Dr. Mordcai Blau – Gynecomastia Surgery Blog

Information on Gynecomastia Incisions by Dr. Mordcai Blau

When it comes to gynecomastia surgery, the choice of how the incision is made is crucial. In 1992, back when relatively less was known about best practices for gynecomastia removal, I decided to invite 100 patients to participate in an on-line comparison survey to find out more information about patient preferences for incisions. Of the 100 patients invited, 50 were those who were my patients and 50 were those who had gynecomastia surgery performed on them by other doctors. The two types of incision I wanted to compare were the lower axelar incision and lateral (under the armpit). I also wanted to find out more information about the advantage of one incision vs. multiple incisions. All of the patients’ incisions were between a year and a half to three years old.

Lateral incision under the armpit

This patient has an incision made under the areola

Some of the conclusions I drew, were that the vast majority of the plastic surgeons who utilize the lateral incision seem to agree that it is effective for liposuction only. A small amount reported that maybe only tiny amount of Gynecomastia can be proven (most of the G could stop in today.) For hard fill number of patients claim they involved sharp instrument they can scrap sore of the glandular time.
In contrasting the responses with my experience, I’ve found that I have personally tried all kind of instrumentation and could not remove even a small amount of breast tissue using the lateral approach. The rate of recurrence with the lateral approach was extremely high and probably between 10-35 %. This is due to the fact that gland removal incision is highly visible even though it may be shorter then axeolar incision. In this case, there is natural liner to hide the gynecomastia incision (in comparison to a line between the areola and the shins). However, my personal experience is that less than 1% of patients with lower areola incision have noticeable scars in comparison to almost all patients that have lateral scars. Utilization of only one incision for breast through which liposuction and gland removal is done in this process. Rarely less than 5% need a drain after subgranlar incision which may be in some cases and second after a third incision to one breast.