Dr. Delgado: This patient is a typical kind of gynecomastia patient. A young man in good shape and he’s had gynecomastia since about 12 or 13 years old. He should get a very good outcome he’s got very good quality skin he’s got in areola that’s not overly stretched out so it should contract very very nicely. He’s got a good definition of his pack and therefore we can be fairly aggressive in taking out his gland and fatty tissue to get give a very nice contour to his chest. so let’s get going in.
Dr. Delgado: What I’m doing here is I was caught messing with the tissue. So I’m putting this fluid in the tissue that contains basal constrictor that stops bleeding and an anesthetic as well, and what this does is it helps control bleeding. So that’s pretty blown up as you can see. Now we have put in our basal constricting agent and we tumessed is the proper term our tissue so it’s blown up and as you can see it’s starting to turn white or pale now. What that means is that the blood is coming out of the tissue. So now it’s going to bleed less so I’m not going to start this until this is almost whitish and you can tell it’s gradually losing its pink color. Once that’s done then I’ll do my liposuction on both sides. About a third of my cases are reduced from other places and the primary reason is that doctors trying and do this case by doing liposuction only and it doesn’t remove the gland or part of the gland. And patients you know want to be fairly flat there so you know you really have to do a combination of gland excision and liposuction to get a really good result. Now I’ll start to do my liposuction and what I’m doing is I’m just gliding through my tissue. Now the tissue coming out is yellow. You see there’s not really any blood in it yet. And this is not gland either this is just strictly tissued fatty tissue. Now as you see me take it away from the fat from around it, you see that there’s a little ball now starting to show up that little ball that you see is that gland that as I said does not come out where your liposuction. But it’s looking more discreet because the fat around it is reduced so you can see how I’ve done the liposuction and you see this little holding them at this little cone and that’s the breast tissue in there that doesn’t come out with liposuction and when you cut it you’ll see it starting to poke out. Cause this under pressure from the tumescent fluid you see that white tissue that’s the glandular tissue. You can hear cutting it the sound of it and as we get away from the areolar there’s a less glandular component to it. So now what I’m doing is I’m elevating the skin off of my tissue so that I can read drape the skin so it will shrink up.
Now we’re going to go to the other side. I want to make sure that my tissue plane is nice and smooth and it’s open all over so it re-drapes nicely. The gland component is right here but we can’t take out the gland like this because you can get a deformity if you just yank it out so I’ll spit him out and then I’ll take it out but it’s right here and obviously you can tell there’s no fat on this gland this is total glandular tissue. Now again I realize if you take out the fat around it you’re going to just have a ball of gland underneath the nipple and men did not like that so I’m going to take that gland out a little bit at a time so I can get a nice flat contour. So we’re going to start dissecting out our gland what makes this case so difficult is that you’re doing it through a small hole and it’s basically a subcutaneous mastectomy so right now I’m cutting my gland in half and as you see this you can see how dense it is and as I say liposuction is not going to go through this at all.
I work medial to lateral just taking out pieces not as one whole one but in pieces. Okay so you see the half of us out on this side we’re trying to get a nice tighter look here and now we’re going at this area. I’ve got these flat duckbill scissors so I’m cutting across and fairly flat as opposed to cutting down. So if you can tell us a piecemeal type of thing it’s not taking out this one big piece because you don’t want to over resect it. So I’m just sculpting a little bit at a time. So you can see it’s full here, it’s full here, a little bit flat there, so there’s a lot of contouring to do. Now I’m just cleaning up little small things. So I kind of like that I’ve got a little flat spot here that I’m gonna have to feather in. now that’s beautiful make sure there’s no bleeding, I also look inside and see if there’s any anything that’s not smooth; if there isn’t I’ll smooth it out at this point.
It’s very smooth what I’m doing now is putting in a drain through the armpit. So now this suction zone so we have negative pressure in there so everything’s starting to stick down. We’ll also put a long-acting marking solution inside to help pain as well which we find is very helpful post-op. So we’re just doing a little touch-up now again with him flat I want to make sure everything is nice and even. Everything is just precisely cut down and blended nicely all around the edges so you don’t get a crater deformity.
Okay for the suturing, so you can see how flat he is laying flat and he’s got some marcaine in there some fluid that’s taking up some space and puffing things out some but I think you can get a good idea of the before and after. See our drains here so you see how nice and flat if the pecs are not touched and all this underneath here is completely gone. See I’m pinching it with my hand and there it’s only skiing with a little bit of fat now throughout this entire area he should do very nicely.
Dr. Gaynor: John is 15 minutes on recovery but my technique is a little different because we want him to relax for an hour here and not move around at all. We don’t try to get him up and going because of a higher risk of bleeding would just want things to relax and to coagulate and for you know this was to kind of find a little bit before getting them up and stressing them. So we’re letting him relax here and he’s doing a good job of doing that yeah.
John: So it’s a little pushed in is that eventually gonna.
Dr. Delgado: Yes fine rich back yes because things are rounded or swell.