Tumescent

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Liposuction. in . Gynaecomastia . Dr . Venkataram . Mysore-Dr Jayashree Venkataram. Venkat Charmalaya-centre for advanced dermatology. Bangalore. www.bangaloreliposuction.com. www.bangalorehairtransplant.com. ID: 427518 Download Presentation

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Tumescent




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Slide1

Tumescent Liposuctionin Gynaecomastia

Dr

Venkataram

Mysore-Dr Jayashree Venkataram

Venkat Charmalaya-centre for advanced dermatology

Bangalore

www.bangaloreliposuction.com

www.bangalorehairtransplant.com

Slide2

Male breasts ( Gynaecomastia)

Gynaecomastia

is a common condition

causing psychological

disturbance and social embarrassment

Slide3

Causes

Puberty

Steroid abuse

Obesity

Tumours

Genetic disorders

Chronic liver disease

Side effects of many medications

Castration

Klinefelter

Syndrome

Gilbert's Syndrome

Aging

Slide4

Causes

In

most cases, underlying cause cannot be found

Tamoxifen,

Danazol

has been found to be useful for

oestrogen

sensitive gynaecomastia

However, treatment of the condition is usually by surgery

Slide5

Surgery

Liposuction, surgical resection are suggested as the surgical techniques

Slide6

Is liposuction alone adequate?

Studies have suggested that liposuction or suction lipectomy alone is an excellent treatment

Slide7

In Indian culture, dress code for men demands that, during religious occasions, visit to temples, marriages, breast area is exposed

Limitation of outdoor activities such as swimming, while playing sports, GymnasiumLimitation in wearing tight shirtsSource of embarrassment for students in hostels with common baths

Gynaecomastia-Situation in India

Slide8

Indications in Indian patients

There are very few centres in India performing tumescent liposuction alone.655 liposuction surgeries from 2004-2013MALE vs FEMALE: 333:322

WOMEN were more than MEN; marginally

Our Experience

Slide9

Different Areas In Men

BREAST ABDOMEN Flanks Thighs Buttocks Arms CHIN

MALE breast was the most common indication

Slide10

Simplified classification of Gynaecomastia

Mild( with prominence of central part of breast and nipple areas only)

Moderate( prominence of entire breast region without skin hanging)

Severe( prominences of entire breast area with hanging resembling female breast).

Slide11

Mild

Moderate

Severe

Slide12

Male breasts our data

Most patients were in the age group of 15-30 years.

Four patients below 20 years

Youngest was 15 years in age (was counseled with parents )

Oldest patient was 60 years-

Slide13

Pre-operative instructions

Routine blood investigations such as blood counts , Coagulation profile, LFT, Blood sugar, HbS Ag, HIV - and ECG, Ultrasound in moderate & severe male breasts

Advice to stop smoking

Avoidance of oral NSAIDs

Preoperative tranquillizer such as diazepam or lorazepam on the night before surgery

Injection Vitamin K to minimize postoperative bruising

Slide14

Preoperative Ultrasound of Breast

Preoperative evaluation by ultrasound was performed in all the moderate and severe cases of

gynaecomastia

Most cases had an admixture of fat and glandular tissue

Severe cases had predominant glandular tissue

Slide15

Preparation of patient

a) Preoperative antibiotic such as cephalexin

b) Preoperative tranquillizer such as oral lorazepam 1 mg

c) Oral Clonidine 0.1 mg to prevent epinephrine induced tachycardia and as an adjuvant anxiolytic drug.

Slide16

Preparation of patient

Surgical cleaning of the area with

povidone

iodine

The area for liposuction is topographically marked, with marker ink of different colours to delineate the bulges and asymmetry

Slide17

Monitoring-we have a standby anesthetist for emergencies

Slide18

Adits

NUMBER

: 1-2

on each side

SIZE : 2 to-2.5mm

PLACEMENT : We avoid upper medial quadrant in breast as this area is seen when shirt is not buttoned as it is more prone for

Keloid

Slide19

Suction apparatus of

1HP power

Slide20

Instruments -microcannulae

Infiltration microcannulae have diameter of 0.5-1 mmAspiration microcannulas have an outside diameter upto 2.8 mm.Cause less bleeding as they are small and hence safer

Slide21

Powered liposuction

We use power Assisted Liposuction-

Microair

,

Euromi

machines are available

No thermal component

We have found that it reduces surgeons strain and fatigue

Cuts short Surgery time

Slide22

Laser Lipolysis

We use

Nd

yag

laser for

lipolysis

for additional benefit.

Laser can access difficult areas

Laser also helps reduce fat and induce tightening of skin to prevent hanging

Slide23

Aspiration

Amount of fat aspirated was between 1 - 4 liters , with an average of 2.5 liters

Duration of surgery was between 2 -4 hours

Slide24

Severe gynaecomastia-use of extraction

In patients with severe gynaecomastia, an additional larger

adit

of 6 mms was placed, just adjacent to areola and the

fibrofattyglandular

tissue was extracted and excised.

This greatly reduced the

subareloar

lump

Slide25

Severe gynaecomastia-result after liposuction and extraction

Slide26

Severe gynaecomastia-result after liposuction and extraction

Slide27

Postoperative Dressing and follow up

No suturing of adits in most cases

In severe cases, which need manual extraction, we put an infraareolar incision which is sutured

This facilitates drainage of fluid

Tight pressure bandages are essential to ensure proper drainage of the tumescent fluid.

Pt goes home the same day

Slide28

Postoperative Drugs

ANTIBIOTIc

PARACETAMOL

PROXYVON

Slide29

Followup

Patient is advised to come for follow up for dressing daily for two days.

More than 50% of results will be seen on day 2

Further improvements happen gradually due to breakdown and absorption of fat

Final result is seen after 4-6 weeks

Slide30

Clinical Results

Slide31

Slide32

Slide33

Slide34

Slide35

Slide36

Slide37

Slide38

Clinical Results

Slide39

Clinical Results

Slide40

Does it have any complications?

All patients had uneventful recovery with out any serious side effects.

Post operative pain and tenderness were mild in all patients.

Adit

sites healed well in all patients

Slide41

Sagging of skin

No sagging was seen except in patients

Even in severe cases, there was no obvious hanging and the

resultwas

mild and was acceptable to patients.

Slide42

Conclusions

Tumescent liposuction is a very safe and effective surgery for gynaecomastia

Thorough tumescence and use of

microcannulae

are important for safety

Most cases can be treated effectively, without the need for more aggressive and expensive surgery

Severe Gynaecomastia needs additional extraction through a

juxtaareolar

adit

Skin hanging is not a significant problem except in the severe cases

Slide43

Slide44

Slide45

Our Doctors- experienced team

Dr

venkataram

MD DNB

DipRCPAth

(

Lond

)- Consultant

Dermatosurgeon

. Past President of Assn of Cutaneus Surgeons India

Dr

Jayashree

Venkataram MRCOG Liposuction

Surgoen

trained with Dr Jeffrey Klein

Slide46


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