Great question and interesting technique by Dr. Mishra. My biggest concern with the trans-areola approach is the direct excision of the tissue under the areola. It could be very easy to over dissect this tissue out and leave a divet or hollow appearance under the nipple. With the peri-areolar approach, you have direct vision of the tissue under the nipple and are able to remove tissue while leaving a small amound behind the nipple so that it does not appear depressed. Be sure to meet with a board certified plastic surgeon who treats gynecomastia often. Good luck!
Ohh, the questions skipped from my view somehow, well I just saw this and though better late than never so I preferred to post my comment on this. I welcome the questions of other surgeons on this method and would request them to read my article published in Indian Journal of Plastic Surgery in 2014 "Trans-nipple removal of fibro-glandular tissue in gynaecomastia surgery without additional scars: An innovative approach" to clear their doubts. I am operating using same method and No downsides reported from my patients till so far.Thanks you.
There are several surgical options to treat gynecomastia but it is not possible to comment not the best option for a given patient without a proper consult and physical exam. I'd suggest booking an appointment with one or more local surgeons to learn more about your options.
I would have to examine you to give you the best recommendation. Look at
reviews and before and after pictures as well as credentials to select
Kenneth Hughes, MD
Los Angeles, CA
It is the Surgeon and not the type of approach that is most important. Picking the most capable plastic surgeon who advise you as to the best technique for your individual problem is key. See the below link on hints how to pick the best board certified plastic surgeon.
I like using the periareola incision to remove subareola tissue directly and liposuction the chest to smooth out the contour. I don't know the technique seen in the video. Good luck
and be safe.
Nguyen, MD, FACS, FICS
Certified Plastic Surgeon
During my residency, I saw a multitude of different techniques ranging from ultrasound assisted gland removal to excision with endoscopic assist. However, there is a reason that direct gland excision via a periareolar approach is the most widely used. In my practice, I have found this to be very well tolerated with the least amount of complications. The scar heals almost imperceptibly and the entire gland is gone. In addition, liposuction as an adjunct can give an exceptionally smooth contour. Best wishes.
The question should be "which gives the best contour results with the least risks?". If too much glandular tissue is excised there will be a divet which is very difficult to fix. Direct vision with the periareolar approach is safer in my opinion. I have done hundreds of these operations and about 85% - 90% of men need some glandular tissue excised in addition to liposuction. I prefer to use Hi Def Vaser Lipo combined with the periareolar incision around 1/3 to 1/2 of the nipple. The scar is rarely a problem. Be sure to see a board certified plastic surgeon who performs this surgery regularly.
notice the capital S because technically there is a tiny scar but its hidden inside the armpit.this is the routine way we perform the operation. Liposuction is done initially but in about 90 percent of the patients there is also gland tissue which is then removed with a specialized instrument which pulverize is the gland portion which is then remove by suction.
In general it is difficult to remove glandular tissue except through a periareolar incision. It is tough tissue and can be hard to aspirate, as in suction lipectomy. Having carried out quite a few periareolar excisions, I find that the vast majority of patients are satisfied with the scar, although it will take up to one year until it is totally mature. Also, even if the scar is less than optimal, patients are so happy with the improved contour of their chest that they find the scar acceptable. (I have never had to revise one.)