Surgical Details of Fat Flap Sculpture for Gynecomastia
Dr. Bermant prefers a dynamic technique to sculpt the male chest when dealing with gynecomastia. Glandular tissue removed by excision can leave a significant defect: a crater with surrounding walls of fat. Liposuction alone or excision with liposuction manage most problems. At other times, loose fat can be sculpted into the defect with sutures. Sometimes there is just too large a gland compared to the amount of easily movable fat. Just what is needed can vary from patient to patient, and from breast to breast.
Improvisation is the artistry of surgical sculpture.
One of the many tools he may use involves moving vascularized fat to fill in significant defects after gland excision. Instead of removing the fat walls with liposuction, Dr. Bermant sometimes moves parts of the wall to fill the cavity. Fat needs a blood supply to survive. Trying to keep a blood supply to the fat can be tricky. A fat graft (transferred tissue without a vascular supply) must regain new blood source from surrounding tissue. A fat flap is attached to the body by blood vessels. Chest fat gets its blood supply from tiny vessels of the skin above and the muscles below. Fat flaps are held in place with sutures.
Moving a fat flap can cause other distortions. Dr. Bermant alternates between his various sculpture tools to optimize the results at the time of the operation.
Arrows point to one of many possible Fat Flaps Dr. Bermant may use during Male Chest Reconstruction.
In gynecomastia, gland tends to concentrate under the nipple and areola. Fingers of gland then can descend through the fat towards the chest muscles.
Dr. Bermant usually removes the gland through a small incision at the areola / chest skin junction. A large gland can often be removed and fat flap sculpture performed through this small access. Sometimes there is a significant crater defect after the gland has been removed. Depending on the fat, a depression may remain if liposuction alone is used to contour the walls.
Fat flap elevation involves mobilization of the fat preserving important blood vessels to supply the tissue. The fat has been released from the skin so it can be moved into the crater and not distort the surface.
Here the fat flaps have been advanced into the crater defect with sutures. The residual crater walls still may need liposuction contouring. Dr. Bermant sometimes uses temporary sutures to help determine how much fat will need to be removed with liposuction.
Blood vessels help keep the fat flap alive during early healing.
With glandular excision, Dr. Bermant may need to contour the deeper remaining tissues with suture as part of the chest sculpting.