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cannula placement points, and duration of procedure

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cannula placement points, and duration of procedure
« on: March 22, 2011, 04:46:07 PM »
Hello this is a question I was meaning to ask months ago,

Wondering about whether there is a 'norm' for placement of entry points for lipo on chest and how many are sufficient - originally told 3 on each side would be done, however have 2 entry points on both side. left hand - one near bottom of breast roughly an inch under nipple a tad to right and one above at top of chest. But on right just two on bottom - none on top. the placements are random don't follow a symmetry and apparently my procedure only took 15 minutes according to parent, was it rushed? Not that that this even matters i guess rather open ended question I know, but playing on mind for a while though. Another question is how important is massaging the area, i may have been a little slack. Its now 7 months later

Linkback: https://www.gynecomastia.org/smf/index.php?topic=22762.0

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Offline Litlriki

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Re: cannula placement points, and duration of procedure
« Reply #1 on: March 22, 2011, 05:10:11 PM »
Every surgeon will have his or her own approach to placing incisions.  If I'm just doing liposuction of the chest, I usually use an incision just near the armpit in the fold (the anterior axillary fold), along with a second incision just below the breast a little toward the side of the chest (in the infra-mammary fold).  I'm right-handed, but I am comfortable using my left hand to do liposuction as well, so I will use the same incisions on the right and the left sides.  Some surgeons are not as comfortable using their non-dominant hand, and I'm guessing that your surgeon was right-handed also, so on the right side, he used two incisions on the lower chest for easier access without too much twisting around or use of his left hand. 

I don't worry about making incisions exactly in a symmetric location, especially after getting a tip from one of my colleagues who practices in southern California.  She purposely does NOT place symmetric incisions, since the friends of her patients look for such give-away signs of a surgical intervention!  If you have little scars that are randomly located, they might be the result of having had a skin lesion excised, rather than having had a cosmetic surgical procedure.  Clever, eh?!

As for the duration of the procedure, fifteen minutes seems a little quick, but much depends on how extensive your condition was to begin with.

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

Re: cannula placement points, and duration of procedure
« Reply #2 on: March 22, 2011, 05:46:43 PM »
Thank you very much for your reply! Has given me a much better understanding and insight to the thought process and method taken whilst carrying out the procedure - use of hand, awkwardness that may be associated with non-dominant hand etc.

With regards to the random placement not giving signs of surgical intervention that sure is clever and makes total sense! I could use many excuses for the placement of scars now thinking about it....

35 cc of fat was taken from both sides

Thanks again :)

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DrBermant

Re: cannula placement points, and duration of procedure
« Reply #3 on: March 22, 2011, 08:23:26 PM »
Hello this is a question I was meaning to ask months ago,

Wondering about whether there is a 'norm' for placement of entry points for lipo on chest and how many are sufficient - originally told 3 on each side would be done, however have 2 entry points on both side. left hand - one near bottom of breast roughly an inch under nipple a tad to right and one above at top of chest. But on right just two on bottom - none on top. the placements are random don't follow a symmetry and apparently my procedure only took 15 minutes according to parent, was it rushed? Not that that this even matters i guess rather open ended question I know, but playing on mind for a while though. Another question is how important is massaging the area, i may have been a little slack. Its now 7 months later

I prefer to have only one incision for each side, and place that at the edge of the areola where scars hide better on the chest. Other independent liposuction access points just do not hide well and look like added scars on the chest. When putting extra scars elsewhere, staggering them so they do not look symmetrical gives a slightly less operated look. Two extra liposuction access points on each side make the case go the fastest and make it easier to lessen the chance of contour problems by coming at the tissue from two different directions.

Merging the center left and right extra incisions means an incision at the center of the chest, where the body tends to scar the most. In trying to minimize such external extra scars, I combined all of them years ago to one incision at the edge of the areola. This incision has gotten smaller and smaller over the years and currently measures 1.6cm or 0.6 inch. Now having this incision at the edge of the areola makes the liposuction component more challenging and demanding. It becomes an exercise in sculpting skill to achieve a great contour with less obvious surface scars. I my opinion, well worth the effort to knock off the more visible extra incisions. Unfortunately, this can be difficult for many surgeons. Performing liposuction at the areola incision point requires unusual dexterity and the right choice of liposuction cannula (I use several different types depending my sculpting needs.)

I am fortunate being ambidextrous, I can use scalpel, sew, cut, and perform liposuction with either my left or right hand. That means I do not have to bend way over my patient nor have the wrong hand available when working on the left or right side of the patient. Some of my athletes and bodybuilders have extremely wide chests and without being both handed, this would be much more difficult with only the one incision.

This central incision is part of the theme of my approach to the surgery, how the results look on animation. Leaving gland behind just does not look good when flexing the body or when the areola presses down against the underlying tissues. Documenting the results first with flexing and arms up overhead pictures and then with video led me to better understand that targeting gland first was just better. Since I was making this incision, why then add additional liposuction incisions? Or for that matter, if on many cases the incision is needed to go after "resistant" gland, why then end up with both the remote incisions and the areola incision? Even under arm incisions do not hide well when playing sports.

There are rare exceptions. Drains do not do well at the edge of the areola. So for my unusual patient needing a drain, then a remote incision is needed on that side. Beyond that occasionally, about once every 3-4 years, I get a case where the fat or scar tissue from prior surgery is just so dense that I need a remote incision to finish the liposuction.

The other much more common exception is my revision gynecomastia surgery. In that case, I use a much longer scar when trying to repair and revise the deformity at the surface. Unfortunately scars cannot be erased, only replaced by new scars. In such cases, the surface incision tends to be so much longer than my typical cases because leaving the old step off or deformed surface scar would look worse than revising it. During revision cases, the liposuction becomes so much easier, but the time saved then gets used up for a much longer surface sculpture repair.

The validity of technique and surgeon's reason for using it is best investigated with seeing how it looks and moves. I want my patients to look good both with arms at their sides, and while living life, swimming, playing sports, and with muscles flexing.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

Re: cannula placement points, and duration of procedure
« Reply #4 on: March 22, 2011, 08:38:53 PM »
One of the advantages of tiny liposuction scars is that within 6 months or more, they all tend to look like a small blemish.

My method is to perform one small (3 mm or less than 1/4 inch) incision on either side of the chest.  Through this incision, I am often able to perform lipo and remove gland/breast tissue as well. The location of the incision works ergonomically for me -- and I am ambidextrous so I can work just as easily on either side. On occasion, if the lipo alone is not satisfactory, then I do perform a peri-areolar incision.  But for many of my patients, I am able to perform the entire operation without any scars on the nipple at all!

Every surgeon has his own techniques and there is no right or wrong way to do something -- what truly counts is the final result -- not the road taken to get to that result.

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

Re: cannula placement points, and duration of procedure
« Reply #5 on: March 23, 2011, 01:50:40 PM »
Wowie! fantastic reading this, makes me really feel like I should have done a lot more research before jumping straight into my lipo procedure! My scars are pretty awful to be honest and the final result is totally not what I wanted to achieve.

Love the fact that Dr Bermant mentioned how he strives to make the patient look good whilst living life and with arms down etc, I only look good when standing absolutely straight. Sitting down they puff out the chest like before the procedure, bending over even worse one side is bigger also - have been told due to being right handed! Nipples remained extremely puffy after 7 months, have been unable to achieve any revision or touch up to rectify my situation as said in previous posts :(.

In a few years I very well may travel to visit one of you guys have read glowing reviews and can see all your great expertise reading the responses. Thank you very much


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