Author Topic: Gynecomastia Surgery Forum - Avoiding Areola Scars Armpit Incisions?  (Read 14320 times)

Offline DrBermant

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I want to avoid scars going around the areola, can this surgery just be done through the armpits?

Remote access for gynecomastia attempts have been available for quite some time. Patients complain about the under arm scars, their length, and how they show especially with the arms up playing basketball, swimming, or volleyball.

Under Arm Incisions Require Sculpture from a remote location and depending on either liposuction or long fine cutting tools.  Some doctors may try the remote location first and then add additional scars by the areola.  I prefer to limit the scars on the surface and internally.  Two surface scars are much better than 4 or more. The color interface of the areola and chest is a great place to hide a scar. My typical at the edge of the areola is now typically 1.6 cm (0.6 inch) long. I can sometimes even improve another surgeon's scar by moving it to this interface as in this  Revision Gynecomastia Surgery.

I have seen just too many unhappy patients with Puffy Nipple Complication After Gynecomastia Surgery remaining after axilla or armpit attempts alone using sharp cutting cannula or other such instruments by other doctors.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesion, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexing here to see what I mean.

For a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used special remote instruments to remove gland, that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.  I prefer to avoid this unnecessary additional scar.  Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  Scars to be considered include the sculpted tissues, yes the entire zone operated on.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Check out this series of pictures and movies to better understand that analysis of how tissues moves is critical to understanding the amount of scars a technique creates.

The areola chest skin interface is a great place to hide a scar.  Check out the many before after pictures of this Areola / Nipple Gallery here, here, and here.  These results are typical for my sculpture of my patients.

Extended Crater Defect Deformity After Gynecomastia Surgery. Now hopefully this example puts into perspective issues like  the areola vs. axilla scar with the video of how that patient chest moves. Scars can be much more than what is on the surface.

Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.  But the results should be much more than a few of the best possible photographic views that can obscure the true nature of the contour of the living male chest sculpture.

Hope this helps,

Michael Bermant, MD
Learn More about Gynecomastia and Chest Sculpture
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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