Gynaecomastia is a medical condition characterized by the abnormal presence of breast tissue in a male. It is a lot more common than most people realize. It tends to occur during two phases of life: puberty to adolescence, and middle age and above. When it occurs in young patients, it sometimes disappears on its own. Not uncommonly however, it persists and become a source of social embarrassment to the affected individual.
There are two types of abnormal breast tissue in gynaecomastia: glandular and fatty.
Glandular breast tissue is firm, tough and gritty. It tends to occur under the nipple and areola region. Fatty breast tissue is softer and usually surrounds the glandular tissue. Most gynaecomastia patients have a both types of tissue in varying degrees. The conventional way of treating gynaecomastia is surgical excision via an incision that runs along the lower margin of the areola. Possible disadvantages of this technique are a surgical scar and a contour depression over the area where the tissue was removed caused by a relatively abrupt junction between it and the surrounding tissue.
On the other hand, gynaecomastia can be effectively treated using the Vaser LipoSelection technique. The ultrasound energy delivered by the Vaser probe is powerful enough to break down and liquefy even the tough, glandular breast tissue, after which it is sucked out using a liposuction cannula. This method avoids the surgical scar of the conventional technique and also produces a contour with less irregularity. In addition, the ultrasound energy of Vaser promotes skin tightening which helps to optimize contours further.
A few small incision (less than one cm) is made in in the underarm area to minimize visibility of the scars. The breast and surrounding areas to be addressed are first infiltrated with a saline solution containing long acting local anesthetic and adrenaline. The fluid causes the area to become swollen (tumescent), causing physical expansion and loosening of the fat and constriction of blood vessels by pressure. The tumescent effect thus facilitates fat removal and reduces bleeding. The local anesthetic ensures that after the surgery pain is well controlled. The adrenaline further reduces bleeding by causing blood vessels to go into spasm.
Next, the ultrasound probe is inserted into the breast tissue, both glandular and fatty, through the same incision and moved back and forth in a fan shaped pattern while the ultrasound energy is delivered. After this, a suction tube (cannula) is inserted and moved back and forth while the vacuum suction removes the fragmented breast tissue and liquefied fat. The wounds are then closed with fine sutures.
The length of the procedure depends on how much breast tissue needs to be removed. In general it ranges from one to 2.5 hours. Although small areas can be addressed under local anesthesia, intravenous sedation or general anesthesia is usually more comfortable for most patients. It is routinely completed as a day surgery procedure without the need for overnight stay or hospitalization.
Pain after surgery is mild and well controlled with oral pain medication. Moderate swelling and bruising are common side effects. The bruising normally takes two to three weeks to subside. About half the swelling will usually have subsided by two weeks, and about seventy percent by one month. Downtime ranges from a few days to about one week, depending on the amount of work done. Stitches are removed after one week.
A vest-like compression garment is worn for six to eight weeks, initially all the time for the first two weeks, then about half the time for the next two weeks, followed by nightly for the last two to four weeks.
Exercise can be resumed about one month after surgery. By three months, about ninety percent of the final result can usually be seen, with the final result being attained at about six months postoperatively.
The removed glandular breast tissue remains permanently removed. As for the removed fatty component, results are normally long lasting as long as body weight is maintained.
Risks associated with liposuction include blood loss, infection, uneven contours, and skin burns. Blood loss is usually minimal as the total amount of glandular and fatty tissue removed is not enough to cause significant blood loss.
Infection is rare, and is prevented by attention to sterility during the procedure and prophylactic antibiotics.
The problem of uneven contours caused by non-uniform removal of the glandular and fatty breast tissue is greatly minimized by the liquefying effect of the ultrasound energy on the solid breast tissues.
The ultrasound energy of Vaser translates into heat energy. This is what produces the skin tightening effect. However, excessive heat energy applied to the skin can cause burns. Therefore, several technical precautions are observed in using this technology that ensure that the risk of this complication is low.