Liposuction for man boobs (or gynaecomastia, which is the medical term) is the mainstay of treatment.
However, it is often not enough to perform liposuction on its own.

Man Boobs are caused by an excess of breast tissue in a male, and males have breast tissue as well as females.

Breast tissue is made up of a combination of fatty tissue and glandular tissue and patients with man boobs often have dense glandular tissue behind the nipple.
Liposuction is very good at removing the fatty tissue and contouring the chest, but it cannot remove the dense glandular tissue.

Liposuction is good, but it may not be enough

If there is glandular tissue beneath the nipple and you just have liposuction, this dense tissue is left behind and you might still have a hard lump leaving the nipple looking puffy.

No one wants a scar, but we can hide them pretty well

This is why liposuction often needs to be combined with excision using a U-shaped excision at the lower border of the areola which can be difficult to see when it is healed as shown below:

It is often by combing liposuction with excision, the dense glandular tissue can be removed and the whole chest can be contoured to give a balanced and athletic look to the male chest whilst hiding the scars, so that once they have faded they are difficult to see.

A combination of liposuction and excision allows us to directly address both the fatty tissue and the glandular tissue and effectively remove the excess breast tissue.

If you want to know more about liposuction for man boobs and other frequently asked questions, you can download my guide here.

If there is anything I haven’t covered, then join me on Facebook Live at 7 p.m. every Tuesday night when you can pitch your questions directly to me, or you can e-mail here if you would prefer a more direct reply.

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The Best Breast Implant?

Patients do a huge amount of research about the best breast implant.  It is good to be informed before having breast augmentation and in this day and age with the internet and information that is freely available, it is reasonable to come to the clinic armed with ideas and expectations of which implant you would like.

We encourage this and one of the unique things about the clinic is that we are all fully trained plastic surgeons, so I feel that we appeal to a group of patients who do tend to research things a bit more and will choose a clinic based on the experience, expertise, and aftercare, rather than purely the price.

However, when it comes to the ‘best breast implant’, I do think that patients can tend to over-estimate the importance of certain aspects.

I often hear them asking for a certain make of implant because they have been told they are the best.

Now if you think about what a breast implant is, it is a silicone shell filled with silicone gel, the gel inside the implant comes from one factory in Texas, so regardless of the make they all have the same gel and the shell is either textured, smooth or polyurethane foam.

There is not a great deal to distinguish between different makes of smooth implants, and whilst there are some differences in the texturing between different makes of implant, I am not sure whether it would be enough to say that one is the better than another.  If you want polyurethane implants, then there is only one manufacturer in the world who makes them, Polytech, so you have no choice!

If there was one manufacturer that was best, we would all use it, but the reality is that there are several very good well-respected manufacturers all of whom make high quality implants.

Trust me, if one make was the best we would be using it.

It is a bit like suggesting that one make of car is better than another.

Is BMW better than Mercedes?

What it often comes down it is actually a model.

It is hard to compare a two-seater sporty BMW with an enormous Mercedes 4 x 4 SUV, but just like choosing a car, you need to think about what sort of model you want, what sort of shape you want, and what sort of look you are trying to achieve, and this is going to affect the outcome much more than the actual manufacturer of the implants.

You can see in the video below, I discuss the importance of the shape and profile of the implant in achieving the final result.

It is not enough just to choose a certain shape and profile for an individual, because that shape and profile has to be matched to your body frame in terms of the dimensions of your chest and the shape and volume of the breasts that you have currently.  The best breast implant for one person may not be the best breast implant for you, even if you think that person has a great result.

This is why it is so hard to give an opinion to someone in an on-line chat or in a forum, because we would need to see you, measure you, and formulate a plan to decide on the best breast implant which is unique to you.

We won’t tell you what implant to have, but we will help you come to a decision as to what implant might be the best for your frame.

In fact, I always say that the most important decision is not about choosing the best breast implant.

The most important decision is your surgeon; it does not matter what make or shape of implant you have, if it is not placed correctly it will not look good.

If the implant is placed too high or too level, too wide apart or too close together, you will be unhappy with the result regardless of the make, shape, profile, or texturing.
This is the decision that is going to make a tangible difference to the outcome that you get.

So, choose your surgeon wisely, both in terms of their qualifications and experience, but also in terms of their personality and your rapport with them.

I do not think you can underestimate the gut feeling that you get when you see a surgeon, because whilst it is only a one-off operation, we do like to keep an eye on you and see you for months and years afterwards.

It is important that you feel you can talk to us, raising any questions or concerns, and convey your desired results to us.

If you do not feel that you can, then I suggest you keep looking.

There are plenty of fully qualified plastic surgeons around.

As long as you choose someone who is or has been an NHS consultant in plastic surgery, then you can be sure they are fully trained.

If you want to know more about what is involved in plastic surgery during the training and how to choose a plastic surgeon, you can get a free copy of my book from my website entitled ‘Never Accept A Lift From Strangers‘, and if you have any questions, you can find me on Facebook every Tuesday night at 7 o’clock and I would be happy to answer them.

But whilst it is important that you are happy with the manufacturer, shape, the texture, and the profile, and all the aspects of your implant choice, please try not to worry about it too much as it might not be as important as you think.

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Rippling of breast implants is one of those things that patients fear because it can cause an unsightly look and feel to the breast.

The cause of rippling is relatively simple.

If you look at any breast implant and hold it up vertically you will see that the shell will naturally cause ripples in the upper pole as the gel falls into the lower part of the implant and the upper part empties.

This is because there is an element of fluidity in the gel which makes the implant feel soft, and so without this attribute the implants would feel very hard.

Indeed if you look at a solid silicone prosthesis such as those used in calf implants or testicular implants, they do not show any signs of rippling but they feel very hard.

And so it is a balance between the composition of the implant and the amount of cover over the implant.

Some implants have softer gel than others, which you may think would be a good thing, but we are actually moving more towards firmer gels these days.

In medical terms this is known as cohesive gel or ‘form stable’.

These types of gel are safer if the shell ruptures because they do not leak liquid silicone and they are less prone to rippling.

The other element that is important to consider when thinking about rippling is the amount of soft tissue cover over the implant because all implants have this rippling in the shell to a greater or lesser degree, and the question is whether you can see the ripples and that is dependent on the amount of skin, fat, and breast tissue that is covering or ‘hiding’ the implant.

What can I do if I have rippling?
 
Rippling is actually quite a difficult problem to treat.  The two main areas to focus on are:

1. The implant
2. Soft tissue cover

The implant “ if you have a less cohesive implant and particularly if you have the saline filled implant which are the least cohesive of all, it may be possible to use a more cohesive filling which would feel firmer and ripple less.  Obviously the downside is that it may feel firmer and you might possibly be able to feel the edges and so there is a balance to be had.

Soft tissue cover “ it can be difficult to get more soft tissue cover particularly in a slim individual.

The first thing to consider is whether the implant is on top of or beneath the muscle.

If the implant is on top of the muscle, it would be possible to change the plane into a submuscular underneath the pectoralis major muscle, although the muscle only covers the implant in the upper part.

If there is visible rippling on the lateral aspect of the breast, then it is not really possible to cover this with muscle, and so this option is unavailable.

Of course the implant might be already under the muscle and so you might want to look at other options.

The best option in this situation is to perform fat grafting over the top of the implant to give it some more cover (of course you could put on weight, although I would not necessarily recommend this).

Fat grafting (link to the fat grafting page or the blog post) is a technique that involves removing fat from one area and then injecting it to another area.

It is particularly useful for localised areas of deformity or loss of soft tissue cover.

It can be tricky to inject the fat over the implant because the space between the implant and the skin is very small, which is why you have the rippling in the first place.

Nevertheless it is something that could be possible, although you would have to be aware of the risks and complications of this surgery because you would be injecting very close to the implant so there is a risk of damage to the implant shell and there is a risk of introducing infection, which could require the implant to be removed and so this is not to be taken on lightly.

Unfortunately there is no simple and quick fix for breast implant rippling, and so it needs a full and frank discussion with your plastic surgeon because it may be that leaving things as they are is a viable option.

If you have any questions about rippling of implants, then download our guide or contact us on the website or on Facebook where our director does a live Q and A on Facebook every Tuesday at 7 p.m.  Please visit our Facebook page if you would like to put a question directly to me.

Feel free to leave a comment below, or drop us an e-mail.

If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

Cosmetic Surgery App aimed at children
 
I have read today about an App that has been made that is aimed at children
https://www.independent.co.uk/voices/plastic-surgery-girls-children-liposuction-nose-job-lip-filler-double-eyelid-surgery-body-image-a8270041.html

This is very worrying and is part of a growing trend to sensationalise plastic and cosmetic surgery.

I have a 13 year old daughter and I feel her pain and insecurities she has around her appearance and if I could give her just one gift it would be self-confidence, and I think this is something that we all lack at times.

Society, and particularly the media, does a great job of portraying idealistic lifestyles and no-one wants to hear if we are not really OK and see an image of someone who has spots or is slightly overweight, and it is a tragedy that these preconceived ideas are being indoctrinated at such a young age, as this App is clearly aimed at small children.

One of the great joys of seeing children playing together is that they do not care if one is fat or skinny, has a big nose or sticky-out ears, is black or white, is rich or poor.

They take them as they find them and this beautiful innocence and tolerance is gradually taken from them.

They do not care if their dad is a shop-keeper or the Prime Minister.

They pay no attention to the make of clothes their friends are wearing or the car that their parents drove them to the party in.

They take each other as they see them.

For some reason this is lost as we get older and we start to judge each other and feel judged and whilst cosmetic surgery can have a huge positive impact on people’s lives and I am very proud to be a part of that, I find it distressing that people can be so obsessed and unhappy with something that in reality is quite trivial, such as the appearance of their face or their breasts or their body, and the longer we can maintain the innocence in our children the better.

I should not be suggesting that there is a need to change how we look, and we should not be indoctrinating our children with the idea that it is preferable to have a certain appearance.

I know that people will look at me and think that I am part of the problem because I perform cosmetic surgery, but if only they could see the transformations that can be made and the lives that can be changed.

I am a great advocate of cosmetic surgery and I think it can be a great force for good, but I am very worried about how it is perceived by many.

I would like our children to hold onto their inner beauty and self-confidence for as long as possible.

If you have any questions or concerns then we’d love to hear from you.  You can e-mail us or call us.

Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

Tuberous Breast Deformity

 
Tuberous breast deformity is a term that I see quite a lot, particularly on blogs and forums.

It is used as a label to encompass quite a wide range of breast deformities.

Patients can get quite upset and anxious when they hear the term and think that there might be something wrong with them when they are given this diagnosis, but it is really just a term used to describe a combination of features of the breast and it is nothing to fear.
In fact, I often see people who have been labelled as having a tuberous breast deformity, when in its mildest forms, it is simply a variation of the normal breast shape.
At the end of the day, it does not really matter what label you are given and as doctors, we are beholden to treat the patient rather than the condition.
This means that if you are unhappy with the size and shape of your breasts it might be possible to do something to improve them, but if you are happy with things it does not matter whether you are told you have a tuberous breast deformity or not and I would suggest you are best off leaving things well alone.

Features Of The Tuberous Breast

The features of a tuberous breast deformity include deficiency in the lower pole of the breasts, so that the line from the nipple to the chest wall is much shorter than normal and the breast lacks the natural fullness in the lower part.
This often goes along with a raised or ill-defined inframammary fold (the fold where the bra sits).
The base of the breast is said to be constricted and the nipple areola complex is often enlarged and herniated, which means that the areola (the pigmented area around the nipple), can look puffy and prominent.
It is also often associated with breast asymmetry. 

Treatment Of The Tuberous Breast

Treatment, as with any form of breast re-shaping is aimed at targeting the patient desires.

In its mildest forms, breast implants alone may restore volume to the breasts and careful selection of shape and profile can restore a natural contour to the breast.
In more severe cases of tuberous breast deformity, expansion of the lower pole may be required.
This can be performed internally by using the same incision as used to put the breast implants in and releasing the lower gland to help the implant to expand the deficient lower pole.
It might also be necessary to perform some scoring internally to help expand the herniation of the nipple areola complex to give a smoother shape to the breast.
There is only so much that can be done by internal scoring and implants, and if a more comprehensive correction of the breast shape is required, then a breast lift can be performed to re-arrange the breast tissue, and it might be necessary to combine this with implants to add the volume.

In order to address the herniation of the nipple areola complex, an areola reduction might be required which is an integral part of a breast lift and this will leave a scar circumferentially around the areola.
It is hard to encompass all of the surgical options for tuberous breast deformity, particularly since in cases of asymmetry, different things may be required to be done to each breast.

Cost Of Correction Of Tuberous Breast Deformity

This means that it is difficult to provide an accurate quote for patients asking about the cost of correction of tuberous breast deformity as I discuss below (starts at 4;04):

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There is no substitute for a personal consultation with a Consultant Plastic Surgeon, and it is cases like these that are often best treated by surgeons who specialise in cosmetic breast surgery.

For more information about finding such a surgeon you can read my book ‘Never Accept a Lift from Strangers‘, which is available from Amazon or my website.

If you have any questions we’d love to hear from you.  You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.