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Archive for the ‘gynecomastia’ Category

OR Snapshots – Puffy Nipple Areolar Gynecomastia Reduction

Sunday, December 25th, 2016

 

Gynecomastia is a well known breast enlargement condition that occurs in men of all ages. Like the broad age range that it affects, gynecomastia also occurs in a wide variety of expressions or degrees of breast enlargement. While often perceived as the appearance of an actual breast mound, most gynecomastias present as much smaller masses.

The smallest presentation of gynecomastia is areolar enlargement or a type 1 gynecomastia. This is also known by how it appears as a puffy nipple. While this can mean a long or protruding nipple, it usually refers to a small growth of breast tissue that sits right under the nipple. It appears as a small hard lump that can be felt under the nipple and causes the nipple-areolar complex to protrude. It may or may not be associated with an elongated nipple as well.

puffy-nipple-areolar-gynecomastia-reduction-with-nipple-reduction-dr-barry-eppley-indianapolisThe treatment of the puffy nipple areolar gynecomastia is open excision. The hard lump can not be moved by liposuction. The inferior areolar incision heals very well and should not be avoided because of scar concerns. The amount of breast tissue removed is usually no bigger than the size of a quarter. But its removal will instantly reduce the protruding areola. If needed, subtotal or complete nipple reduction can be safely done at the same time as well for a more complete nipple-areolar flattening effect.

Open excision of small gynecomastias is an art form and the amount of tissue to be removed is an intraoperative judgment. On the one hand over resection is to be avoided so a crater deformity does not result. Conversely under resection, although aesthetically safer, will create less areolar projection but will not make it completely flat. This results in my experience for a 10% to 20% revision rate for this type of male breast reduction surgery to get the most symmetric and complete nipple flattening effect.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Gynecomastia Reduction with Power-Assisted Liposuction

Thursday, December 31st, 2015

 

Background: Gynecomastia reduction is a well known surgical procedure that can be used in males of almost all ages. Male breast tissue enlargement can occur for a variety of endocrine reasons from pubertal hormonal surges to the older male with declining testosterone levels. In every case the mass of breast tissue increases starting centrally under the nipple and radiating outward, creating differently sized breast/chest mounds.

While the size of the breast tissue in gynecomastia varies amongst each individual male, one very important element that factors into its treatment is the quality of the overlying chest skin. How much chest skin exists (is there any sag), its natural elasticity and the position of the nipple determines whether any skin excision is needed. (lift) This becomes more of an issue in very large gynecomastias of any age and in older gynecomastias even of smaller sizes. A low nipple position may necessitate some type of nipple lift.

Power Assisted Liposuction Indianapolis Dr Barry EppleyLiposuction can be done by a variety of energy-driven methods. One of these devices is power-assisted liposuction. (PAL) This is mechanically driven and moves the tip of the cannula back and forth several thousand times a minute. Such an oscillating is particularly good in tough or high fibrous bearing fat tissue such as most gynecomastias. This is particularly effective for the firmest of breast tissue which is always located right under the nipple.

Case Study: This 50 year-old male had a saggy chest with small breast mounds that became more pronounced after weight loss. Despite intense exercise and weight lifting, he could not improve or exercise off his gyneomastia.

Mark Gynecomastia Reduction result front viewUnder general anesthesia, he initially had power-assisted liposuction performed on both sides of his chest from a singe small 4mm incision at the lateral chest wall. A total of 1,000 of aspirate was obtained with 500cc removed per side. At the completion of the liposuction, an eccentric periareolar nipple lift was done to move the level of the top position of the areola up by 1cm.

Mark Gynecomastia Reduction result oblique viewIn the older male, particularly after weight loss, residual breast tissue will remain and the nipples will hang lower often near the level of the inframammary fold. Gynecomastia reduction by lipoaspiration will flatten the chest but will not lift the nipples. The skin retraction in the older male’s chest skin is limited and often requires some help to better reposition the nipples.

Highlights:

  1. Gynecomastia reduction can be successfully done in some cases by liposuction alone.
  2. The use of power-assisted liposuction and basket cannulas can be effective for the stubborn fibrous breast tissue right under the nipple.
  3. The success of gynecomastia reduction by liposuction depends on how well the skin retracts and the original position of the nipple.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Injection Fat Grafting for the Gynecomastia Crater Deformity

Saturday, June 27th, 2015

 

Background: Gynecomastia is a well known male chest abnormality that has a wide range of expression from puffy nipples to that of an actual breast mound.  It is treated by two basic approaches, liposuction and open excision. Which treatment method is sued depends on the size and tissue quality of the gynecomastia problem. Most commonly a combination of open excision through a lower areolar incision and more encompassing liposuction of the entire chest is done to get the optimal result.

The results of gynecomastia surgery is reflective of how much fat is removed and the evenness of its removal, regardless of the treatment method used. Both excision and liposuction are as much art as science as there is no way to know for sure as to how the tissue removal will ultimately look. While the plastic surgeon wants to get the most complete gynecomastia reduction, there is also the fear that too much tissue removed will cause the opposite problem. This would appear as an inward retraction of the nipple areolar complex known as the ‘gynecomastia crater deformity.’

While many early gynecomastia results may show a slight inward contour, these usually resolve on their own to a smoother appearance. But when excessive breast tissue is removed the inward retraction of the nipple-areolar complex becomes more obvious and pronounced as postoperative healing occurs. It is most manifest when one’s arms are raised as the adhesion between the underside the nipple-areolar complex and the pectoralis fascia causes a maximal retraction effect.

Case Study: This 38 year-old male had two prior gynecomastia reduction surgeries through an initial liposuction procedure followed by a secondary open excision procedure to get rid of some residual nipple puffiness. After the second procedure the nipples started to invert inward which became really evident with raising the arms. This continued to persist and did not change by six months after the second procedure.

Fat Injections for Gynecomastia Reduction Retractrion result front view Dr Barry Eppley IndianapolisUnder local anesthesia, fat was harvested from the lower abdominal area with small cannulas. It was concentrated by filtering and double washing into 40ccs. A small cannula was initially used to break up the scar and adhesions under the nipples and then fat was injected both under and around the nipple areolar complexes.

Fat Injections for Gynecomastia Reduction Retraction result oblique viewFat Injections for Gynecomastia Reduction Retraction result side viewAt three months after surgery his postoperative results showed improvement in the nipple areolar-chest contour and less nipple retraction. Fat take at this point would be assumed to be maximal. A second stage fat grafting is planned for further improvement.

When there is not an adequate buffer of tissue between the nipple and the pectoralis muscle, adhesion and scar contraction will occur. Correction of the gynecomastia crater deformity almost always requires release of the scar bands (adhesiolysis) and restoration of intervening tissue between the nipple and chest muscle. Injection fat grafting provides the easiest way to achieve both objectives. It could also be done through an open method using the lower areolar incision and placement of a dermal-fat graft. This approach poses more of a donor site harvest concern.

Highlights:

1) The gynecomastia crater deformity is caused by excessive breast tissue resection and scar contracture.

2) Gynecomastia defects can be successfully treated by injectable fat grafting which may require more than one session for optimal improvement of chest contour.

3) Injection fat grafting can be combined with PRP and Acell particles to optimize fat graft take.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Power-Assisted Liposuction for Male Gynecomastia Reduction

Sunday, May 24th, 2015

 

Background: Gynecomastia, or male breast enlargement, occurs in a wide variety of forms and ages. While typically perceived as a condition that occurs in teens and young men as a reaction to elevated hormonal levels from puberty, gynecomastia occurs equally in older men as well. ‘Man boobs’ as they are often called can be an aesthetic affliction to any man at any age.

older male gynecomastiaOlder men can develop gynecomastia for a variety of reasons from weight gain, dropping testosterone levels (and elevated estrogen levels) and various medications. (e.g., propecia or testosterone supplements) Often the cause is multifactorial and weight gain is a common denominator. Many older men as their abdomens become bigger and rounder will develop a similar but smaller enlargement of their breasts as well.

The surgical treatment of gynecomastia consists of only two basic approaches, liposuction or open excision. In many gynecomastia reductions surgeries of all ages, a combination of open excision and liposuction is usually needed. But softer gynecomastias and those thayt have little evidence of any lumps or masses under the nipple will do well with liposuction alone. Many different types of liposuction can be used for gynecomastia surgery and will work equally well based on the practitioner’s skill and experience.

Case Study: This 54 year-old male came for liposuction of the chest, abdomen and flanks…the three classic liposuction areas for men. He had lost as much weight as he could through diet and exercise and had ‘hit the wall’. He needed a surgical boost to make a more significant change than we he could accomplish. His chest had a softer type of breast enlargement that had no hard lu

Power-Assisted Liposuction Indianapolis Dr Barry EppleyUnder general anesthesia, liposuction was performed on his abdomen and flanks as well as both sides of his chest using a 3mm cannula on a power-assisted device. (PAL, power assisted liposuction) A total of 700ccs was removed from both sides of his chest. After surgery he wore a circumferential chest compression garment for three weeks.

Male GYnecomastia Liposuction Reduction result front viewMale Gynecomastia Liposuction Reduction side view 2His six month postoperative results showed a much improved chest contour with no residual signs of his ‘man boobs’. He also had no nipple protrusion or residual puffy nipples.

For many older men with gradual onset gynecomastia, liposuction alone can be a very effective treatment. It is often combined with other body areas such as the abdomen and flanks which many men have problems with as well. Power-assisted liposuction aids in fat and/or breast tissue removal through its oscillating tip, lessening the workload on the surgeon.

Case Highlights:

1) Liposuction is the most common surgical method used for gynecomastia reduction.

2) Men that develop gynecomastia as they age or gain weight are more likely to have a softer less fibrous type of breast tissue.

3) Power-assisted liposuction is an effective method to treat older softer male gynecomastias.

Dr. Barry Eppley

Indianapolis, Indiana

Gynecomastia Reduction in Male Body Builders

Friday, February 6th, 2015

 

Gynecomastia is a well known condition of breast enlargement in men. It can occur in any male body shape from a thin teenager to an older male. The size of the gynecomastia  and the extent of chest deformity can vary considerably. But the one feature that all gynecomastia patients have is the very firm lump of breast tissue that lies under and around the nipples.

Gynecomastia Reduction in Male Body Builders Dr Barry Eppley IndianapolisOne very unique form of gynecomastia is that seen in male body builders. Even though they have little body fat and are long past puberty, gynecomastia can occur most often due to the use of anabolic steroids or other high dose supplements. While their gynecomastias are small in size compared to many other forms, it is disturbing to them due to their high aesthetic standards and its easy visibility as a stand out feature on their chest which is highly scrutinized if they participate in competitions.

In the February 2015 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Correction of Gynecomastia in Body Builders and Patients with good Physique’. Over a 33 year period, over 1500 body builders underwent gynecomastia reduction. Subtotal excision of most of the firm breast tissue was removed through an open approach using an inferior areolar incision in all cases. Liposuction was minimally used in 2% of the cases. Good aesthetic results was obtained in 98% of the cases. Hematoma rates averaged 6% over the study period. The authors has no infections, contour deformities or redevelopment of breast tissue.

This paper highlights that successful gynecomastia reduction in male body builders requires essentially a near complete subcutaneous mastectomy. The tissue needs to be thinned out under the nipple-areolar complex to just a few millimeters so that it will lay flat on top of the pectoralis fascial/muscle layer. This will also prevent recurrence of the breast tissue since these patients may likely continue taking steroids and supplements that caused the problem initially. Attention to the smallest chest contour detail is important since these patients are by nature of their body types perfectionists.

One very important element of this type of gynecomastia reduction is the postoperative activity level. Male body builders are very religious about their workout routinues and it can be hard to keep the out of the gym for any extended period of time. Exercises of the chest need to be restricted for at least two weeks after surgery with three weeks preferred. Noncompliance is associated with higher rates of hematoma and seroma formation.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study – Thin Teenage Gynecomastia Reduction

Thursday, December 4th, 2014

 

Background: The development of breast tissue is very common as a result in puberty for many teenagers. While it occurs with greater frequency and amounts in teens with more weight, it can also even occur in very thin males. In some cases it is almost more bothersome or noticeable in thin teenagers because they have so little body fat otherwise.

While some cases of teenage gynecomastia do go away on their own, the actual incidence or likelihood that this does occur is not precisely known. It is widely stated that most cases of puberty-induced gynecomastia resorb over time, but I suspect that this actually occurs much less frequently than believed. When the gynecomastia is a more firm glandular type, it is hard to imagine how such dense masses of tissues would just ‘dissolve away’ naturally.

The thin teenage male is particularly susceptible to the effects of gynecomastia. With little natural fat on their chest, hard nodules of breast tissue stick out very noticeably and are particularly palpable. Despite often small amounts of breast tissue development, it creates a more prominent breast mound effect. Like all forms of gynecomastia, this can cause great amounts of emotional distress and embarrassment.

Case Study: This 15 year-old male teenager was embarrassed by the shape of his chest and his small breast mounds. They had developed right after puberty several years ago and never went away. They felt like hard lumps under his nipples. He did not take off his shirt at the pool or in the locker room at gym.

Teenage Gynecomastia Reduction tissue intraop Dr Barry Eppley IndianapolisUnder general anesthesia, an open approach was used to excise the firm breast tissue through lower areolar incisions. The breast tissue was very firm, gritty and was white in appearance. The amount of hard breast tissue that was removed was considerable and much more than would be thought just looking from the outside. No drains were placed, only circumferential chest compression via an external wrap was used for several weeks after surgery.

Teenage GYnecomastia Reduction results front view Dr Barry EppleyTeenage Gynecomastia Reduction results side view Dr Barry Eppley IndianapolisAt six months after surgery, he had a fairly flat chest with good symmetry. The nipples were flat but not inverted. The inferior areolar scar line were still seen but fading with decreasing redness of the scars. He was pleased with the result and his parents reported that he now took his shirt off at the pool over the summer.

Teenage GYnecomastia Reduction result oblique view Dr Barry Eppley IndianapolisOpen excision for small to moderate nodular gynecomastia can be very effective in the young male teen. Given the hardness of the nodules, early removal can be advocated since they are unlikely to go away on their own. Care must be taken to avoid over resection and subsequent nipple inversion. The most common complication is residual breast tissue/nodule that may require revisional surgery to remove. Its occurrence is not rare (even though it did not occur in this patient) with revision rates of 10% to 20% on average.

Case Highlights:

1) Gynecomastia after puberty often does not go away and requires surgical reduction. This is particularly relevant for today’s male teen agers and young men where a flat chest and nipple appearance is aesthetically preferred.

2) Open excisional reduction is the most effective form of chest reshaping/reduction for glandular forms of gynecomastia.

3) Perfect symmetry in gynecomastia reduction is difficult and may require a revision for small amounts of residual nipple protrusion and chest wall asymmetries.

Dr. Barry Eppley

Indianapolis, Indiana

The Use of Drains in Gynecomastia Reduction Surgery

Thursday, March 20th, 2014

 

Gynecomastia  Reduction Dr Barry Eppley IndianapolisGynecomastia reduction surgery is very common for either young or middle-aged males who have various amounts of breast tissue development. While some forms of gynecomastia are treated by liposuction alone, more than half of them require an open approach through an inferior areolar incision. When doing an open gynecomastia reduction, it is common practice to insert a drain to prevent an after surgery fluid collection.

While the use of a drain out the side of the chest is not usually in place for very long after surgery (a few days up to a week), it is still an annoyance to the patient. Like the use of drains in other procedures like breast reduction and facelifts, the question is often raised as to their true need. It may be tradition to use them but are they really necessary

In the March 2014 issue of the Aesthetic Surgery Journal, an article was published entitled ‘Necessity of Suction Drains in Gynecomastia’. In this paper, the authors looked at their complication rates in gynecomastia reduction surgery when no closed suction drains were used. In 138 consecutive men who had gynecomastia reduction by ultrasonic-assisted liposuction both with and without the pull-through technique. The average of the patients was around 30 years old. The amount of fat removed from each side of the chest was around 350ccs. The pull through was needed in 23 patients. (17%) They had only one hematoma and no seromas. These results lead the authors to conclude that the use of drains is not needed in gynecomastia reduction.

It is important to realize when looking at these study results that less than 20% of the patients treated had an open excision of the gynecomastia tissue, which is the main indication for the use of a drain. Drains are never used in chest liposuction. Thus, this study is not convincing that there is no value whatsoever for drains in gynecomastia surgery. I would be a lot more convinced if all 138 patients in the study had an open pull through technique done.

What this study does demonstrate is that smaller amounts of breast tissue removed through an open areolar approach is probably not needed. But for larger amounts of breast tissue removed, particularly in combination with liposuction in the surrounding chest, a few days of a drain would not hurt.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Older Male Gynecomastia Reduction with Nipple Transposition

Monday, February 24th, 2014

 

Background: Gynecomastia, the development of breasts in men, is often thought of as a young man’s problem. While hormonal changes certainly set the stage for the emergence of breasts in some teenagers and young men, similar problems of a slightly different nature occur at the opposite end of the age spectrum.

When older men develop what used to be called ‘senile gynecomastia’ due to testosterone decline, it is not the ‘plump’ type of gynecomastia seen in youth. Rather it is a sagging mass of chest tissue in which the nipple and breast mound sags over the inframammary fold. There is a loss of skin elasticity and ligamentous laxity that allows the chest to fall off of the pectoralis muscle inferiorly.

While liposuction is a frequent treatment for gynecomastia reduction, it will not produce the desired result in many older gynecomastias. While some chest volume reduction will be achieved, the skin will not tighten up and the nipple will not be elevated higher on the chest wall afterwards. Some type of skin excisional chest wall tightening is needed.

When a breast lift is needed, men must be treated differently than women. Men can not have the same type of breast reduction scars since there is no mound to hide them when the lift is completed. It is the vertical scar between the nipple and the fold that would be objectionable in men.

Case Study: This 76 year-old man was bothered by the sagging shape of his chest. He did not like his appearance in shirts and felt he needed a ‘mansier’ to really hold his chest up. While he had some excessive breast tissue, his excessive skin was as much if not more of a problem.

Gynecomastia Reduction with Nipple Transposition markings Dr Barry Eppley IndianapolisPrior to surgery, his existing inframammary fold was marked as well as around his areolas. An elliptical excision pattern was then marked from one end of the inframammary fold to the other going above the nipple. Under general anesthesia, a tumescent solution was infiltrated into each side of the chest. Using power-assisted liposuction, 200cc of fat and breast tissue was aspirated from each side. The upper and lower ends of the horizontal excision pattern was incised as well as around the areolas. The intervening skin was de-epithelized. An upper chest skin flap was raised up near the collar bones on each side. The thinned out breast mound and nipple was then lifted as the skin edge of the raised chest flap was brought down over it. The new position of the nipples were marked and the overlying skin removed. The nipples were brought through and the circumareolar and inframammary skin edges were then closed to complete the reduction. The nipple transposition eliminated any need for a vertical scar.

Older Male Gynecomastia Reduction with Nipple Transposition front view Dr Barry Eppley IndianapolisOlder Male Gynecomastia Reduction with Nipple Lifts result Dr Barry Eppley IndianapolisHe had drains that were removed two days later  and the incisions remained taped for ten days as he wore a circumferential chest compression wrap. When seen at six weeks after surgery, his chest was flat and the nipples in a much more uplifted position. It would take another 3 to 6 months for the scars to completely mature and fade.

Gynecomastia Reduction and Nipple Transposition result side viewFor the man who has significant chest sagging and requires a breast lift, gynecomastia reduction with nipple transposition creates an acceptable location of the scars.

Case Highlights:

1) The older male patient often develops chest sagging that is difficult to hide and not cured by exercise.

2) With loose and inelastic skin due to age, liposuction does not produce a satisfactory gynecomastia reduction for many older men.

3) Gynecomastia reduction with nipple transposition is the most effective chest reshaping method for the older male with ‘man boobs’.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Reduction of Puffy Nipples in Young Men

Saturday, June 15th, 2013

 

Background:  Gynecomastia is historically perceived as being the development of breast tissue in men that creates the appearance of an actual breast mound. While this is certainly true, gynecomastia takes on many forms based on the amount of breast tissue development that actually occurs. Gynecomastia presentations can occur along a spectrum from a full blown development of a breast mound to just a firm nodule under the nipple in the teenager and younger man.

Over the years the young men that appear for the surgical treatment of gynecomastia has changed. While very obvious breast enlargements, either one one side or both sides, used to be the norm, smaller types of gynecomastia now appear. Years go they would have been deferred from surgery as their gynecomastia was not deemed significant enough to warrant the risks of surgery.

But contemporary younger male physiques have a standard of a completely flat chest with no nipple-areolar protrusion. Any amount of chest mound prominence or nipple-areolar elevation is viewed as undesireable. It is embarrassing for young men, or men of any age for that matter, to have nipples that show through their shirt or chest mounds that jiggle as they run or exercise. (or even walk) A flat chest profile prevents these aesthetic and clothing problems, avoids embarrassment and potential ridicule and improve’s a young man’s self-esteem.

Case Study: This 21 year-old make college student wanted to improve the shape of his chest. While he was athletic and muscular, he felt his nipples were ‘puffy’ and stuck out too far. He could feel a small lump under his nipples and wanted it removed to flatten them. Given the size and location of these chest lumps, this type of breast enlargement can be an areolar gynecomastia.

Under general anesthesia, a dual approach to his gynecomastia problem was done. Initially small cannula liposuction was performed through an entrance on the side of the chest wall. The entire chest was aspirated as much as possible to reduce its profile, removing a total of 125cc per side. Then through inferior areolar incisions, hard gritty lumps of breast tissue was removed from directly right under the areolas back to soft yellow fat. A small drain was placed that exited out from the small skin hole which was initially used for the liposuction. Immediately after surgery, he was placed in a circumferential chest wrap for compression.

He wore the chest compression wrap for three weeks after surgery on a regular basis and refrained from any arm exercises. He developed minimal bruising and had a very acceptable amount of discomfort. No fluid collections (seromas) developed. He had achieved elimination of his puffy nipples and a more pleasing chest profile to him.

Smaller gynecomastia concerns are the norm for young men today. Areolar protrusions caused by underlying firm lumps of gynecomastia are aesthetically intolerable as they create nipple show. Direct excision of the breast lumps combined with liposuction to feather the shape of the chest outward can create an effective solutions to the areolar gynecomastia problem.

Case Highlights:

1) Puffiness of the nipple, most commonly seen in younger men, is caused by a small amount of underlying gynecomastia.

2) Puffy nipple gynecomastia does not respond very well to liposuction due to the firmness of the breast tissue.

3) Open excision of the breast tissue causing the protruding male nipple is the most effective approach to getting a flat areolar and nipple profile.

Dr. Barry Eppley

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Body Procedures

Thursday, June 13th, 2013

 

When it comes to plastic surgery, just like many other areas in life, men are different than women. Not only are their faces and bodies not the same, but their attitudes and expectations about plastic surgery are also different. Having treated a fair number of men over the years in my Indianapolis plastic surgery practice, I have made a number of observations on these gender differences.

It is true that the number of men, particularly younger men, are making up an increasing percentage of the total plastic surgery population. While the number of men having actual surgery or in-office injectable and skin care treatments will always be substantially less than women, men are noteworthy in that their procedures are either unique or require modifications. Numerous cosmetic procedures are not only uniquely different in men, but some of them are exclusive to men.

Enhancement of the male chest is an increasingly popular male plastic surgery procedure.  Chest issues are very different from that of the female breast. While women have surgery for small, poorly shaped or asymmetric breasts, men consider surgery because their chest appearance is not masculine enough due to gynecomastia, prominent nipples or lack of pectoral muscle size and definition. Gynecomastia reduction surgery is vastly different than female breast reduction surgery. Lack of visible scarring in a man takes on primary importance and the use of liposuction tissue extraction subsequently takes on greater importance. Prominent nipples, which occurs far more frequently in men than women, can have a very negative psychological effect for some men. Having them be obscure in a tight shirt is a common goal of all ages of men and this nipple reduction procedure can be accomplished as an office procedure under local anesthesia

Male chest enlargement is done by soft solid silicone implants that have to stay within the  lower and lateral borders of the pectoralis muscle. Female breast augmentation is done with non-solid filler materials in a shell (bag) that must be often be placed beyond the lower border of the muscle to get the proper shaping effect.

When it comes to body implants, the shape objectives between men and women are different. Men undergo have body enhancements, such as the chest, arms or calfs) to create increased muscle size and definition. Women have body implants of the breasts and buttock to create more shapely soft tissue curves which are non-muscular in structure.

The distribution of fat in men is uniquely different from women. Men have liposuction exclusively in the stomach and love handle areas. While women have liposuction in the same areas they have a broader expanse of potential fat collections which leads to aspirated fat removal also being done in the extremities as well as the trunk areas of the back, hips and buttocks.

Excess and loose body skin occurs more selectively in men than women. Because of pregnancies and weight loss thereafter, women frequently require tummy tucks. Men only need such excisional body contouring surgeries after extreme amounts of weight loss. (greater than 75 to 100 lbs) Those skin removal needs are almost exclusively limited to the abdomen (tummy tucks) and chest and almost never in the extremities.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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