Summary: The symptoms of gynecomastia can be physically uncomfortable as well as take a negative toll on self-esteem in affected men. While surgical excision is necessary to remove glandular breast tissue in true gynecomastia, excess adipose tissue in both true and pseudogynecomastia can be addressed effectively through ultrasound-assisted liposuction, which offers a number of unique benefits for improving the appearance of male breasts.
Challenges in Gynecomastia Treatment
Historically, the treatment approach for gynecomastia has been liposuction, direct excision, or a combination of the two.
- Direct excision without lipo can result in scarring as well as irregular contours for a subpar final aesthetic.
- Liposuction alone is effective for removing adipose tissue, yet cannot resolve the fibrous breast bud.
- A combination approach incorporates liposuction with direct surgical excision of the breast parenchyma.
While the technical aspects of gynecomastia treatment are not particularly challenging per se, male breast reduction does need to treat the physical manifestations of the condition adequately, yet without advertising having had male breast reduction surgery. The combination liposuction/excision approach requires only a periareolar incision to ensure total discretion after the procedure; the enlarged breast is effectively resected without compromising aesthetics, bringing out the best in the individual techniques.
The Advantages of Ultrasonic Liposuction
Tumescent liposuction has previously been the default standard for lipo used in gynecomastia treatment, yet utilizing ultrasonic liposuction instead (or in addition) offers several distinct advantages:
- UAL is more effective for targeting adipose tissue in highly fibrous areas, which is clearly beneficial when addressing the muscular male chest.
- Skin contraction after surgery is improved through the use of UAL, reducing gynecomastia-associated skin redundancy for better contouring.
- Minimal cross-tunneling is needed during UAL, so fewer incisions are required.
- UAL is a gentler procedure than traditional liposuction, offering less capillary tearing for reduced blood loss during surgery as well as a less physically strenuous surgery overall, which translates to a faster, more comfortable recovery for patients.
Proper surgical technique is essential for ensuring optimum results with UAL. Topographic marking should first be used to denote chest contours. After making a periareolar incision, the breast parenchyma should be infiltrated with tumescent solution. Using this smaller incision as opposed to the traditional inframammary incision not only minimizes visible scarring post-recovery, but also allows for a more precise pull-through and excision of the breast bud.
Ultrasonic liposuction should be performed radially, while ensuring feathering at the transitional periphery. Targeting the breast bud with lipo as well helps morselize the more fibrous tissue. Through careful shaping, the core parenchymal center is centrally isolated; this can be resected by pulling the breast bud through the periareolar incision and sharply excising it. Ideally, the fibrous tissue should be removed in strands for more precise contouring control. It’s important to avoid an overly aggressive approach, which could result in uneven contours, particularly saucer deformity.
Taking a Combination Approach
While pseudogynecomastia may be effectively addressed through ultrasonic liposuction alone, incorporating glandular tissue excision at the same time is necessary for treating true gynecomastia. Using a combination approach that utilizes the benefits of ultrasonic-assisted liposuction with direct excision enables successful treatment of both the fatty and fibrous male breast tissues.
Ultrasonic liposuction allows for a more precisely contoured final result along with a nearly imperceptible scar, eliminating the symptoms of gynecomastia while still respecting the discretion needed to avoid the stigma associated with male breast reduction.