dr venkataram mysore-dr jayashree venkataram venkat charmalaya-centre for advanced dermatology...
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TUMESCENT LIPOSUCTIONIN GYNAECOMASTIA
Dr Venkataram Mysore-Dr Jayashree Venkataram
Venkat Charmalaya-centre for advanced dermatologyBangalorewww.bangaloreliposuction.comwww.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
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
Gynaecomastia-Situation in India
INDICATIONS IN INDIAN PATIENTS
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
Our Experience
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 Nd yag 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 juxtaareolar adit
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