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Planning a liposuction only? Maybe not a good idea. Advice and some questions

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Hi guys, I am new here.

This site is packed with a lot of useful information and unfortunately I became aware of it a little too late - my usual bad luck! - as I already had my surgery (liposuction only) on May 7th.
 
To make a long story short: I am a 40 year old guy with a degree of gynecomastia that can be defined as mild, simply because I was always able to somehow mask it: during my childhood and adolescence  by being fat and in the last 20 years by building pectoral muscles: I look kind of OK without a t shirt on, though, as soon as I am not training for a while and/or eating a bit badly, thus putting some weight on, my teats are more visible.

I knew virtually nothing about gynecomastia and my surgeon (I am based in denmark, Europe) suggested to perform a liposuction only, as he claimed I mostly had fat to be removed; moreover,  taking out the tissue would have caused cavities on my chest, so he said.

In retrospective, I wish I had seen this web site before my surgery; I would have done things differently as I read a lot of posts in here which are basically saying that only liposuction does not work.

The problem here in Denmark is that most of surgeons do not know very well this particular field in plastic surgery: I will try to warn the Danes in the local forums section of this web site against doing the surgery with this doctor - who is supposed to be a good one! - also depending on what kind of answers I will get). I really hope the guy knew what the hell he was talking about, as I am beginning to question his know how ...

- First he goes for the lipo only; (maybe this is the only thing he knows)
- second he does small incisions outside the areola-area, in the lower chest area - this is the least of my problems, as the scars are tiny and they won't bother me;
- third just after the surgery things were already not looking good: my right chest had remarkably improved, my left one only a little because of a lot of swelling (he indeed took out more fat from my left side..). 
- Fourth he did not tell me to massage the chest to prevent the creation of scar tissue.

Now, 7 days post surgery, I briefly removed the compression vest and realized that the situation is back to what it was before the surgery, if not worse: of course, I still feel that my breasts are still there, 'cause most of the original tissue has not been removed by the lipo, namely because it was not fat, but tissue!
My right chest has only slightly improved, my left chest got even worse then ever because it swelled quite a lot and probably scar tissue is forming as we speak.

QUESTIONS:
I do realize it's going to take upward to 6 months for the final results or so, but the question is what are they gonna be?
Does anybody knows what kind of effects 'liposuction only' have?
Only a small improvement which does not justify the price of the surgery? Maybe I was expecting too much!
Forget about the money and the time, that I most probably wasted, but is worst case scenario that I am going to be back to where I started, or can things get even worse, like a lot of extra skin hanging?

Then, how long should I wait before starting to massage myself in the chest area? I read a lot of posts in here, some saying almost immediately after the surgery, other posts claiming that it was best to wait 2 or 3 weeks ... any ideas? My doc still maintains that I do not have to do it.

How long should I wait for a revision: again different answers in different posts, 4, 6 months? A year?


ADVICE:
After a week of this crap I am starting to believe that 'liposuction only' is probably not the answer, you gotta go the extra mile, that is to say for the whole thing,  lipo + excision.
I'll keep you posted about my progress (or lack of it), but I have a bad feeling about this.


Thanks in advance

Shane



Linkback: https://www.gynecomastia.org/smf/index.php?topic=14083.0

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GynO_DuDe

Liposuction does work depending on the case. My surgeon was telling me yesterday (went to visit him first time since I had my surgery) and he told me that in older men like yourself its usually fat that needs to be removed. Where as in my case (I was 20) its glandular tissue that had developed really badly so he had to excise that.

Quote
Then, how long should I wait before starting to massage myself in the chest area? I read a lot of posts in here, some saying almost immediately after the surgery, other posts claiming that it was best to wait 2 or 3 weeks ... any ideas? My doc still maintains that I do not have to do it.

Massaging is your choice, if you do it, it promotes healing. But if you don't it'll just take a bit longer to sort itself out.
I would start massaging after a month or two but it depends on when you feel comfortable. If your chest feels fine when you press on it, then go for it, start tommorow if you want! Regular massaging helps get rid of scar tissue (and it really does work, ive noticed it)

Quote
How long should I wait for a revision: again different answers in different posts, 4, 6 months? A year?

6 months, but most surgeons suggest you give it a year before definitely having revision as then your chest should be 100% healed for ROUND 2.

GynO_Dude ... thanks a bunch for your reply ..

you wrote had your gyne removed in August 2007 .. (so are you happy with the results?)
it is great that you are still sticking around the site in order to help 'new' guys like myself!
So, thanks for confirming that massaging promotes healing and it worked for you as well.
Did you hear about any risks in starting too soon?
 

LIPOSUCTION ONLY:

My doc himself told me that I also have glandular tissue, but he'd rather not remove it in order not to create cavities in
my chest. I am beginning to suspect that he simply did not know how to do it.
Having said that, if my chest will improve even only 50% compared to my condition prior to surgery, that would be great.

The real question is, has anyone in my condition only tried liposuction? What were the results?

Anybody knows it?

*

DrBermant

Hi guys, I am new here.

This site is packed with a lot of useful information and unfortunately I became aware of it a little too late - my usual bad luck! - as I already had my surgery (liposuction only) on May 7th.
 
To make a long story short: I am a 40 year old guy with a degree of gynecomastia that can be defined as mild, simply because I was always able to somehow mask it: during my childhood and adolescence  by being fat and in the last 20 years by building pectoral muscles: I look kind of OK without a t shirt on, though, as soon as I am not training for a while and/or eating a bit badly, thus putting some weight on, my teats are more visible.

I knew virtually nothing about gynecomastia and my surgeon (I am based in denmark, Europe) suggested to perform a liposuction only, as he claimed I mostly had fat to be removed; moreover,  taking out the tissue would have caused cavities on my chest, so he said.

In retrospective, I wish I had seen this web site before my surgery; I would have done things differently as I read a lot of posts in here which are basically saying that only liposuction does not work.

The problem here in Denmark is that most of surgeons do not know very well this particular field in plastic surgery: I will try to warn the Danes in the local forums section of this web site against doing the surgery with this doctor - who is supposed to be a good one! - also depending on what kind of answers I will get). I really hope the guy knew what the hell he was talking about, as I am beginning to question his know how ...

- First he goes for the lipo only; (maybe this is the only thing he knows)
- second he does small incisions outside the areola-area, in the lower chest area - this is the least of my problems, as the scars are tiny and they won't bother me;
- third just after the surgery things were already not looking good: my right chest had remarkably improved, my left one only a little because of a lot of swelling (he indeed took out more fat from my left side..). 
- Fourth he did not tell me to massage the chest to prevent the creation of scar tissue.

Now, 7 days post surgery, I briefly removed the compression vest and realized that the situation is back to what it was before the surgery, if not worse: of course, I still feel that my breasts are still there, 'cause most of the original tissue has not been removed by the lipo, namely because it was not fat, but tissue!
My right chest has only slightly improved, my left chest got even worse then ever because it swelled quite a lot and probably scar tissue is forming as we speak.

QUESTIONS:
I do realize it's going to take upward to 6 months for the final results or so, but the question is what are they gonna be?
Does anybody knows what kind of effects 'liposuction only' have?
Only a small improvement which does not justify the price of the surgery? Maybe I was expecting too much!
Forget about the money and the time, that I most probably wasted, but is worst case scenario that I am going to be back to where I started, or can things get even worse, like a lot of extra skin hanging?

Then, how long should I wait before starting to massage myself in the chest area? I read a lot of posts in here, some saying almost immediately after the surgery, other posts claiming that it was best to wait 2 or 3 weeks ... any ideas? My doc still maintains that I do not have to do it.

How long should I wait for a revision: again different answers in different posts, 4, 6 months? A year?


ADVICE:
After a week of this crap I am starting to believe that 'liposuction only' is probably not the answer, you gotta go the extra mile, that is to say for the whole thing,  lipo + excision.
I'll keep you posted about my progress (or lack of it), but I have a bad feeling about this.


Thanks in advance

Shane



Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.   I have even done revisions on some patients of doctors who wrote articles in plastic surgery journals claiming how great these new devices were for treating gynecomastia!

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques. 

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

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GynO_DuDe

GynO_Dude ... thanks a bunch for your reply ..

you wrote had your gyne removed in August 2007 .. (so are you happy with the results?)
it is great that you are still sticking around the site in order to help 'new' guys like myself!
So, thanks for confirming that massaging promotes healing and it worked for you as well.
Did you hear about any risks in starting too soon?
 

LIPOSUCTION ONLY:

My doc himself told me that I also have glandular tissue, but he'd rather not remove it in order not to create cavities in
my chest. I am beginning to suspect that he simply did not know how to do it.
Having said that, if my chest will improve even only 50% compared to my condition prior to surgery, that would be great.

The real question is, has anyone in my condition only tried liposuction? What were the results?

Anybody knows it?


Yeah its been somewhat 8 months since my op ... I had many ups and downs and im still not fully healed yet according to my surgeon which is fantastic because im more than chuffed with the results so far. My surgeon pinched a a bit underneath my nipples and basically pointed out scar tissue as I originally thought it was a bit of sagging skin (as I had a case of extreme gyne) so thought I might need revision to rectify the skin after a year ...

He also operated on me through a small incision under my armpit area which the scar isn't even visible any more .. using a vibrating cannula which removed gland and fat. I have photos for evidence before any one starts questioning the technique saying "oh its just another case of lipo" ... because its not.

"I have photos for evidence before any one starts questioning the technique saying "oh its just another case of lipo" ... because its not."

Can you post a link to pics? I'm considering a doctor who uses this technique and I'm curious as to how well it works

UPDATE ON LIPOSUCTION ONLY Surgery   

Hi trojan213 ...
I do not have some pics taken before the liposuction, but I have a few taken a few days after and it looked like hell!

But I do not want to be too hasty: I know that it can take upward to 6 months for the final results.
I will take some new ones after 4 weeks (this would be a good check point), so that everybody can see whether I achieved some improvemnets with the LIPOSUCTION ONLY technique.
As a matter of fact, I think I had a type of lipo-like surgery very similar to milesed1.
I saw his posts today and this gave me hope!

http://www.gynecomastia.org/smf/index.php?topic=13122.msg91575#msg91575

My gyne was a bit worse than his, though I have bigger pecs, so I was always able to mask it .....


As I said, since it really seems that nowadays all Dr's do lipo with the incision no matter what (also the good doc Michael Bermant) I wanted to keep you posted about my progress (or lack of it) to see if the lipo-like surgery works.
I think it turned out great for milesed1 and if I will achieve the same results I'll be a happy man!

so long

Shane,

You're right.  Most cases today involve a combination of direct tissue excision and liposuction.  The methods selected will vary with the individual case, as you know.  You mentioned that you had this problem in childhood and adolescence, so you possibly have some glandular tissue as well.  I think you said your surgeon even told you you have it.  But don't be too quick to judge your result.  Give your chest plenty of time for swelling to resolve.  I always start my patients on aggressive massage, and I instruct them to get an electric massager.  I instruct them to massage daily for at least 10 to 15 minutes.

Good luck, and be patient!

Dr. Pope, M.D.
George H Pope, MD, FACS
Certified - American Board of Plastic Surgery
Orlando Plastic Surgery Center
www.georgepopemd.com
Phone: 407-857-6261

Doctor Pope,
thanks for taking the time to answer my post.. it was very kind of you!

Now 10 days post operation, the swelling is going a bit down and have not much pain any longer; but I am noticing a lot of hard scar tissue forming on my left chest (from where my surgeon sucked out more fat).
I have read that very early massage after surgery can be detrimental (it can create more inflammation and swelling than it helps) ... so when do you usually recommend massage, if at all, 4-6 weeks after surgery? 2-3 weeks ?  My doc still maintains that I do not have to do it.
What's your opinion?

Then a comment: I am pretty much in good shape, and for sure my gynecomastia is also caused by some glandular tissue as well. My doc claimed that taking out that tissue would have caused cavities on my chest and I agreed with him since I knew virtually nothing about the subject.
Now that I discovered this site, I am not sure that this was the right thing to do: I am wondering why the guy did not go the extra mile taking away the glandular tissue since he was at it!?
There are so many other cases described in this forum in which a combination of direct tissue excision and liposuction worked out perfectly. 
As I mentioned the problem is that here in Denmark (or in the whole Scandinavia) there aren't many experienced surgeons with regard to gynecomastia: it seems they only know liposuction.
As a proof, I wrote another post in which I am asking if anybody in Denmark or Sweden knows a capable surgeon: lots of people read it, but no one single reply!
Are you interested to start a frenchising in Denmark?   ;D
 
For the moment being I'll only have to be patient: for sure there will be an inprovement as he did take out around 250 ml from each breast.

As I saw that quite many people are reading this thread about liposusction only, I'll keep posting news about my progress.
 


Bye for now

Shane,

Yes, it's a good thread, so keep it up! Und ich spreche ein bischen Deutsch, aber kein Danish, so kann ich  nicht in Denmark arbeit.  :'(

But, I do have my patients start massage after a couple of weeks, as soon as they can tolerate the massage with no pain.  That has to help.

Regarding your glandular tissue, you may be fine.  Give it some time; I'm sure you look much, much better after aggressive liposuction.  But if you need revision surgery down the road for gland tissue removal, so be it.  Not really a big deal, and it can probably be done under local. 

Dr. Pope, M.D.


Mange tak (thanks a bunch in danish) doc!

Again, you have been most kind.

regards

shane

UPDATE: 24 may (more than 2 weeks after liposuction)

OK 2 weeks have gone since the operation: the situation seems to be a bit better.
My left chest is still bigger (because of swelling and scar tissue) if compared to the right one.
Anyway, the stitches have been removed and, since I have practically little pain, I will start massaging the area today.

I tried to post some pictures, but I can't attach any files, nor insert images in the post ...




Shane

New Status after more than 7 weeks post-op. DOES THE LIPOSUCTION WITHOUT EXCISION WORK?

A little recap:
I am a 40 year old guy with a degree of gynecomastia that can be defined as more than mild, though I was always able to mask it by building pectoral muscles.

I knew virtually nothing about gynecomastia and my surgeon suggested to perform a liposuction only, as he claimed I mostly had fat to be removed; moreover,  taking out the tissue would have caused cavities on my chest, so he said.
Another odd thing, he did small incisions outside the areola-area, in the lower chest area (this is the least of my problems, as the scars are tiny and they won't bother me).
I tried to upload pre and post-op pictures, but apparently they take too much space and cannot proceed with it, so we'll have to go with mere descriptions....

Just after the surgery things were already not looking good: my right chest had remarkably improved, my left chest got even worse then ever because it swelled quite a lot (he indeed took out more fat from my left side..). 

Now 7 weeks have gone and I can say that the healing process should be more or less completed .. so the results I have gotten now, are probably as close as possible to the final outcome.

Both chests have quite improved if compared to where I was before the operation. I know that I should wait until 6 months have gone to be sure about the final results.
However, no further progress will remove the tissue that is still there, especially in my left chest (which is a bit bigger than my right chest).
As a result of this combination of tissue + my big pecs, my chest area looks quite disproportional compared to the rest of my body.
I can still feel the tissue, unless I flex my muscles.... but, I can't flex my pecs 24-7, can I´? :-)

Such a small improvement does not justify the price of the surgery. I have no one to blame as this is actually my own fault: I did not do my homework properly.
In retrospective, I wish I had seen this web site before my surgery; I would have done things differently: only liposuction does not work when, like me, the patient has also a lot of tissue to be taken out. You gotta go the extra mile, that is to say for the whole thing,  lipo + excision.

Be careful when choosing a doctor, because not necessarily they know what they are doing.
I am based in denmark, Europe, where most of surgeons do not know very well this particular field in plastic surgery and believe they can solve everything by performing a lipo.
The guy still maintain that removing the tissue would make my chest deformed!


Anyway, I am also choosing to look at the bright side. My situation was not so bad to begin with (I saw some pictures in this site that depicted situations far worse than mine) and I did get a small improvement and no extra skin hanging.
I have begun working out today (I did loose a lot weight because of forced inactivity) and will grow my pecs bigger in the next 2-3 months.


Then, at the beginning of next year I will go for a revision: though choosing another doctor.
When the time comes, there would be no liposuction to be performed, so the recovery period should be shorter.




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Offline MSJ108

  • *****
  • 855
Liposuction does work depending on the case. My surgeon was telling me yesterday (went to visit him first time since I had my surgery) and he told me that in older men like yourself its usually fat that needs to be removed. Where as in my case (I was 20) its glandular tissue that had developed really badly so he had to excise that.

Quote
Then, how long should I wait before starting to massage myself in the chest area? I read a lot of posts in here, some saying almost immediately after the surgery, other posts claiming that it was best to wait 2 or 3 weeks ... any ideas? My doc still maintains that I do not have to do it.

Massaging is your choice, if you do it, it promotes healing. But if you don't it'll just take a bit longer to sort itself out.
I would start massaging after a month or two but it depends on when you feel comfortable. If your chest feels fine when you press on it, then go for it, start tommorow if you want! Regular massaging helps get rid of scar tissue (and it really does work, ive noticed it)

Quote
How long should I wait for a revision: again different answers in different posts, 4, 6 months? A year?

6 months, but most surgeons suggest you give it a year before definitely having revision as then your chest should be 100% healed for ROUND 2.

agree all around. good post

Hi there,
I was in this forum during the last 2 years trying to describe my postop experiences when I had both a liposuction (June 2008) and gland removed (July 2009).
 
I had a long break from this site (basically 10 months), simply because I needed to get away from the whole matter for a while: I really feel that my gynecomastia problems always played a very dominant role in my life and now that the (t)issue  is 'gone' (or at least greatly minimized) it was time to get completly away from it!
Now, one whole year since my last operation has passed; its results are pretty much stable and most satisfactory, so it is time to share my experiences with others.
More importantly, I would like to give some words of advice so that, those of you that are considering a GYNO operation right now, would not make some of the same mistakes I made.

Let me start writing down the things I have learnt..

1) doing a liposuction only is (maybe) not a good idea if you both see and feel the gland in your chest. You will be disappointed by doing the lipo only and such small improvements (if any at all) do not justify the price of the surgery. Believe me.
2) do your homework properly: find a specialist in the field, who has performed many gyno operations before (I went to DR Jacobs in NY: he's great, but maybe there are other docs located closer to where you live): 'normal' plastic surgeons, though experienced, might have limitations especially in those cases where liposuction is not enough and you need to remove the gland as well.
3) the right specialist is extremely important especially when you are dealing with situations that are not so bad to begin with and only small improvements are necessary. You want to have those improvements without nasty side-effects like extra skin hanging, cavities etc. Basically, you gotta go the extra mile, financially and, sometimes geographically: as I said, I went to Dr Jacobs in NYC, but I am based in Europe! Spending a big bucket of money once (and for all), is better than doing 1 or 2 revisions afterwards, in terms of time, pain and saved money!!
4) do not have highly unrealistic expectations: it all depends on your degree of gyno; the worst your initial situation is, the most difficult it would be to get what you might perceive as the 'perfect result'. Within the boundaries of  reason huge improvements can be obtained, but miracles are not possible.  


more details here:

http://www.gynecomastia.org/smf/index.php?topic=21128.0





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