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Gynecomastia Surgery

Not all surgeons have the same skills nor do they use the same techniques. Good surgery starts with careful documentation of the individual patient's problem. Then there must be careful documentation of before, recovery, and after surgery results. The actual operation must be meticulously documented. Then the results analyzed, critiqued, and methods improved. That is what Dr. Bermant employed over the years to evolve what he calls his Dynamic sculpture of the male chest. This is way more than just adopting what is done during the operation to what is found on the tissues.

gynecomastia surgery

Analysis of The Problem

His Dynamic Technique start out with an analysis and stabilization of the patient's problem. Surgery breast regrowth. Ignoring this critical concept usually results in recurrence. Dr. Bermant found that for analysis of the male breast, the normal history form was not enough. He designed his own Male Breast History form that has continued to evolve over the years of its use. Collecting such details permits a better understanding of that particular patient's cause for the breast growth and if the condition is stable or not.

Global Fat Contour Issues are assessed during the examination, Body Mass Index Calculation and a Body Fat Analysis. Men tend to put fat on first in be belly and chest regions. With weight loss, we take it off those regions last, this is part of normal Male Body Fat Distribution. Why do surgery first to "jump start" the process, then lose weight. If this weight comes off in typical male fashion, it will look like the gynecomastia has returned. Major weight loss can also result in loose skin issues.

In considering this contour issue as surgical sculpture, the wise sculptor picks the coarse tool first, and one of refinement last. In this case, losing weight is the coarse tool. Surgery is better at refinement.

Red Flag System

Over the years Dr. Bermant has worked with a number of Endocrinologists as to which patients should be then sent for an evaluation. This became his Red Flag System. If a patient has these red flags, surgery should not be the next step. Instead the patient should be evaluated by an experienced Endocrinologist first. If indicated, laboratory test ordered, and medical management started to stabilize the problem first.

Examination Male Chest

This analysis then continues with the exam of the male chest. Again done with forms he evolved over the years, Dr. Bermant takes careful measurements of the contour components of the male chest. Such measurement then can be used to document the degree of effectiveness of the surgical sculpture.

exam male chest

Size reduction of areola seen after surgery.

Resources

Forum Overview is an introduction to our forum, boards, and an introduction to the definition, symptoms, causes, diagnosis, and treatment of male breasts.

Male Breast Reduction Surgery is a detailed explanation of surgical sculpture and the various types of male breast reduction.

Frequently Asked Questions collects the most commonly requested information. Try looking for answers here first.

Pictures shows details about photos and videos of the male chest. Find before and after photographs and movies. Learn what views help define the problem and show issues about the results.

Surgeon learn how to pick your surgeon and about consultations the learning process about the operation.

Forum Search

Forum Search is a powerful tool to find answers. Help with Searching is the starting point for those not familiar with this function. You can also Search our Encyclopedia and our Older Forums.

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Evolution of a Technique

Analyzing the literature, Dr. Bermant did not like the documentation of results offered. What can look good in a still picture, just was not the same a in life. For the male breast, it is that firm gland or scar component under the nipple areola structure. Learn more on our Male Breast Reduction Pictures Resource. Other articles just removed gland leaving deformity. The dominant method for this surgery was to perform liposuction and if the contour not not good enough, then go after the gland component. A shelving layer of gland was left behind to "support" the nipple.

Puffy Nipple Complication
Dr. Bermant was seeing so many unhappy patients done elsewhere with these techniques. What he saw convinced him the offending contour issue was the gland. It may not be cancer, but leaving the gland behind was creating contours that did not look good. For the chest to look good on animation, remaining gland becomes an issue. Gland just does not compress like fat. So when the chest skin is compressed against the muscle, such as with flexing, the nipples stuck out. The problem was that liposuction does not remove gland. Dr. Bermant could find no papers proving the gland was the element being removed in the literature. That was also his observation in the operating room on his own cases and the revision surgery he was performing on patients unhappy with surgery done elsewhere. Instead the liposuction was digging a hole for the remaining gland. He saw so many such patients that he coined his term Puffy Nipple Contour Complication After Surgery that describes this defect. Any technique that only looks good in a few static pictures, but not in real life was just not adequate.

Crater Defect
Another deformity was also coming in for help after surgery done elsewhere. The gland was removed but nothing was done to fill in the defect. Dr. Bermant coined another term Crater Complication Scar to describe this problem. Here is another variation: Bursa Crater Complication Deformity Floating Nipple gynecomastia complication video and movie.

Excessive Liposuction
Dr. Bermant also has been seeing patients with too much removed from the chest. The skin needs a thin layer of fat to act as lubrication during animation. Too much fat gone, and there is a Deformity Complication gynecomastia complication video and movie. Here is another Extensive Crater Deformity After Excessive Liposuction gynecomastia liposuction complication video and movie.

Big Nipple Areola Complication
Donut mastopexy, reducing a band of skin around the areola can produce a disaster when the forces are left unbalanced. The male areola tends to be much smaller in diameter than in women. Forces to keep that small size will defeat any not permanent solution.

Key Break with Tradition
Targeting the gland first was the big change. This meant that there were resources there not removed by liposuction that could be used to keep the nipple from collapsing. If starting with liposuction first, then some gland would need to be left behind or a crater would be created.

Dynamic Technique

This dynamic technique starts out by careful analysis of the problem, stabilizing the problem, working on coarser weight loss issues first, and then surgery. The surgery targets the gland first. Then uses an artist's assortment of surgical sculpting tools to contour the remaining tissues.

You can see a graphic Surgery Video - Dynamic Technique listen to patients talk about gynecomastia male breast, sound clip, audio filegynecomastia movie and video showing actual during surgery movie. Less graphic the operation starts with Chest Wall Markings and Plan. The surgery is done under Tumescent Anesthesia with Sedation.

The areola chest skin junction is a great place to hide a scar. The Gland is Removed through a very Short Scar Techniquegland removed short incision that often measures less than 16mm (0.6 inch). This takes more work than having multiple incisions. But the other sites for liposuction, lower chest, under arms, just do not look good unless the doctor demonstrates how "great" they look by showing pictures with arms at the sides (try playing basketball with arms at your sides). The gland is first separated from the nipple areola complex. The remaining gland and the fingers of glandular tissues extending through the fat are then targeted. This is done by feel to remove the firmer structures.

The next step depends on the size of the defect created by the removal. If big enough, nearby fat is mobilized on its blood supply and advanced into the defect. The first to describe this method as applying to gynecomastia reconstruction, Dr. Bermant calls this his Fat Flap Sculpture. Not all chest sculpture requires these flaps. If enough fat remains without the additional mobilization he skips directly to Sculpture Chest with Tumescent Liposuction. Once the coarse general contour has been achieved, fat flaps (if done) are then sutured together. The tissues are then further refined with Microcannula Liposuction and sutures.

Long or Big Nipple Reduction

Big nipple reduction can be done by itself without any work behind the areola. When long nipples are a component of the contour, Dr. Bermant prefers to perform surgery in stages. Operating behind the nipple damages the blood supply to this structure that he waits for the tissues to recover, typically at least 6 days after surgery. This is done under local anesthesia. After a wedge of nipple is removed, Suture Sculpt the remaining tissue into a shorter nipple structure. A thin Dressing then protects the wound.

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Revision Gynecomastia Surgery

Revision or Secondary Gynecomastia Surgery adds prior surgical scars to the contour problem. Check just what any surgeon offers for documentation of their skills for this problem. The best revision surgeon has done many of these sculpture but does not need to do this for their own patients. Although Dr. Bermant does many such operations, it is quite rare to have one of his own patients ask for such changes.

It is easier to remove than replace, so preventing the need for the revision is the best method. Not all deformities have decent revision options as this Liposuction Adhesion Scar Complication gynecomastia liposuction complication video and movie. Other examples can be found in the Excessive Liposuction discussion. To understand possible options, Dr. Bermant prefers extended documentation of the way the tissues move before surgery. For most, the additional views of these pictures provides enough to schedule tentative surgery. For some, an in office exam becomes necessary to understand the extend of the damage done. Having copies of the previous operations, doctors' office notes, and before surgery images, can be important to understanding the problem. Surgical options depend on the specific deformity. When there is residual deformity, surgical sculpture targets the excess gland scar tissue complex as in this Repeat Operation. When the prior surgeons access scar is a significant deformity, revising it can result in much longer scars that needed for primary surgery as in this Revision Surgery. The defects present after targeting the deforming gland scar complex can be quite extensive as in this Revision Male Breast Reduction. The nearby fat flaps are a powerful tool in such sculptures.

Male Mastopexy Chest Lift

Male Mastopexy breast lift is a powerful tool for dealing with contour issues that involve excess skin. Low Nipples Look Weird on the Male Chest. After major weight loss or lost muscle volume, sagging and drooping can distort the chest. Loose skin can contribute to to the contour of a male breast. Unless this skin is managed, contour problems will remain. The Skin Reduction Chest Lift is a compromise. There needs to be a place to remove the excess skin. Dr. Bermant evolved his Internal male mastopexy breast lift to lift drooping tissues with a small surface scar. However, this internal lift is limited in that it does not manage the excess skin. Male donut areola Reduction Surgery is an option for some. However, this is an extremely difficult operation needing permanent sutures tighten skin to reduce big areola and prevent the Massive Nipple Areola Complication. Here are dressings after surgery to reduce male areola.

Transgender FTM Top Surgery

Transgender Surgery Female to Male Top Surgery is another form of male chest contouring. This is just another formal of a female breast on a male body. The contour to correct comes in many different sizes and shapes. Options depend on the problem present. If there is excess skin, it most likely has been there for quite some time and will not shrink as well as transient breast enlargement. For these individuals a skin reduction option is necessary.

Healing and Recovery

During surgery careful attention is made to minimize damage to tissues and lower power level cauterization to control bleeding. This results in an amazing minimal Bruising, Swelling, and Recovery Picture Gallery typical for our patients. Look for such early after surgery documentation to understand the degree of injury a surgeon has for his / her method.

Optimizing Healing starts out before the operation. Each of Dr. Bermant's patients is fitted with two types Compression Garments by our team. This permits compensation for the many different body types we see such as our Compression Vest for our Body Builders With Gyno. The Stage I Garment is for stabilization and comfort. It is easier to get on and off after surgery. The Stage 2 Garment is for the scars. Scars that evolve under pressure do much better than without. These garments provide much more pressure, but are too dangerous to wear right after surgery. Trying this on before surgery permits our patients to understand the tension putting this garment on over healing tissues.

These Dressings completely seal the wound, no leaking, normally no drains, and thin enough to let the contour show through permitting the patient to immediately see the surgical results.

Each patient receives an individualized set of After Male Chest Contouring Instructions reinforcing details discussed before the operation. Again Dr. Bermant has designed his own set that also evolved over the years.

Comfort and male chest sculpture can also distinguish between surgical techniques. Although we give our patients a prescription for strong pain medication, almost all tell us that plain Tylenol is enough to keep them comfortable.

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