Today I’m doing a case of gynecomastia with the minimal invasive procedure called the pull through procedure. And what you see in this young man, he’s got a dishshaped glandular component to his gynecomastia on each side. In this case his right is larger than his left side. So in the pull through procedure we make a small incision at the areola and basically pull out the entire gland as one piece. The advantage of this is that there’s a smaller incision, it takes out all the glandular component. I only do this on men that are fairly lean and not heavy men because there are a lot of problems that resolve from that, so this is an ideal candidate.
So if we go over to the case itself, what we do is I’ve done some dissection and I’m pulling out the gland as you see here. This is the entire gland coming out now. The entire gland is coming out as one piece. So what I do as I bring it out, I dissect around it as you see here. You see the whole glandular component is coming out as one piece. And there is being attached. So this tissue surrounds this entire area deep down and it’s taking it off from almost to pectoralis fascia, so I like men to be very lean so I don’t get a crater. You got to be careful not to have a crater deformity because this goes right down to his chest wall. So I’m going to dissect this out and we have the tail of it coming out here, and you see how this entire piece of tissue comes out through this very small incision.
And were getting the tale of the gynecomastia over here. And we’re just getting to little bits of it here again. He wants it all out, so I mean most men in his case want this whole gland out. So that’s what you see in that area. This is again the pull through procedure. And you can see there’s a dark glandular tissue as well as white tissue. And we’ll go to the opposite side, and again I do the same procedure. I’ve done some dissection, pulling it out. Pull through procedure. Again you want to get this white glandular component out completely. This side’s a little bit smaller. And I’m keeping the fat on as much as I can just in trimming, and we want to avoid a crater that’s really important. So here you see from each side the pull through procedure. You know you notice that sometimes the glandular tissue is different from side to side. This is a lot larger, this is a lot smaller, and this is what could be actually very very tender as you see it, as you palpate, it. And this obviously cannot be removed from liposuction. This is dense glandular tissue and it has to be excised. Thank you very much, that’s the pull through procedure. Thank you very much.