Surgical Details of Secondary Gynecomastia Male Breast Reduction Surgery - Scar Revision, Gland Excision, and Chest Contouring
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The following material on this page is graphic in nature. Please skip if explicit surgical details bother you.
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Revision Gynecomastia Surgery - Dynamic Chest Sculptureand Gynecomastia |
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It is easier to sculpt the male chest as the first surgeon. Balancing the contour when gland is a factor is much different when fat can be used as a structural element. Natural tissue movement uses the fat as a buffer between the skin and muscle. Even very thin people have a small fat layer. Scarred skin to muscle just does not move very well.
With normal primary surgery, Dr. Bermant can use surrounding fat to fill the void left by removing the thick glandular tissue. This fat under the areola and nipple looks better both at rest and in motion. After surgery, there is usually less fat to move around. Some doctors leave very little fat behind as in this case. Dr. Bermant avoids the need for revision gynecomastia surgery with an intense attention to detail for each patient. This patient had prior gynecomastia surgery by another doctor. More details about this patient
In this particular revision, the patient needed a scar revision,
one areola lowered, prominent dense gland removed, surrounding fat
liposuction, and the remaining fat sculpted into the void under
the areola and nipple. On one side there was inadequate fat left
by the other doctor forcing some gland to be used as the spacer
between the skin and muscle.
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Superficial anesthesia with a long fine needle is important start in secondary gynecomastia when scar tissue can make work tough. |
A microcannula with a pointed end was used for instilling the tumescent anesthesia. The small size and pointed tip permitted fine control over fluid placement in tissue scarred by prior surgery. |
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Dr. Bermant normally does not make such a large incision for his male chest sculpture. However, when performing a scar revision, an unsatisfactory old scar must be either excised or left in place. |
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Dr. Bermant's typical scar for gynecomastia surgery is only about 2 cm instead of the 4 cm in this case
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Picture of scar excised during secondary gynecomastia surgery. |
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Picture after scar excision during repeat gynecomastia surgery. |
In this patient there was a large gland fragment remaining after the first doctor's operation. In these pictures, the white firm gland is dissected first from the nipple areola and then from the surrounding fat.
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| Pictures of gland excision during revision of another doctor's gynecomastia surgery. |
Pictures after scar excision during repeat gynecomastia surgery. |
On this side there was enough surrounding fat to remove most of the gland. A thin layer remained under the areola.
Excess fat was contoured with secondary microcannula liposuction. Such revision surgery again must deal with the scar tissues from the prior surgery. |
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Dr. Bermant then sculpted the surrounding fat back under the nipple areola. Without such sculpture, there would have been a severe depression. Fat also provides a good dynamic buffer so that the skin can move over the muscle without tethering.
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Pictures during revision gynecomastia surgery of surrounding fat being drawn into the defect under the areola with sutures. |
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Moving attached fat with a blood supply is much more reliable than fat grafts (moving fat in from other parts of the body).
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During revision gynecomastia surgery, pictures of deep skin repair. |
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Pictures of skin closure during secondary gynecomastia surgery. |
Deep dermal tissues and superficial skin are then repaired with dissolvable sutures.
Here the gland and scar are shown after the secondary gynecomastia surgery. This does not include the fat liposuctioned from the surrounding regions. |
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Continue with more pictures during this secondary gynecomastia surgery.
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Revision Gynecomastia Surgery - Dynamic Chest Sculptureand Gynecomastia |
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