Tumescent local anaesthesia allows bloodless planes of dissection for complete glandular removal in every patient of male breast whatever be the size. Tumescent technique permits complete en-block lifting of glandular tissue off the pectoral muscles, totally under local anaesthesia and without sedation. Traditionally gynecomastia surgery is done under general anaesthesia and glandular tissue is removed in pieces. Excessive blood loss in traditional technique obscures clear vision of all glands tissues. Therefore, there are chances of incomplete glands removal. Incomplete removal of glands will result in residual bulge in the chest area and an unsatisfied patient. Cosmetically the results are less than satisfactory in traditional way of doing surgery. As such gynaecomastia surgery is almost always done for cosmetic and psychological reasons. On the other hand, Tumescent ‘awake’ technique allows easy and bloodless identification of planes of dissection of mammary glands. Therefore, with Tumescent technique it is possible to remove the glandular tissue en-bloc and achieve complete flattening of male breast.
There are basically three components in a breast– skin, mammary glands and fat. Liposuction is done to remove excess fat. Liposuction removes not just fat but, fat cells also. Therefore, fat will not deposit in the chest area again, even if there is significant weight gain. Only residual fat cells enlarge due to weight gain. Liposuction is followed by complete glandular removal following well defined planes of dissection, through a small cut in the dark circle around the nipple. Almost always, we never excise skin in primary surgery. It is usually not required. Skin shrinks very well later on.
Virtually bloodless surgery gives a completely avascular operative field. The glandular tissue is very well identified. The incidence of postoperative hematoma (blood collection) or infection are very rare. Patients achiev complete flattening of chest every time and in every size of breast. Patients were back to their normal daily activities from the very next day and scars of surgery, though permanent, are hardly visible after few months. As such the incision is placed within the dark circle (areola). In some cases of pendulous breasts, residual excess skin which does not shrink may be removed after a year from surgery, after allowing full time to shrink naturally.