Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘power-assisted liposuction’

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.


  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 – 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

The Mechanism and Effectiveness of Power-Assisted Liposuction

Sunday, September 15th, 2013


Liposuction is a plastic surgery technique that relies heavily on mechanical equipment as well as some fundamental physics for effective subcutaneous fat removal. For many years liposuction was done using blunt-tipped cannulas with various hole arrangements just off of its rounded end. Subsequent technological advancements have focused on delivering various energies to the fat tissue to help break it down prior to cannular suction extraction including ultrasound, laser and high-pressure water to name a few of the most notable.

One of the ‘under the radar’ liposuction technologies which employs low-level technology (by comparison to many more well known liposuction technologies) is that of power-assisted liposuction. (PAL) This approach uses an electrically powered handpiece which causes the cannula to vibrate back and forth at a high speed. With the tip of cannula reciprocating at 2000 to 4000 cpm with a 2 to 3mm stroke, the fatty tissue is more easily penetrated with less surgeon fatigue and effort. It also helps loosen up the fat by a vibratory method, simplistically seen as whipping it as opposed poking it with the cannula prior to it being suctioned.

This vibratory action at the cannula tip not only helps in the removal of fat but allows more precise control of its removal. The vibrating tip allows the surgeon to place the tip of the cannula in exact location and allow it to do the work, resulting in greater precision of the fat removal. This vibratory motion is also of benefit when doing liposuction under local or light sedation anesthesia. These vibrations appear to dampen transmitted pain stimulation through the nerve ends, making it potentially less uncomfortable than other liposuction methods.

Like all liposuction, PAL is performed in conjunction with the tumescent technique. Tumescent fluid is a universal component of every liposuction procedure and involves the injection of a high quantity of a specific solution before the actual suctioning takes place. This solution is a mixture of a local anesthetic (lidocaine) and the vasoconstrictor epinephrine. While the local anesthetic helps reduce pain for a few hours after surgery, the epinephrine is more important as it minimizes bleeding during the surgery and bruising after surgery.

Studies have been done to determine whether the effects of mechanical tissue injury produced by a PAL liposuction device results in some tissue shrinkage and tightening. In these clinical studies there does appear to be a mild skin tightening effect that could be quantitatively measured, Since the skin and fat temperatures do not approach that known for collagen denaturation (around 40 to 42 degrees C), how does this effect occur? Most likely the observed skin surface area reductions was due to natural retraction from underlying fat volume removal rather than active skin contraction by induced collagen alteration. This is a typical passive form of tissue tightening effect.

PAL is a very effective liposuction method of fat removal that has the primary benefits of better precision in fat removal, efficient fat extraction and less surgeon fatigue in doing the procedure. It may not be the most highly marketed form of liposuction but it deserves to be.

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.

Read More

Free Plastic Surgery Consultation

*required fields

Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits