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Tumescent Liposuction in Gynaecomastia

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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  1. Tumescent Liposuctionin Gynaecomastia Dr Venkataram Mysore-Dr Jayashree Venkataram Venkat Charmalaya-centre for advanced dermatology Bangalore www.bangaloreliposuction.com www.bangalorehairtransplant.com

  2. Male breasts ( Gynaecomastia) Gynaecomastia is a common condition causing psychological disturbance and social embarrassment

  3. Causes • Puberty • Steroid abuse • Obesity • Tumours • Genetic disorders • Chronic liver disease • Side effects of many medications • Castration • Klinefelter Syndrome • Gilbert's Syndrome • Aging

  4. 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

  5. Surgery • Liposuction, surgical resection are suggested as the surgical techniques

  6. Is liposuction alone adequate? • Studies have suggested that liposuction or suction lipectomy alone is an excellent treatment

  7. 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

  8. 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

  9. Different Areas In Men • BREAST • ABDOMEN • Flanks • Thighs • Buttocks • Arms • CHIN MALE breast was the most common indication

  10. 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).

  11. Mild • Moderate • Severe

  12. 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-

  13. 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

  14. 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

  15. 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.

  16. 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

  17. Monitoring-we have a standby anesthetist for emergencies

  18. 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

  19. Suction apparatus of 1HP power

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Severe gynaecomastia-result after liposuction and extraction

  26. Severe gynaecomastia-result after liposuction and extraction

  27. 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

  28. Postoperative Drugs • ANTIBIOTIc • PARACETAMOL • PROXYVON

  29. 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

  30. Clinical Results

  31. Clinical Results

  32. Clinical Results

  33. 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

  34. 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.

  35. 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

  36. 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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