Surgical Details of Dr. Bermant's Dynamic Technique for Gynecomastia Male Breast Reduction Surgery
There are many types of male breast deformity and surgical options for treatment. No one operation can manage all deformities. Predicting the specific problem to be treated before surgery can be difficult. Dr. Bermant evolved his dynamic technique to manage what is found during the operation. The technique varies depending on what is found during surgery. To help you better understand some of the variations, the following pages show photographs during specific cases that all use this dynamic sculpture.
Gland, fat, and skin can all contribute to a female like contour of the male breast. Gland is very firm and is not well treated by liposuction and better managed by excision. Fat is softer and can be sculpted with liposuction alone. The most common is a combination of fat and gland. Glandular tissue can be in a lump or spread with fingers of gland extending through the fat. View more details of gynecomastia anatomy and chest anatomy. Liposuction of the fat between these fingers can condense them into a solid lump of gland. Removing gland alone can result in a crater deformity of surrounding fat. Dr. Bermant blends various techniques for each of his sculptures of the male chest.
Warning: The following material is graphic in nature. Links will bring you to pages of graphic during surgical details.
Dr. Bermant starts out the day before surgery mapping out the contour problems of the chest. The tumescent technique can obscure what needs to be done during the operation. These before surgery markings help define the deformity during surgery.
Tumescent anesthesia with sedation minimizes bruising and increases after surgery comfort. The feel of the cannula is different going through fat vs. gland. Gland is tough, fat is easy.
This is the first stage of the dynamic technique. If Dr. Bermant senses denser glandular tissues with the cannula he then progresses to a glandular excision using an open approach.
Gland excision can result in a large cavity. If there is no fat left between the skin and underlying muscle, results do not look as good during animation and movement. By removing the gland early, Dr. Bermant can better judge how much of the surrounding fat will be needed to move back under the nipple areola to prevent a deformity. 
The incision he uses is typically 2 cm and just at the lower areola chest skin junction. A very large gland can commonly be removed through this small incision.
If gland is not present, the tumescent cannula passes easily during anesthesia. Then Dr. Bermant starts with liposuction alone. The most common location for this incision is at the lower pole of the areola. Other less common access sites for liposuction alone are the axilla (arm pit) and lower chest.
Find more details about male chest recontouring with liposuction that includes a short movie.
As liposuction progresses, sometimes a mass condenses as the fat is removed between subtle fingers of gland. Dr. Bermant will then stop the liposuction early and remove the gland. Liposuction can then continue contouring the crater walls. If the gland excision resulted in a significant defect, Dr. Bermant then sculpts fat back under the areola. This fat flap is still attached to surrounding tissues under the skin with a much higher chance of survival than fat grafts.
As tissues come together under the areola during this deep tissue sculpture, deformities can occur. Closing a circular defect can result in internal "dog ears" in the fat layer. Microcannular liposuction of the male chest as another tool that Dr. Bermant uses minimize chest scars and fine tune his sculpture.
Dr. Bermant's Internal Male Mastopexy Breast Lift is an extended version of his Fat Flap sculpture for men with breast ptosis o
r drooping chest tissues associated withgynecomasita. Tissues are lifted and sculpted through ashort incision. For patients with too much loose skin for an Internal Lift, Dr. Bermant has other options such as his Short Scar Skin Reduction Chest Lift.
Male chest surgery for gynecomastia is much easier when tissues are not scarred.
Here is a patient with a large gland left after another doctor's gynecomastia surgery. Revision of another doctor's male chest reduction is often more difficult than primary surgery.
Secondary male chest sculpture after another doctor's surgery may need scar revision and removal of dense glandular masses. Repeat male breast reduction has a smaller fat buffer region to use as deep tissue sculpture requiring improvisation for effective sculpture.
Although results evolve over time, there is immediate improvement at the time of Dr. Bermant's Gynecomastia chest sculpture. Learn more about Dr. Bermant's typical dressings after gynecomastia surgery. For comfort, we design the sculpture to permit a compression garment for comfort after male chest surgery.
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