Tumescent liposuction in gynaecomastia
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Tumescent Liposuction in Gynaecomastia. Dr Venkataram Mysore-Dr Jayashree Venkataram Venkat Charmalaya-centre for advanced dermatology Bangalore www.bangaloreliposuction.com www.bangalorehairtransplant.com. Male breasts ( Gynaecomastia).

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Tumescent Liposuction in Gynaecomastia

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Tumescent Liposuctionin Gynaecomastia

Dr Venkataram Mysore-Dr Jayashree Venkataram

Venkat Charmalaya-centre for advanced dermatology

Bangalore

www.bangaloreliposuction.com

www.bangalorehairtransplant.com


Male breasts ( Gynaecomastia)

Gynaecomastia is a common condition causing psychological disturbance and social embarrassment


Causes

  • Puberty

  • Steroid abuse

  • Obesity

  • Tumours

  • Genetic disorders

  • Chronic liver disease

  • Side effects of many medications

  • Castration

  • Klinefelter Syndrome

  • Gilbert's Syndrome

  • Aging


Causes

  • In most cases, underlying cause cannot be found

  • Tamoxifen, Danazol has been found to be useful for oestrogen sensitive gynaecomastia

  • However, treatment of the condition is usually by surgery


Surgery

  • Liposuction, surgical resection are suggested as the surgical techniques


Is liposuction alone adequate?

  • Studies have suggested that liposuction or suction lipectomy alone is an excellent treatment


Gynaecomastia-Situation in India

  • In Indian culture, dress code for men demands that, during religious occasions, visit to temples, marriages, breast area is exposed

  • Limitation of outdoor activities such as swimming, while playing sports, Gymnasium

  • Limitation in wearing tight shirts

  • Source of embarrassment for students in hostels with common baths


Indications in Indian patients

Our Experience

  • There are very few centres in India performing tumescent liposuction alone.

  • 655 liposuction surgeries from 2004-2013

  • MALE vs FEMALE: 333:322

WOMEN were more than MEN; marginally


Different Areas In Men

  • BREAST

  • ABDOMEN

  • Flanks

  • Thighs

  • Buttocks

  • Arms

  • CHIN

MALE breast was the most common indication


Simplified classification of Gynaecomastia

  • Mild( with prominence of central part of breast and nipple areas only)

  • Moderate( prominence of entire breast region without skin hanging)

  • Severe( prominences of entire breast area with hanging resembling female breast).


  • Mild

  • Moderate

  • Severe


Male breasts our data

  • Most patients were in the age group of 15-30 years.

  • Four patients below 20 years

  • Youngest was 15 years in age (was counseled with parents )

  • Oldest patient was 60 years-


Pre-operative instructions

  • Routine blood investigations such as blood counts , Coagulation profile, LFT, Blood sugar, HbS Ag, HIV - and ECG, Ultrasound in moderate & severe male breasts

  • Advice to stop smoking

  • Avoidance of oral NSAIDs

  • Preoperative tranquillizer such as diazepam or lorazepam on the night before surgery

  • Injection Vitamin K to minimize postoperative bruising


Preoperative Ultrasound of Breast

  • Preoperative evaluation by ultrasound was performed in all the moderate and severe cases of gynaecomastia

  • Most cases had an admixture of fat and glandular tissue

  • Severe cases had predominant glandular tissue


Preparation of patient

  • a) Preoperative antibiotic such as cephalexin

  • b) Preoperative tranquillizer such as oral lorazepam 1 mg

  • c) Oral Clonidine 0.1 mg to prevent epinephrine induced tachycardia and as an adjuvant anxiolytic drug.


Preparation of patient

  • Surgical cleaning of the area with povidone iodine

  • The area for liposuction is topographically marked, with marker ink of different colours to delineate the bulges and asymmetry


Monitoring-we have a standby anesthetist for emergencies


Adits

  • NUMBER : 1-2 on each side

  • SIZE : 2 to-2.5mm

  • PLACEMENT: We avoid upper medial quadrant in breast as this area is seen when shirt is not buttoned as it is more prone for Keloid


Suction apparatus of

1HP power


Instruments -microcannulae

  • Infiltration microcannulae have diameter of 0.5-1 mm

  • Aspiration microcannulas have an outside diameter upto 2.8 mm.

  • Cause less bleeding as they are small and hence safer


Powered liposuction

  • We use power Assisted Liposuction-Microair, Euromi machines are available

  • No thermal component

  • We have found that it reduces surgeons strain and fatigue

  • Cuts short Surgery time


Laser Lipolysis

  • We use Ndyag laser for lipolysis for additional benefit.

  • Laser can access difficult areas

  • Laser also helps reduce fat and induce tightening of skin to prevent hanging


Aspiration

  • Amount of fat aspirated was between 1 - 4 liters , with an average of 2.5 liters

  • Duration of surgery was between 2 -4 hours


Severe gynaecomastia-use of extraction

  • In patients with severe gynaecomastia, an additional larger adit of 6 mms was placed, just adjacent to areola and the fibrofattyglandular tissue was extracted and excised.

  • This greatly reduced the subareloar lump


Severe gynaecomastia-result after liposuction and extraction


Severe gynaecomastia-result after liposuction and extraction


Postoperative Dressing and follow up

  • No suturing of adits in most cases

  • In severe cases, which need manual extraction, we put an infraareolar incision which is sutured

  • This facilitates drainage of fluid

  • Tight pressure bandages are essential to ensure proper drainage of the tumescent fluid.

  • Pt goes home the same day


Postoperative Drugs

  • ANTIBIOTIc

  • PARACETAMOL

  • PROXYVON


Followup

  • Patient is advised to come for follow up for dressing daily for two days.

  • More than 50% of results will be seen on day 2

  • Further improvements happen gradually due to breakdown and absorption of fat

  • Final result is seen after 4-6 weeks


Clinical Results


Clinical Results


Clinical Results


Does it have any complications?

  • All patients had uneventful recovery with out any serious side effects.

  • Post operative pain and tenderness were mild in all patients.

  • Adit sites healed well in all patients


Sagging of skin

  • No sagging was seen except in patients

  • Even in severe cases, there was no obvious hanging and the resultwas mild and was acceptable to patients.


Conclusions

  • Tumescent liposuction is a very safe and effective surgery for gynaecomastia

  • Thorough tumescence and use of microcannulae are important for safety

  • Most cases can be treated effectively, without the need for more aggressive and expensive surgery

  • Severe Gynaecomastia needs additional extraction through a juxtaareolaradit

  • Skin hanging is not a significant problem except in the severe cases


Our Doctors- experienced team

  • Dr venkataram MD DNB DipRCPAth(Lond)- Consultant Dermatosurgeon. Past President of Assn of Cutaneus Surgeons India

  • Dr Jayashree Venkataram MRCOG Liposuction Surgoen trained with Dr Jeffrey Klein


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