Can glandular tissue be taken out through Vaser Lipo?

Question

I have minor gynecomastia and am looking for surgery to get the glands (which are small) removed, along with some body tightening for loose skin. I have a surgeon who told me that he can remove the glands through the same incision/cannula he uses for VASER lipo. Is this possible? From what I’ve read and seen on here, the glandular tissue can only be resected through cutting it out. I want to be sure before I pay for the surgery.

Azita Madjidi, MD, MS, FACS · Answer

I always use VASER to treat gynecomastia and removing the gland is not done by VASER alone but with liposuction component of it and using a specific cannula. I rarely have to do any incisions around the areola to remove the glandular component.

George Marosan, MD · Answer

Thank you for your question. VASER does not remove thick glandular tissue. Gynecomastia surgery is my most common procedure in men. I always use the VASER to remove the fat off the lower aspect of the pectoralis major muscle, lateral chest wall between the lateral pectoralis and and anterior border of the latissimus dorsi muscle. This is done through a 1 cm incision in the armpit and within the areola (pigmented tissue around the nipple). No visible scar postop, period. I remove the gland through the same 1 cm incision within the areola without creating visible incisions.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck. See attached web reference. This patient had a subcutaneous mastectomy, almost all hard gland tissue (250 gm), and still managed to liposuction 250 cc of fat per side.

Jason Emer, MD · Answer

its very important you go to someone experienced. VASER cannot remove gland tissue. see my IG and youtube. Best, Dr. Emer.

Arian Mowlavi, MD, FACS (license on probation) · Answer

You would benefit from gynecomastia surgery. In addition, chest masculinization using high definition VASER liposuction and renuvion skin tightening could produce incredible HD results. The Gold Standard for superior liposuction results requires use of the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I perform full body liposuction cases every week. VASER liposuction has been the only modality that has consistently resulted in outstanding liposuction outcomes. VASER liposuction ensures a smooth contour regardless of degree of excess fat by virtue of being able to remove any and all remaining fat comprehensively and uniformly. If skin redundancy is observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing.

Respectfully,
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

VASER is better at removing fat that has a lot of connective tissue and can remove some of the fat in the transition zone between the breast tissue and pure fat.

From my first hand experience it doesn’t remove all glandular tissue and sometimes insufficient.

Did your plastic surgeon show you impressive before and after pictures of gynecomastia surgery using a VAS ER and men who had chests that looked similar to yours?

If so how many results were shown?

Personally the best way to treat gynecomastia for most men it’s a combination of liposuction and direct excision of glandular tissue. The scar is usually very forgiving.

It gives consistent predictable results.

I should tell you that skin laxity is a fairly major inhibitor of getting good results for gynecomastia surgery. Even moderate skin laxity causes the lower chest to bulge significantly.

In my opinion there is no treatment that actually does a good job of tightening skin other than cutting skin out.

I don’t want to sound too pessimistic but I think it’s much better to hear the truth and what can and cannot be accomplished than to leave patients dissatisfied with some type of excuse of why the technology didn’t deliver.

The following are some general recommendations for patients seeking cosmetic surgery.
1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.  
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom MD

Kristine Brecht, MD (license suspended) · Answer

Dear VA,
I’ve helped many patients with gynecomastia, make a more masculine chest. 
The answer to your question is, it depends on several factors.
Excess fat, excess skin and excess glandular tissue all play a role in gynecomastia.
 Each component has different treatments during the same surgery. Vaser can do some skin tightening and fat removal, Renuvion jplasma can do more skin tightening (which is most often needed, older techniques excise the skin away, but bigger scars) and excision of glandular tissue (through a tiny incision in the areola region). Liposuction alone can not getting rid of glandular fibrous tissue. 
Happy to help!
Best. Dr.Brecht 
Seattle, Wa

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