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Male Nipple Reduction Male Nipple Reduction Yoon, Sang Yub Silhouette Clinic CBBC (Center of Breast and Body Contouring) Purpose of Study: Nipple enlargement is an ethnic characteristic frequently encountered among Asian male. Male patients seek correction to alleviate psychological and physical discomfort. I present some techniques of male nipple reduction. Subject and Methodology: Between May of 2010 and May 2015, these techniques were performed in 323 male patients. I classified male nipples into two groups for surgical correction. If the diameter of the nipple is more than 10mm corresponds to group I. The cause is usually habitually chronic touched. Smaller nipple corresponds to group II. The most common cause of is the lipocomastia. The neonipple is designed to reduce the nipple diameter at the superior pole of the nipple while preserving the central portion including vessels and nerves. A longitudinal shaped section of nipple is excised, maintaining the integrity of the central core. The remained skin flaps are trimmed to reduce the height. The flaps of the neonipple are then sutured to the areola (Fig. 1 & 2). This technique has been performed in 113 patients (group I). The superior pedicled flap method has been performed in 210 patients (group II, Fig. 3 & 4). Results: Follow-up examinations were performed at 1 to 36 months. The results were excellent; nevertheless, 55 patients (13.9%) get reoperation to decrease the size of the nipple. Postoperative recovery was rapid and a few complications were encountered. Conclusion: These techniques decrease both the diameter and height of any size nipple and can be modified to meet patient preferences. Additionally, these techniques provide reproducible and reliable results. Legend Fig. 1. Operative procedure. (Above, left) Marking and incision at the nipple-areolar junction. (Above, right) Two longitudinal shaped section (3 o’clock and 9 o’clock) of nipple is excised, maintaining the integrity of the central core. (Below, left) Additional two longitudinal section (6 o’clock and 12 o’clock) of the nipple skin is de-epithelized. (Below, right) The remained skin flaps are trimmed to reduce the height. Fig. 2 (Left) Preoperative view of the patient with hypertrophic nipple (12 x 12 x 7 mm) without lipocomastia. (Right) Immediately postoperative view, this nipple look smaller-sized one (5 x 5 x 2 mm). Fig. 3 Operative procedure. (Above, left) Preoperative view. (Above, right) Marking of the superior pedicled nipple flap (diameter 4- 5 mm). (Below, left) Inferior portion (usually 2/3 – 3/4) is excised. (Below, right) The remained flap is sutured to the areolar. Fig. 4. (Left) Preoperative view of the patient with hypertrophic nipple (8 x 8 x 5 mm) with lipomastia. (Right) Immediately postoperative view, this nipple look smaller-sized one (4 x 4 x 1 mm). 실루엣성형외과 윤상엽원장 +82-2-3443-1180/1280 www.gynecomastia.co.kr www.nipple.or.kr 2017-05-16
Scar Revision after Scar Revision after lipoabdominoplasty Sang Yub Yoon Silhouette Clinic CBBC (Center of Breast and Body Contouring) Purpose of study: The popularity of Abdominoplasty appears to be increasing. Lipoabdominoplasty (Abdominoplasty combined with lipoplasty with limited central panniculus undermining) has several advantages which minimize the complications. I report the experience of lipoabdominoplasty for focusing the scar revision. Subjects and Methodology; From May 2007 to January 2015, 300 patients have got the lipoabdominoplasty (3 patients lipominiabdominoplasty) and resulted in high satisfaction rates without significant complication, such as, untreatable seroma, full-thickness flap necrosis, pulmonary embolism and deep vein thrombosis. But 43.3% (n = 130) patients got scar revision because of wide, noticeable, hypertrophic, and asymmetric scars (Fig. 1 and 2). Some patients got tattoo for camouflage the scars (Fig. 3 and 4). Results; I observed good results and high patient satisfaction with respect to abdominal profile appearance. Overall, patients were able to return to their routine activities approximately 2 weeks postoperatively. I also found a low complication rate among patients who underwent lipoabdominoplasty. Epidermolysis was observed in 2% of cases and hematoma 0.3%. But scar revision is relatively common. So, I explain the patient that scar revision is not a complication. Conclusion; This lipoabdominoplasty help to reduce surgical trauma and to preserve lymphatic and vessel system that are the main factor affecting complication formation. Some of the patients complain about the visible scars. So, plastic surgeon should bear in mind that scar revision is normal process to improve the final result. Legend Fig. 1. (Above, left) Preoperative views of a 43-year-old woman with striae and wrinkles on the abdomen. (Above, right) Postoperative views 8 months after lipoabdominoplasty. Note; long, reddish, wide and visible scar. (Below, left & right) Postoperative views 4 years after lipoabdominoplasty. Fig. 2. (Above, left) Preoperative views of a 37-year-old woman with striae, redundant skin and wrinkles on the abdomen. (Above, right) Postoperative views 6 months after lipoabdominoplasty. Note; asymmetric, brown, lifted and visible scar. (Below, left) scar revision design. (Below, right) Postoperative views 3 years after scar revision. Fig. 3. Tattoo to camouflage the scars Fig. 4. (Above, left) Preoperative views of a 41year-old woman with multiple striae on the abdomen. (Above, right) Postoperative views 2 weeks after scar revision and 7 months after initial lipoabdominoplasty. (Below, left & right) Postoperative views 4 months after scar revision. She got tattoo for camouflage the visible scar. 실루엣성형외과 윤상엽원장 +82-2-3443-1180/1280 www.abdominoplasty.co.kr 2017-05-16
165cm 58kg lipo 2,290/2,470cc exc 700g BEFORE AFTER 2017-05-15
Correction of Lipomastia through a Stab Incision on the Nipple Areolar Junction Correction of Lipomastia through a Stab Incision on the Nipple Areolar Junction 2017-05-15
How to Avoid the Visible Scars for the Treatment of High - Grade Type Lipomastia How to Avoid the Visible Scars for the Treatment of High - Grade Type Lipomastia Sang Yub Yoon, M.D. Silhouette Clinic, Seoul, Korea Purpose of study: Lipomastia (fatty-type lipocomastia) may be defined as the benign enlargement of the male breast attributable to accumulation of the breast adipose tissue. It is not uncommon to encounter patients who have undergone surgery for lipomastia but who were not fully satisfied with the results because of visible scar. The aim of this study was to describe the operative technique avoiding the conspicuous scars on the male breast against the treatment of high-grade type lipomastia. Subjects and Methodology: A simple classification of lipomastia is as follows: type I – prominent breasts with elastic skin; type II – prominent breasts with visible inframammary fold; type III – ptotic breast with inelastic skin and/or well-defined inframammary fold. To treat the high-grade lipomastia, I applied the skin-fascia fixation between the posterior surface of the chest skin and pectoral fascia(Fig. 1) after ultrasound-assisted liposuction, scavenging suction lipectomy, fibroglandular excision via stab incision(Fig. 2). Results: These techniques were applied to 1,734 patients(Fig. 3 & 4). Complications were minimal. Thirteen patients got secondary operation (i.e. chest lifting) to improve the contouring. Conclusion: I present some minimally invasive technique for the management of lipomastia in patients with significant ptosis or skin excess that combined the advantages of ultrasonic liposuction with the precise and controlled excision of fibro-glandular breast tissue. These techniques are also alternative to treat the ptotic lipomastia, avoiding undesirable scars. Legend Fig. 1. (Above, left & right) The skin-fascia fixation procedure. (Below, left) Preoperative standing view. Note; prominent inframammary fold and ptotic breast. (Below, right) Postoperative standing view after 1 day. Fig. 2. The operative procedure. (Above, left) Lipocomastia design and periareoalr stab incision. (Above, right) Ultrasound-assisted liposuction and conventional suction-assisted lipectomy. (Below, left) Remained palpable firboglandular tissue which limited the margin of areolar diameter. (Below, right) Pull-out method for removal of the fibroglandular tissue. Fig. 3. A 22 year-old patient (type III, with well-defined inframammary fold) treated with skin-fascia fixation after peri-areolar stab incision, ultrasound-assisted liposuction, suction-assisted lipectomy and pull-out method. (Above, left) Preoperative view. (Above, right) Postoperative view after 1 day. (Below) Postoperative view after 2 years. Fig. 4. A 28 year-old patient (type III, ptotic breast) treated with skin-fascia fixation (Above, left) Preoperative view. (Above, right) Postoperative view after 1 month. (Below, left) Postoperative view after 4 months. (Below, right) Postoperative view after 13 months. 실루엣성형외과 윤상엽원장 02-3443-1180/1280 www.allthatbreast.co.kr www.gynecomastia.co.kr 2017-05-15
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