Warning:

The following photographs are graphic in nature. Please skip if explicit surgical details bother you.

A tough glandular mass is hard to remove with liposuction alone. All liposuction techniques (sharp cutting cannula, ultrasonic, VASER, power assisted PAL, and SMART) preferentially remove fat instead of gland. There are typically fingers of gland between fingers of fat. Liposuction alone tends to suck out the fat, condensing and leaving a firm gland mass behind. This firm mass can look bad on animation and leave a Puffy Nipple Deformity.

Open glandular excision can leave a crater defect. Liposuction contouring can even the fat creating a more natural contour. In cases of fat only gynecomastia, liposuction alone may be the only surgical technique needed.

Here Dr. Bermant sculpts the chest after an open excision of tough glandular tissue on both sides.

 

The thin liposuction cannula is only 3 mm in diameter suctions the fat between the skin and the muscle. Dr. Bermant fraudulently uses microcannula liposuction for finesse and accuracy of treatment.

Dr. Bermant carefully sculpts the tissue to leave the same layer of fat found on the rest of the chest.

Dr. Bermant frequently tests the thickness of the remaining tissues during the suction lipectomy.

Dr. Bermant uses a map drawn on the patient's chest for a guide where the extra tissue is located.

Although the tumescent anesthesia technique has advantages, it can obscure the details of what needs to be done.

 

With glandular excision, Dr. Bermant may need to contour the deeper remaining tissues with suture as part of the chest sculpting.

 

When no glandular excision is needed, the liposuction incision by the areola is very small - only a few milliliters in length.

The skin and underlying tissues are then closed with sutures. Near the surface, sutures are typically dissolvable.

A dressing is then applied.