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Dr Venkataram Mysore-Dr Jayashree Venkataram
Venkat Charmalaya-centre for advanced dermatology
Bangalore
www.bangaloreliposuction.com
www.bangalorehairtransplant.com
Gynaecomastia is a common condition causing
psychological disturbance and social embarrassment
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Puberty
Steroid abuse
Obesity
Tumours
Genetic disorders
Chronic liver disease
Side effects of many medications
Castration
Klinefelter Syndrome
Gilbert's Syndrome
Aging
 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
 Liposuction,
surgical resection are
suggested as the surgical techniques
Studies
have suggested that liposuction
or suction lipectomy alone is an excellent
treatment
Gynaecomastia-Situation in
India
 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
Our Experience
 There
are very few centres in India performing
tumescent liposuction alone.
 655 liposuction surgeries from 2004-2013
 MALE vs FEMALE: 333:322
WOMEN were more than MEN; marginally
 BREAST
 ABDOMEN
 Flanks
 Thighs
 Buttocks
 Arms
 CHIN
MALE breast was the most common indication
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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 Mild
 Moderate
 Severe
 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-
 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
 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

 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.
 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
Monitoring-we have a standby anesthetist for emergencies
 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
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Infiltration microcannulae have
diameter of 0.5-1 mm
Aspiration microcannulas have an
outside diameter upto 2.8 mm.
Cause less bleeding as they are
small and hence safer
 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
 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
 Amount
of fat aspirated was between 1 - 4 liters ,
with an average of 2.5 liters
 Duration of surgery was between 2 -4 hours
 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
Severe gynaecomastia-result after liposuction and extraction
Severe gynaecomastia-result after liposuction and extraction
 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
 ANTIBIOTIc
 PARACETAMOL
 PROXYVON
 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
Clinical Results
Clinical Results
Clinical Results
 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
 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.

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

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Severe Gynaecomastia needs additional extraction through a
juxtaareolar adit
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Skin hanging is not a significant problem except in the severe
cases
 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