwilling to undergo both procedures, you can certainly start with the Vaser lipo and if dissatisfied with the resutls, you can always come back for a glandular resection at a later date.