suction assisted liposuction (sal) of the …...conrad jupiters, gold coast 29 august to 1 september...
TRANSCRIPT
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 1
SUCTION ASSISTED LIPOSUCTION (SAL) OF THE
MALE BREAST PRESENTED BY:
Dr. Josef Goldbaum
M.B.B.S.(Melb), F.A.M.A.C., F.A.C.N.E.M., F.F.M.A.C.C.S.
ACCS & CPSA Combined Conference
Conrad Jupiters, Gold Coast 29 August to 1 September 2003
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 2
Most males experience unilateral or bilateral breast enlargement during their life time.
Gynaecomastia is the most common breast problem in men, and requires no treatment unless it causes embarrassment or discomfort, or is associated with malignancy.
2
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 3
v Male Gynaecomastia has traditionally been treated by surgical excision of glandular and associated adipose tissue.
v The resultant aesthetic appearance is often poor with visible scars and
irregular appearances. v There is a significant rate of complication from general anaesthesia, acquired
infection, nipple necrosis, loss of nipple sensation and post op breast enlargement.
v Whilst the causes of gynaecomastia are many and varied, the reasons for the procedure are primarily aesthetic and psychological.
v Enlarged breasts can occur in males with normal body weight; but is
predominantly associated with obesity of the abdomen and hips.
v The triad of breasts, belly and love handles is a common presentation.
3
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 4
Simon in 1973 grouped patients into the following categories:-
I. Mild breast enlargement without skin redundancy.
4
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 5
II(a). Moderate breast enlargement without skin redundancy.
5
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 6
II(b). Moderate breast enlargement with minor skin redundancy.
6
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 7
III. Gross breast enlargement with skin redundancy. (Pendulous type of breast)
7
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 8
Idiopathic Physiological Pathological Alcohol related Drugs
Aetiology of Gynaecomastia
8
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 9
Neonatal Puberty Senility
Idiopathic
Most cases are idiopathic or genetic.
Physiological
9
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 10
Primary testicular failure such as Kleinfelters, Mumps and Irradiation. Secondary testicular failure such as pituitary, adrenal, or testicular tumors. Carcinoma such as Lung and Lymphoma. Hepatic disease such as Cirrhosis and Haemachromatosis Drugs Alcohol Obesity
Pathological
10
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 11
Drugs & Alcohol
Drug
Percentage*
Total Number (sole suspected)
Spironolactone
16.1
77 (62)
Cimetidine
11.2
49 (39)
Famotidine
3.8
11 (6)
Rantidine
2.5
32 (25)
Digoxin
2.4
22 (7)
Omeprazole
2.3
10 (8)
Verapamil
1.6
14 (7)
Simvastatin
1.2
19 (11)
Frusemide
1.1
13 (0)
Asprin
1.0
12 (0)
• Percentage of all reports for that drug
Report from the Australian Adverse Drug Reactions, August 1997
11
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 12
Obesity Biological breasts can occur in males with normal body weight; however in this series it was predominantly associated with obesity of the abdomen and hips. The triad of breasts, belly and love handles was a common presentation. Whilst the causes of male gynaecomastia are many varied, the reasons for breast reduction are primarily psychological and aesthetic. The literature relating to gynaecomastia is sparse, reflecting primarily surgical management and incidences of carcinoma of the breast. The writer undertook a random retrospective study of 50 male patients, who had undergone liposuction of the breast, either as a single procedure or in conjunction with other body areas.
12
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 13
Various surgical techniques have been utilised through sub-mammary or periareolar incisions. The resultant scarring and deformities are often cosmetically unacceptable and the risks of the surgery significant.
General anaesthesia Infection Nipple desensitization Nipple necrosis Hypertrophic scarring
Post-op breast enlargement.
Common Risks of Gynaecomastia Surgery
13
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 14
v A review of 50 male patients treated by SAL was undertaken.
v Liposuction of the breasts was the only procedure or was included with other body areas.
v All procedures were performed under LA with or without mild sedation.
v Two angles of approach were used to facilitate:-
- Maximum fat removal
- Smooth aesthetic appearance
- Avoidance of known areas for hypertrophic scarring
14
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 15
42% single procedures58% multiple procedures
Percentage of Patients
15
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 16
22%
8%
20%
50%
Basal Metabolic Rates
The BMI was calculated for each patient producing the following chart.
Average BMI = 28.6
Total 50 patients
16
Healthy BMI 20 to 24.9
Overweight BMI 25 to 29.9
Obesity BMI 30 to 34.9
Morbid Obesity BMI 35 to 39.9
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 17
Comorbidities All patients were assessed for pathology & comorbidities.
Some patients exhibited several concomitant comorbidities.
0
5
10
15
20
25
30
hypertension LFT Obesity Diabetes Hypothyroid Alcoholism Pacemaker Gallstones Nil
Type of condition
Num
ber
of p
atie
nts
17
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 18
Liposuction / liposculpture was performed utilising the wet technique of tumescent local anaesthesia.
The levels of Xylocaine required to produce regional anaesthesia were in the range of 11 to 47 mg / kg.
Mg xylocaine/kg weight
0
5
10
15
20
25
30
35
40
45
50
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
No. Patient
mg/
kg %
27.4
18
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 19
The volume of fat removed from the breasts ranged from 300 ml to 3200 ml. Average 850 ml.
0
500
1000
1500
2000
2500
3000
3500
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
No. Patients
Mls
850
Volume of Fat Removed
19
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 20
By comparison the volume of Infranate removed was in the range of 100 ml to 700 mls.
Volume of Fat vs Volume of Infranate
0
500
1000
1500
2000
2500
3000
3500
4000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53
Mls
Fat Removed From Breasts mlsInfranate 850 Fat
250 Infranate
20
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 21
Complications
SIGNIFICANT COMPLICATIONS – NIL
ECCHYMOSIS (Extensive Bruising) – 5 (10%)
2 related to alcohol
3 not related to alcohol
21
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 22
Results
Satisfactory aesthetic results were achieved in all patients, even in those with redundant skin and / or tightly adherent inframammary crease / fold.
22
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 23
Results
23
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 24
Results
24
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 25
Results
25
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 26
Results
26
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 27
Results
27
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 28
Results
28
Dr Josef Goldbaum – ACCS & CPSA Conference – 29 Aug – 1 Sep 2003
SAL OF THE MALE BREAST
Dr Josef Goldbaum 29
Conclusion
Liposuction / Liposculpture of the male breast is a safe and effective method of treating benign male Gynaecomastia without resulting scarring or deformity.
The wet technique of tumescent local anaesthesia allows the removal of maximum volume of fat and allows multiple areas to be treated within the safety range of Xylocaine.
Male Gynaecomastia is often associated with comorbidities, and although no cases of male breast carcinoma were encountered in this series, it must be excluded prior to Liposuction.
Ecchymosis or extensive bruising is a common complication, and may benefit from increasing the adrenaline content of the tumescing infiltrate.
29