In this day and age most patients opt for the non or minimally invasive procedures as they carry less risk and the down-time is less and recovery is faster.
In some cases though it is not appropriate to perform the non-invasive techniques and the surgical ones are more indicated. It is then also imperative to inform the patients of the associated risks with the surgical options. Although you may get a better result, you may also put yourself at more risk in terms of complications and side-effects. It is thus important to balance the risk to benefit ratio.
We want exactly the opposite of what is depicted in this image.
If the wrong technique is used then the risk of adverse outcome is also higher.
The options are really 1. doing nothing 2. weight loss and losing some fat deposit in the area (if the bulk is glandular tissue then weight loss will not help at all) 3. traditional liposuction 4. VASER tumescent liposuction 5. Micro-cannula tumescent liposuction 6. surgical excision
Any of these can of course also be combined. The most conservative is obviously 1. and 2. These may certainly not be an option if the situation is causing distress, clothing limitations and self consciousness.
Patients coming to us will have started doing some research on the various techniques available and generally come with some idea of what may be required.
3. is old style technique and usually performed under general anesthesia (completely asleep). It has its limitations and works well if there is mainly fatty tissue and little breast gland.
4. targets the gland and the fat and can be performed under local anesthesia (only the treatment area is numbed)
5. targets the gland and the fat - suitable with smaller amounts of bulk.
6. suitable for large gland excision and often skin excision in combination. This is always performed under general anesthesia (completely asleep). It comes with a variety of different risk factors and longer recovery period.
The important factor is that not too much of the tissue is removed and leaves fibrotic scar tissue that is visible when the chest muscle contracts. This may leave you with an indented nipple or nipple that gets sucked in when you contract your chest muscles (see pictures below)
These are patients that have presented to me after surgical excision that have had too much removed. The scar tissue attached to the underlying muscle now causes the nipple to get sucked in when contracting the chest muscles.
Hence I always leave some tissue behind which can be felt as a small disc of hard tissue just behind the nipple complex.
Seen on the left is a common male chest diagram with representation of enlargement of the gland component (right). This may appear in various degrees - some having more fat or some having more gland. We obviously want to remove as much as possible, but also prevent the nipple retraction.
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