Author Topic: Sharp cutting cannulas  (Read 4266 times)

Offline hatemymoobs

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I had a consultation with a PS today who has designed a sharp cutting cannula. He examined me did some Q&A etc.
I like the idea of the sharp cutting cannula because I'm afraid of having scarred up nipples. On the other hand I'm afraid of the sharp cutting cannula because I hear good and bad about it.
The doc I saw said excising the gland removes a mass, that sometimes is hard to contour right when taken out.
Using this cannula, he explained, he can removed it slowly and accurately, along with fat to get a contour. At least that's what I got from what he said. Hopefully I'm understanding this right.

To be honest my chest feels almost exactly like my stomach fat to me- I feel a little difference but not much.

I'm sick of not knowing what to do. I really need some good advice from doctors, not salesmen, on what procedure works the best. What is taught in med school- the method that has the most success?

Also- I would think most plastic surgeons would have photos to show. This one, very surprisingly, had none to show me other than the 4-5 on his website. If he does 25 a year and has been doing this for 15+ years, he should have more than that. But he says he doesn't take after photos. He said the result is in front of you. I guess my point is that photos aren't always taken for the patient, but for the potential patient to see his work...

Help? Really sounded good, but not sure.

Linkback: https://www.gynecomastia.org/forum/index.php?topic=23472.0

Offline hatemymoobs

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I'll just go out and say his name- it's not like I'm slandering. Maybe you doctors know him, and if you have an opinion you can send me a PM if you don't find it suitable for public forums.
Robert Hamas in Dallas.

Like I said, everything sounded good... but no photos? And I hear good and bad about this technique.
Please help. Thanks.

Offline Litlriki

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I don't know Dr. Hamas, nor have I used his cannula.  I used the Rosenberg cannula in the past, and I was completely unimpressed with my ability to manage thick glandular tissue with it.  I have found that I have the greatest control of the glandular tissue with a direct excisional approach through a short peri-areolar incision, and the scars heal and fade quite well in nearly all cases.  I'm not sure why the surgeon wouldn't have photos of more than 4 or 5 patients if he does a lot of the cases.  You might want to check around a little more.  There are lots of surgeons in Dallas.

Good luck,

Rick Silverman
Dr. Silverman, M.D.
Cosmetic and Reconstructive Plastic Surgery
29 Crafts Street
Suite 370
Newton, MA 02458
617-965-9500
800-785-7860
www.ricksilverman.com
www.gynecomastia-boston.com
rick@ricksilverman.com

Certified by the American Board of Plastic Surgery

Offline hatemymoobs

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Thanks for the reply.
I'm not sure that my gyne has much tough glandular tissue, so it may not be an issue for me.
In any case that doesn't help me feel better choosing a surgeon who has a very small portfolio to view.
He says he does about 25 gyne surgeries a year, I don't have a clue why you wouldn't want to take before and after pictures of your work, though.

I still have a consult set up with Dr Dr. Wilcox. I'm hoping to see 3-5 surgeons, and each surgeon I contact that doesn't have a lot of experience in gyne I'm asking for a referral to a PS who does.

If you know a doc experienced in gyne in the north TX (Dallas / Fort Worth) area please let me know.

Offline hatemymoobs

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Any more feedback from other doctors?

Sharp cutting cannulas? Can they be 100% successful in any cases?
I don't want to be left with puffy nipples...

Offline Dr. Elliot Jacobs

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I have designed my own specific cannula for gynecomastia.

In about 40% of cases, it is capable of removing virtually all excess tissues -- the only scar is a tiny nick in the skin near the armpit area.

I know some other docs don't think it works -- but they haven't tried it!

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

DrBermant

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I had a consultation with a PS today who has designed a sharp cutting cannula. He examined me did some Q&A etc.
I like the idea of the sharp cutting cannula because I'm afraid of having scarred up nipples. On the other hand I'm afraid of the sharp cutting cannula because I hear good and bad about it.
The doc I saw said excising the gland removes a mass, that sometimes is hard to contour right when taken out.
Using this cannula, he explained, he can removed it slowly and accurately, along with fat to get a contour. At least that's what I got from what he said. Hopefully I'm understanding this right.

To be honest my chest feels almost exactly like my stomach fat to me- I feel a little difference but not much.

I'm sick of not knowing what to do. I really need some good advice from doctors, not salesmen, on what procedure works the best. What is taught in med school- the method that has the most success?

Also- I would think most plastic surgeons would have photos to show. This one, very surprisingly, had none to show me other than the 4-5 on his website. If he does 25 a year and has been doing this for 15+ years, he should have more than that. But he says he doesn't take after photos. He said the result is in front of you. I guess my point is that photos aren't always taken for the patient, but for the potential patient to see his work...

Help? Really sounded good, but not sure.

I have posted here before about my experiences of many patients coming to me after being unhappy having surgery done by these cannula by surgeons claiming that they work. Have you tried searching this forum for patient experiences by doctor's name or the phrase "sharp cutting cannula"? The search function is a powerful tool to see others' results.

Over the years I have been asked for help by so many patients done elsewhere that I recently reviewed the past few years and found over 500 requests for help after liposuction done elsewhere. There were so many that I divided the patients by where they were asking for help and recently published some of the requests and complaints for New York, New Jersey and Texas. There were so many more, I have yet to consider publishing. On my site I have posted actual after surgery complications pictures for patients having had sharp cutting cannula liposuction. I coined the phrase Puffy Nipple Complication for one variation of the deformity I was correcting for this problem. In another example I posted results for which I could not repair the extended crater deformity (another term I coined for complications of another type). The main point of that page is that when looking at limited documentation (relaxed views) the true results could be hidden. When flexing muscles, lifting arms up overhead, and videos the real life issues are no longer hidden. (Unless the individual only cares what they look like with their arms down, muscles relaxed.)

In addition I have used aggressive designed cannula over the years and never saw it remove gland components. With my Dynamic Technique I start with the gland at the edge of the areola. When fingers of gland extend beyond the original under nipple component, I have documented that liposuction does not remove those elements, just the fingers of fat. I have made videos in the operating room documenting the process. Fat floats in the liposuction container. Gland and firm tissues sink. I have looked in these canisters and have yet to find any gland elements.

If I did not see so many unhappy patients done with such tools, it might not matter. There is no reason why someone who is happy with a method should come to me. However if something works, a surgeon should be able to demonstrate such results more than just a few images with muscles relaxed. With what I have been documenting from unhappy patients done by surgeons advocating such methods, my own experiences dealing with the elements of male chest contouring in the operating room, the complaint in this forum from patients unhappy after liposuction only surgery, and the revision cases that I have then removed residual gland from patients who had surgery done elsewhere, no, I do not see sufficient documentation that something works. Liposuction will work fine if the gland contribution to the contour is so small that remaining fat can hide the gland.

Remember that whenever a surgeon needs to add additional incisions, check how the other incisions look. Something you cannot do if they only show images with arms hiding those incisions! My read is that 2 small incisions is better than needing 4. You should also look for close up pictures of the scars since verbal claims for small scars is not as powerful as seeing what they look like. (Again something that does not matter if you don't do any activities which can end up showing those regions.)

Sorry, new forum rules ban the linking of proof and documentation by surgeons. Taking someones word for proof is not as powerful as actual pictures and video documentation. Look for something as critical for at least my Standard After Gynecomastia pictures or even more refined, Standard Videos. Otherwise it is a gamble having surgery by something that you cannot critically examine what that method produces.

Hope this helps,

Michael Bermant, M.D.

Offline hatemymoobs

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Dr Bermant- I have read your thoughts on sharp cutting cannulas and it is obvious you are against them for the treatment of gynecomastia.

What I don't understand is why there are other surgeons who stand by this method. If it didn't work for them, why would they continue to use this method?

Also- of all the revisions you've done of all liposuction only surgeries, is it documented whether or not it was a standard cannula, sharp cannula, if it was a general or plastic surgeon, if they surgeon had much experience?

What I'm getting at is that it is possible lipo-only is more likely unsuccessful in more cases than not- but are the cases that they're not successful in done by inexperienced surgeons with a blunt cannula made for standard liposuction procedures?

Dr Jacobs,
Thank you for your reply. Is there a good way- pre-op to determine if a patient is likely to succeed from a lipo only (using a sharp cannula) or is it not until during the surgery when the surgeon is aware of what kind of tissue is inside the breast that needs removal.

My concern is that I don't feel a disc like hard bump or anything like that. For the most part it just feels fatty, but perhaps slightly more firm and "lumpy" when pressing my fingers around. I've read in female breast tissue it is common for them to feel "lumpy" and that is just the ducts and other things that make up the breast. Is this true of male (normal) chest fat?

I've only seen one consult and he pretty much exclusively uses the sharp cannula, but didn't provide any photos. So far he's out, and it doesn't help that it's been nearly a week since I sent in some follow up questions with no response at all...

Any feedback greatly appreciated, from both of you- and any other doctors who have opinions on this topic and the replies within.

Thanks.

Offline hatemymoobs

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While I'm at it- do any of you have photos of a traditional cannula vs a cannula designed for gynecomastia?
I'd love to see how they are different, and if the method of using the cannula is any different.


Offline Dr. Elliot Jacobs

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I can never tell for sure -- pre-operatively -- if my cannula alone will be sufficient to do the job.  That is why I use a graduated approach to gyne surgery.  I first do whatever I can to achieve results using my cannula alone -- and in roughly 40% of cases, that is sufficient to achieve a smooth and contoured chest. 

If, however, I encounter some extremely dense breast tissue (usually directly under the areola), then without hesitation, I will proceed to perform an excision through a peri-areolar incision.

To perform adequate gyne surgery, a surgeon must be prepared to do anything necessary to achieve a good result on the initial operation.

This is a brief summary of my approach to the operation.  I know other doctors have different approaches -- as long as the results are good, it really doesn't matter which technique is used.  However, I do not disparage other doctor's approaches.

If you go to my website, you can see photos of patients all of whom have had surgery with my cannula.  You can also view an entire section on peri-areolar scars to illustrate how they tend to heal.

Dr Jacobs

Offline hatemymoobs

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Yes, Dr Jacobs- I have been to your site many times and am impressed with your results.
Believe me- if I had the money I'd get it and fly to NY to have you do my surgery.

Any chance you'd want to fly down to TX and do my surgery? ;D



 

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