Today is Michael’s surgery day. The day he has been waiting for his “whole life”. Michael developed gynecomastia when he was in puberty and it never went away. Now, at the age of 30, he is ready to have gynecomastia surgery and stop wearing rash guards on the beach. This video is the actual surgery: liposuction (Tumescent liposuction), and gland removal under the nipple.
S. Larry Schlesinger, MD, FACS: Any questions, Mike?
Mike: Nope, no questions.
S. Larry Schlesinger, MD, FACS:Any questions, Sarah?
Mike: Thank you so much.
So the first thing we’re going to do is put in tumescent. And tumescent fluid is fluid that has a tiny bit of epinephrin in it (one to a million) and what it’s going to do, the epinephrin will actually force capillaries to shut and the pressure from the fluid will overcome capillary pressure therefore driving the fluid out of the capillaries, the blood out of the capillaries into the, back into the venules and that way we’ll get less bruising, less swelling, quicker recovery.
OK, now that we’ve got the fluid on both sides we’re going to kind of take the fluid and kind of disseminate it through the different layers.
Now, we’re going to give it 20 minutes to percolate.
We take a 3 millimeter internal diameter cannula and just make a few passes to find out kind of the lay of the land. It feels like this side is broken up very nicely. Much easier to pass through than the tumescent needle.
We’re sucking out a lot of the tumescent fluid put in so it’s very clear, what’s in here is very clear. OK, so now we’ve done the basics. Now it’s time to start with the more aggressive cannulas. You’ve gotta eat your Wheaties before you do this stuff. It’s definitely aerobic therefore you can lose weight right along with the patient.
So here we’re going to make an infra-areolar or peri-areolar incision. We’ve already numbed this area up. We’ve got epinephrin in so it decreases bleeding tremendously. [This] is a cutting tool and also it acts to cauterize any bleeders.
My finger is under the nipple now. This is breast gland. This is associated fibrous tissue, fat, and so on. We’ve got a lot of gland over here. This is true gynecomastia. Any more we’re going to get a depression.
Let’s see what he looks like. Go ahead and set him up, John.