“Is VASER liposuction effective for gynecomastia correction?” by Dr. Jag Chana
by Dr. Jag Chana
VASER liposuction is a relatively new form of liposuction which uses ultrasound energy to emulsify the fat thereby facilitating the liposuction process. It is a useful technique for the treatment of the male chest in mild to moderate cases where there is minimal skin excess. The advantages of using VASER liposuction is that the fat on the male chest can be quite fibrous and standard liposuction can be quite traumatic causing bruising and discomfort. VASER is useful since the ultrasonic energy helps to break down the fat and allows a gentler and smooth fat extraction with less bruising along with faster recovery times. In situations of gynecomastia where there is considerable skin excess, skin removal is usually required resulting in additional scarring. Vaser liposuction is particularly useful in borderline cases since this technique has an enhanced effect on skin retraction and therefore in certain cases a skin excision can sometimes be avoided which otherwise might have been necessary when using standard techniques.
The question arises whether VASER liposuction is effective for removing the breast gland itself. This issue was discussed during a presentation on my technique at the European Plastic Surgery Conference (ESPRAS) in Edinburgh. The study presented by my team analysed over 100 cases of gynecomastia procedures and found that VASER Liposuction was not effective at removing the firm glandular tissue behind the nipple. In fact 40% of the patients undergoing surgery were secondary cases who were unhappy from having residual glandular tissue after being treated at other clinics usually by doctors who were untrained in plastic surgical techniques. These patients had previously undergone VASER liposuction alone with no gland removal. These patients therefore required secondary corrective surgery which involved removing the gland via a very small incision within the areola.
A demonstration of this is shown below where VASER liposuction has been used to remove the fat element of the gynecomastia but what is left behind is the gland itself. In this patient the gland itself was so dense that the VASER probe could not be passed into the glandular tissue. It had to be removed by avulsing it through a small areolar incision and excising it. As can be seen this can be performed without extending the incision beyond the areola thereby keeping the scarring very limited.
This image shows VASER liposuction having been carried out on both sides of the chest and is taken during surgery. On one side ( the patient’s right side) the procedure has been completed along with an excision of the gland itself and can be seen to be flat . On the other side the Vaser liposuction has been carried out but leaves behind the glandular tissue which has been herniated through a small areola incision prior to formal excision.
It is therefore recommended that this glandular tissue needs to be carefully assessed prior to surgery . Occasionally small amounts of glandular tissue become evident during surgery after the liposuction has been performed. The surgeon therefore needs to be ready to remove this gland at the time of surgery in order to provide the result that is expected. As a result of the additional surgical gland excision it is often advisable for this surgery to be carried out under general anesthetic.
The results of the study indicate that although VASER Liposuction is a very useful technique in gynecomastia patients it is most effective in combination with a gland excision in a large number of patients.