Medesthetics

MAY-JUN 2016

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

Issue link: https://medesthetics.epubxp.com/i/668890

Contents of this Issue

Navigation

Page 64 of 71

surgicalaestheticsmagazine.com | MAY/JUNE 2016 63 surgery," says Dr. Dadvand. "Sometimes it's decreased sen- sation; sometimes they have hypersensitivity. It typically goes back to normal in weeks or months." To prevent necrosis, Dr. Dadvand limits his incisions to the bottom part of the areola rather than making an inci- sion all the way around it. This maintains the blood supply to "about 65% of the skin above my actual incision," he says. "That in combination with putting on a compression garment that isn't too tight is why, I think, I've never had an issue with necrosis." If the patient needs skin excision or a reduction in areola size, Dr. Dadvand performs those procedures at a different time. "In order to reduce the areola or tighten the skin, you do need to make an incision all the way around the areola," he says. "Combining that with the debulking and liposuction creates an unnecessary amount of risk, so I do it at a second stage after they've healed from their gynecomastia surgery, and that second stage can be done under local anesthesia." If too much tissue is removed resulting in a depression, "you can use a fat graft or fat fl ap to improve the depres- sions," says Dr. Blau. PREVENTING RECURRENCE Gynecomastia surgery is a unique procedure in that results are typically permanent. "If you do a facelift, with time that skin will droop again. If you do a breast lift, with time it's going to sag again because you can't cure gravity," says Dr. Dadvand. "However, this is one of those procedures that, if done right, can last a very, very long time." Recurrence is most common in patients who had a lot of excess fatty tissue and gain a signifi cant amount of weight in the years following surgery, because some of the fatty tissue must be preserved to maintain the contour of the skin. "If the gynecomastia is the result of steroid use or a testosterone booster, I tell my patients, 'If you go back to using it, it can come back because you will restimulate the breast tissue,'" says Dr. Dadvand. "Granted there is a much smaller chance because they don't have nearly as much breast tissue to stimulate following surgery." Body builders are, in fact, one of the largest groups of patients seeking gynecomastia surgery—joined by young people and overweight patients. "You have to be very care- ful with body builders and young people," says Dr. Blau. "Young people because they have their whole lives ahead of them, so it's going to be devastating for them if you don't get a good result. With body builders, they are very particular and they are looking for perfection. You have to be very fair with them and tell them exactly what you can and cannot do. If you don't have a lot of experience, don't touch them." Dr. Blau recommends starting with simple cases and being careful not to overpromise what you can deliver. "If you don't have experience with gynecomastia, don't toy with severe cases," he says. "Start with simple cases that are not large, where skin elasticity is good and slowly go to more complicated cases. With the severe cases where the skin is sagging and the gynecomastia is very large, you really have to know how much tissue to take and where to take it from in order to have a really nice contour. And tell the patient the truth. If he is not a good candidate or may require a second surgery, tell him up front." WORKING WITH MINORS Gynecomastia often fi rst appears during puberty—known as physiological gynecomastia—and it can be psychologically destructive for the teenagers who are affected. Because most of these cases resolve on their own within two years, pediatricians typically counsel patients to wait until they are 18 to seek a surgical consultation. But Dr. Dadvand and Dr. Blau both disagree with this advice. "If it hasn't gone away after three years, it's not going to," says Dr. Dadvand. "I've seen kids who are being home schooled because of bullying and teasing, so if they've had it for more than three years and it's not due to an underlying hormonal or endocrine issue, I do not hesitate to operate." Dr. Blau agrees. "If somebody is young and has noticeable gynecomastia—more than 1.5 inches—and he's having a hard time, then there is no point in waiting until he is 18. If it's severe, it's never going to disappear on its own and you will save the patient a lot of psychological problems." Inga Hansen is the executive editor of MedEsthetics. "No matter the race or ethnicity of the patient, the areola is going to be a different color than the skin around it, so when you place the scar right in that confl uence, it heals exceptionally well."

Articles in this issue

Links on this page

Archives of this issue

view archives of Medesthetics - MAY-JUN 2016