DOES SMARTLIPO OR ULTRASONIC-ASSISTED LIPOSUCTION WORK FOR GYNECOMASTIA?

This is a very good question and one that is often asked in consultation.  I have used ultrasonic liposuction and I continue using it today for liposuction.  However, I do not use SmartLipo or ultrasonic liposuction with my gynecomastia cases.  The reason I do not use ultrasonic-assisted liposuction is because in some cases the ultrasonic heat will cause some undue trauma to the skin and can be difficult to control. Therefore, I do not use the ultrasound in the chest itself; however, I do use it sometimes in the axillae (under the arms) for extraction of that fat.  I think that it is a mistake to use ultrasound or SmartLipo to treat gynecomastia only.  These modalities will treat the fat well, but will not extract the glandular tissue and, therefore, it will remain and the patients seeking male breast reduction, in most cases, are not happy with the results.  Approximately 25%-30% of my gynecomastia practice is redo surgeries from other establishments and the primary reason is that a patient has had liposuction only. Due to the scar tissue caused by liposuction, the corrective surgery may be more difficult and sometimes the contraction of the skin is a little bit more unreliable when liposuction has been done first.  The liposuction is very adequate for patients that have pseudogynecomastia, which is gynecomastia due to fat accumulation.  This would be caused by weight gain in men or boys past puberty. Therefore, my suggestion is that if you do not have pseudogynecomastia, that a combination of liposuction, whether SmartLipo or ultrasound or tumescent liposuction, in conjunction with glandular excision is the best means for a good outcome.  In some cases, you can do the light gynecomastia technique with a small incision depending on the extent of the gynecomastia, as explained in an earlier blog dated March 31.

MIGUEL A. DELGADO, M.D.