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 liposuction in gynaecomastia

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

Male breasts ( Gynaecomastia)

Gynaecomastia is a common condition causing psychological disturbance and social embarrassment


Causes

Causes

  • Puberty

  • Steroid abuse

  • Obesity

  • Tumours

  • Genetic disorders

  • Chronic liver disease

  • Side effects of many medications

  • Castration

  • Klinefelter Syndrome

  • Gilbert's Syndrome

  • Aging


Causes1

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

Surgery

  • Liposuction, surgical resection are suggested as the surgical techniques


Is liposuction alone adequate

Is liposuction alone adequate?

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


Tumescent liposuction in gynaecomastia

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

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

Different Areas In Men

  • BREAST

  • ABDOMEN

  • Flanks

  • Thighs

  • Buttocks

  • Arms

  • CHIN

MALE breast was the most common indication


Simplified classification of gynaecomastia

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).


Tumescent liposuction in gynaecomastia

  • Mild

  • Moderate

  • Severe


Male breasts our data

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

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 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

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 patient1

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


Tumescent liposuction in gynaecomastia

Monitoring-we have a standby anesthetist for emergencies


Adits

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


Tumescent liposuction in gynaecomastia

Suction apparatus of

1HP power


Instruments microcannulae

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

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

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

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

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


Tumescent liposuction in gynaecomastia

Severe gynaecomastia-result after liposuction and extraction


Tumescent liposuction in gynaecomastia

Severe gynaecomastia-result after liposuction and extraction


Postoperative dressing and follow up

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

Postoperative Drugs

  • ANTIBIOTIc

  • PARACETAMOL

  • PROXYVON


Followup

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


Tumescent liposuction in gynaecomastia

Clinical Results


Tumescent liposuction in gynaecomastia

Clinical Results


Tumescent liposuction in gynaecomastia

Clinical Results


Does it have any complications

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

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

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

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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