This young man came to see S. Larry Schlesinger, MD, FACS for male breast reduction. He had surgery once before but still had gynecomastia (man boobs). S. Larry Schlesinger, MD, FACS, a board certified plastic surgeon at The Breast Implant Center in Honolulu and Kona, performs the surgery and shows the process of removing both kinds of gynecomastia: True gynecomastia is the gland, Pseudo gynecomastia is the fat.
We already liposuctioned the love handles or hips. We’re going to liposuction the abdomen and we’re going to liposuction the chest or gynecomastia. He also has gland all the way up to here. This is called the tail of Spence and this is breast tissue from when he was twelve – it turns mostly to fat on most people, but it’s mostly gland on him and you need to suction it out for aesthetic reasons, but also breast cancer can occur there so you want to take it out for safety reasons.
So the first thing we do is we put tumescent in and tumescent means to make rigid with fluid. So we’ll put a small injection site right here and we’ll open this with a #15 Bard-Parker (scalpel) and we use a hemostat to get into the space. We’ll start filling it up with a tumescent needle to go right into the substance of the gland. The reason for sucking out the sub-cutaneous fat on this is if you were to take out all or most of the gland without taking out the fat, you could get a depression. So this is more for cosmetic reasons then anything else. But, we’re going to try and get as much gland out as possible with the liposuction and then the rest will be done with directly cutting it out.
Ok, so we’ve made rigid with fluid which is what tumescent means and now we’re just going to leave it for awhile.
I’m using an aggressive cano (cannula), it’s called a tiger tip and it’s got a tip that’s sharper than the average cano. We’ll go up here and get the tip of the tail of Spence out. That’s a fairly easy piece of tissue to remove. Mostly fat with a bit of gland.
What you’re looking at is mostly fat. White fat, little bit of yellow fat, but mostly white. We’re going to start harvesting some of the fat, some of the breast tissue and we’re just going to take it out bit by bit. Now this is breast tissue.
We’re far enough below the nipple that we won’t be causing a dent around the nipple and we’re far enough above the pectoralis muscle that we’re not going to enter the pec and create some kind of pec deformity. There’s the muscle, right there. So we’re going to go back and see if we can do some suctioning now that we’ve kind of cleaned out some of this.
Bit by bit, we’re getting it smaller. We always send this breast tissue to pathology because male breast cancer is a reality. We can’t just throw it away and he certainly has enough breast tissue that we should have a pathologist look at this and give us their best opinion.
Ok, let’s try and lipo some more. Looking better and better.
This is a drain going in, Jackson-Pratt drain coming out through the armpit, using a trocar. And this will stay in for probably a couple days. We’ll sew it in.
What we’ve done here, the skin is loose and it has to tighten back. But it will. This is a young man and therefore… and he’s hairy, he’s shaved his chest, and he has dark skin – dark skin shrinks up better than light skin. Men’s skin shrinks up better than women’s skin and hairy skin shrinks up better than non-hairy skin. So this should shrink up very well. And we’re just about to start on that one. And we’ll get the other side done and that’s that.