Gynecomastia, male chest reduction, gland excision, VASER liposuction

Many of my male patients have some form of male breast enlargement.  Not all decide to have that area treated as it does not bother them that much.  However, the patients that seek to have treatment for this particular area frequently ask about the other options available.  If they dont ask it is part of my consultation process to inform them of the other options available that are suitable.
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.





                                                         www.DrWolf.com

Lipoedema treatment - tumescent liposuction, VASER

I was fortunate enough to attend the Lipoedema conference on the 24th June in Reading this year.  It was well attended and very informative for networking and sharing experiences with other professionals.
It was re-iterated that not much information was available for patients with the condition and still many GP are misdiagnosing the condition as obesity.  The training course offered by Lipoedema.co.uk has however had overwhelming response from GPs in getting the word out.
Many GP are now recognizing the condition and referring patients in the right direction.
Some interesting data were produced by a German clinic on the success of tumescent liposuction including VASER and the treatment of Lipoedema.  It remains the only real way of preventing the condition from worsening especially when caught in the early stages (stage I or II).
Stage III requires more interventional treatments such as skin excision and reconstruction.
The key is to diagnose it in the early stages and manage it appropriately.  This includes MLD and wearing hosiery.

www.Lipoedema.co.uk
www.MLDuk.org.uk
http://www.lipedema-simplified.org
Henrietta@MLDLondon.co.uk

VASER 360 degree legs (circumferential)

We have had a resurgence of requests for the circumferential treatment of legs/ thighs.  Our success rate has been really good.
With the majority of patients also having mild lipoedema we always work hand in hand with MLD therapists.
Some of the excellent practitioners we refer to are Henrietta Cassar from MLDLondon , Julie Bradford and Petra Erving, Kimberley Harrington, Helen Fox
It really is vital to find a good therapist that will see you through the recovery period.

Obviously the more fatty deposit there is the more impressive the results will be.  We can however also make smaller thighs look more shapely by making them more proportionate.

The important factor is the skin texture and elasticity.  If this is not ideal then any removal of tissue may result in loss of skin turgor and resultant laxity.  Then one would need to consider a thigh-lift which is more complex and involves excising skin and pulling the remaining tissue tighter by stitching it back together. 
We would certainly recommend this option if the VASER liposuction is not suitable.
In all cases it is important to maintain realistic expectations.  We are not magicians and cannot create something out of nothing.......
In most cases we can create something more shapely that will fit much more comfortably in clothes especially around the hips and thighs.

3000 VASER liposuction procedures!!!

I am pleased to be able to share with you that I have just recently performed my 3000th case of liposuction using the VASER.
Due to patient confidentiality we could not share this publicly, but the patient was pleased to be able to celebrate this milestone with us.

We did however take a celebratory "Team" photo.

Looking forward to the next 1000!!!

DrWolf.com

DrDennisWolf.blogspot.co.uk

YouTube DrWolf.com  channel

The healing process after Vaser lipo or Micro lipo

The healing process can take varying amounts of time. As each person has their own genetic make-up, lifestyle, diet and exercise routine the recovery pathway in each case is different.

Hence it is difficult to give concise time frames. On the whole though it would take 5-6 months. Even after that the last 10-15% of healing is not visualised externally.  This all takes place under the skin and is microscopic. Occasionally one may have certain sensations such as itchiness, pulling sensation, electric shock type sensation, hypersensitivity or even mild lumps that appear and disappear.

Every person is different and that is normal.

If you have any concerns it is best to see your treating doctor.

Exercise after VASER lipo and Microlipo

After your surgical procedure you will need to let your body rest and recover.  In addition your nutrition will need to be balanced to help with the healing process.
Most patients who are active prior to the procedure get really itchy feet in the first week or two after the procedure as they feel lethargic and get the unfit feeling.

Stretching is very important every single day.  You want to get your body out of its comfort zone and break up the scar tissue.  Try touch your toes, flex to the right and the left and try and touch your knees.  If you feel any "knots" massage them with firm pressure.  These may come and go.  The more you stretch and massage the quicker the lumps and knots will disappear.  Remember that you will also feel numerous types of sensation - itchiness, hypersensitivity, numbness - all these are normal and indicate that the healing process is progressing.

Exercises you can start doing immediately after the procedure are hill walking and treadmill low impact, high incline walking.  You will prefer not to do any impact work such as running or jogging.  You can also go swimming after all the incision points have healed - generally a week after the procedure.

Obviously areas that have not been treated can be exercised with caution and if it feels comfortable then continue and build up the levels.  Your body will remind you what can what cant, or should not be done.
If any doubt just speak to your Doc.

I find it really helpful wearing a heart rate monitor as this can give you an idea of how many calories you are burning.  There are various types on the market.  Best to get one that determines the calories from the heart rate.  Ideally you want to get to heart rate ranges of 160bpm.  If you can sustain this for 40 seconds and then have a 10s rest and repeat the process about 4 times, would be good.  Your fitness levels will soon improve.

After 4 weeks you should be able to get back into a fairly normal routine.  Build it up slowly.   Don't jump straight into "Insanity".  Use a week to get back up to speed.

Nutrition after VASER or Microlipo

After having VASER or Microlipo its important to give your body enough energy and strength to fast-track the healing process.  It also helps in strengthening your immune system to fight any infection.

Obviously a well balanced diet is important - this will include vitamins, minerals, fibre, protein, carbohydrates and fat - Yes FAT.
Minerals - Zinc and Iron are important in the healing process and also forming new red blood cells as you will most likely lose a bit of blood. Foods rich in these are red meat, green leavy veg, broccoli and seafood.
Vitamins can be gained from veg or fruit as a daily intake.  Some may be taking vitamin supps which is also ok.


Fibre - in many cases after surgery you will be taking pain relief tabs which can cause constipation.  Drink plenty of fluid - not tea and coffee as this will dehydrate you even more.
Drink at least 1.5 litres of water.  You may be leaking from incision wounds and this needs to be replenished.  Make sure your urine is always very light in colour and that will give you a good idea of your hydration.


Protein - For your body to heal it requires lots of protein, amino acids etc. to manufacture the building blocks of regenerative tissue and scar tissue.  Foods rich in protein for example are chicken, tuna, seafood, nuts, eggs, tofu and certain dairy products.  In addition protein shakes can also be used.

Fats - from nuts, avocado, coconut and olive oil are the best and are required for absorption of certain vitamins and foods.  They also act as a supply of energy.


Carbs - Lots of energy is required during the recovery phase. Carbs in the form of veg, fruit, whole grain (NOT whole wheat) should be taken.  Avoid white bread, pasta, rice and potatoes.  If you crave potatoes then try sweet potato.

As you are most likely not in full exercise routine its best to limit your white refined carbs such as white sugar, fizzy drinks, sweets, chocolate etc.  These will only stimulate your insulin levels and result in fat storage rather than breakdown.