Dr. Neavin joined leaders in the field of male breast reduction surgery at the American Society of Plastic Surgeons in Chicago last week. He was invited to participate in a panel for the Plastic Surgery Educational Network (PSEN), along with Drs. Ernest Mander, Brian Heil and moderator, Keith Jeffords. This is Dr. Neavin’s third invitation. Last year, Dr. Neavin spoke for the PSEN on hair transplantation and male plastic surgery for their teaching series.
Each panelist discussed how they approach the patient presenting with gynecomastia and presented cases that were deemed challenging. While Dr. Heil and Dr. Manders subscribes to the technique of avulsion of glandular tissue after liposuction, Dr. Neavin and Dr. Jeffords shared their belief that a more accurate removal of glandular tissue can be removed by direct excision after aggressive chest wall liposuction. Skin properties among all of the speakers were often the most important considerations
The panel agreed unanimously on the importance of presenting staged options to patients with advanced cases of gynecomastia. Because in younger adults the skin tends to heal remarkably tight with proper post operative garment wear, large incisions necessary for skin removal can at times be obviated. However, Dr. Neavin believes that in those men who have lost massive weight rapidly, the elastic properties of the skin are far less predictable. In such cases, while two stage surgeries can be presented to the patient, more often than not skin after glandular excision and liposuction will not adequately tighten to flatten the chest. Dr. Neavin presented such a case to the panel.
While Dr. Heil uses ultrasound assisted liposuction (UAL) on all gynecomastia cases, Dr. Neavin believes it is best saved more more advanced cases where skin retraction may be a difficult endeavor given the increased risk of seroma formation with UAL. Dr. Manders offered that he generally feels UAL is unnecessary with proper post operative garnet fitting.
Indeed, all panelists agreed that garment wear must be part of the program for a minimum of 4 weeks and often as long as six weeks to three months and that compression is a critical factor in achieving optimal results after male breast reduction surgery.
Dr. Jeffords and Dr. Heil demonstrated remarkable cases of single and two stage procedures, respectively, where patients went on to lose weight with diet and exercise. These cases illustrated the point that gynecomastia correction is often a strong impetus for men to take control of their body. That the surgery is as effective as it is emotionally rewarding to those living with gynecomastia.
Dr. Tim Neavin is a board-certified plastic surgeon located in Beverly Hills, California.