Tumescent Liposuction in - PowerPoint Presentation

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Tumescent Liposuctionin Gynaecomastia

Dr

Venkataram

Mysore-Dr Jayashree Venkataram

Venkat Charmalaya-centre for advanced dermatology

Bangalore

www.bangaloreliposuction.com

www.bangalorehairtransplant.com

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Male breasts ( Gynaecomastia)Gynaecomastia is a common condition causing psychological disturbance and social embarrassment

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CausesPuberty Steroid abuse ObesityTumours Genetic disorders Chronic liver disease

Side effects of many medications

Castration

Klinefelter

Syndrome

Gilbert's Syndrome

Aging

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CausesIn most cases, underlying cause cannot be foundTamoxifen, Danazol has been found to be useful for oestrogen sensitive gynaecomastiaHowever, treatment of the condition is usually by surgery

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SurgeryLiposuction, surgical resection are suggested as the surgical techniques

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

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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, Gymnasium

Limitation in wearing tight shirts

Source of embarrassment for students in hostels with common baths

Gynaecomastia-Situation in India

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Indications in Indian patientsThere are very few centres in India performing tumescent liposuction alone.655 liposuction surgeries from 2004-2013MALE vs FEMALE: 333:322WOMEN were more than MEN; marginally Our Experience

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Different Areas In MenBREAST ABDOMEN Flanks Thighs Buttocks Arms CHIN

MALE breast was the most common indication

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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).

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MildModerateSevere

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Male breasts our dataMost patients were in the age group of 15-30 years.Four patients below 20 yearsYoungest was 15 years in age (was counseled with parents )Oldest patient was 60 years-

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Pre-operative instructionsRoutine 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 surgeryInjection Vitamin K to minimize postoperative bruising

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Preoperative Ultrasound of BreastPreoperative evaluation by ultrasound was performed in all the moderate and severe cases of gynaecomastia Most cases had an admixture of fat and glandular tissueSevere cases had predominant glandular tissue

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Preparation of patienta) Preoperative antibiotic such as cephalexinb) Preoperative tranquillizer such as oral lorazepam 1 mgc) Oral Clonidine 0.1 mg to prevent epinephrine induced tachycardia and as an adjuvant anxiolytic drug.

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Preparation of patientSurgical 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

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Monitoring-we have a standby anesthetist for emergencies

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AditsNUMBER : 1-2 on each side SIZE : 2 to-2.5mmPLACEMENT : We avoid upper medial quadrant in breast as this area is seen when shirt is not buttoned as it is more prone for Keloid

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Suction apparatus of 1HP power

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Instruments -microcannulaeInfiltration 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

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Powered liposuctionWe 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

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Laser LipolysisWe use Nd yag laser for lipolysis for additional benefit.Laser can access difficult areasLaser also helps reduce fat and induce tightening of skin to prevent hanging

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AspirationAmount of fat aspirated was between 1 - 4 liters , with an average of 2.5 litersDuration of surgery was between 2 -4 hours

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Severe gynaecomastia-use of extractionIn 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

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Severe gynaecomastia-result after liposuction and extraction

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Severe gynaecomastia-result after liposuction and extraction

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Postoperative Dressing and follow upNo suturing of adits in most casesIn severe cases, which need manual extraction, we put an infraareolar incision which is suturedThis facilitates drainage of fluidTight pressure bandages are essential to ensure proper drainage of the tumescent fluid.Pt goes home the same day

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Postoperative DrugsANTIBIOTIcPARACETAMOLPROXYVON

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FollowupPatient is advised to come for follow up for dressing daily for two days.More than 50% of results will be seen on day 2Further improvements happen gradually due to breakdown and absorption of fatFinal result is seen after 4-6 weeks

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Clinical Results

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Clinical Results

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Clinical Results

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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

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Sagging of skinNo sagging was seen except in patients Even in severe cases, there was no obvious hanging and the resultwas mild and was acceptable to patients.

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ConclusionsTumescent liposuction is a very safe and effective surgery for gynaecomastiaThorough tumescence and use of microcannulae are important for safetyMost cases can be treated effectively, without the need for more aggressive and expensive surgerySevere Gynaecomastia needs additional extraction through a juxtaareolar aditSkin hanging is not a significant problem except in the severe cases

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Our Doctors- experienced teamDr venkataram MD DNB DipRCPAth(Lond)- Consultant Dermatosurgeon. Past President of Assn of Cutaneus Surgeons IndiaDr Jayashree Venkataram MRCOG Liposuction Surgoen trained with Dr Jeffrey Klein

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