The incision (and scar) is one of the major concerns for patients undergoing gynecomastia Surgery. Surgeons like myself become accustomed to the minimal scars left by surgery, but we have to step back and think about it from the patient’s perspective. For many patients, that is one of the biggest deciding factors.
In addition to the scar, the location of the scar is a variable that patients have to consider. Most gynecomastia experts prefer working thru the areola, and I prefer working around the areola, and perform over 85% of my cases, as I have said elsewhere on this site, thru a minimal incision on the inferior third of the areola. This incision is the most popular amongst those of us that are gynecomastia specialists. It heals almost imperceptibly.
Over the years, many different surgeries and approaches have been developed for gynecomastia. I have been in practice for fifteen years, and over the years I have learned and tried all those techniques either during my training or practice. One of these incisions is the lateral pull thru technique. The basic premise of this technique is that a patient would prefer a lateral chest scar over the areola scar.
In the lateral pull thru gynecomastia technique, an incision is made on the lateral chest and both the liposuction is done thru that incision. After the liposuction, this is followed by the surgeon more or less, without direct visualization, grabbing the remnant gland and teasing out of the lateral incision with scissors.
Unfortunately, over my early years, I have noticed that the lateral chest scar technique is much more noticeable than a small periareolar scar, and for that reason, I do not recommend it to my patients anymore.
There are several factors that cause it to be more visible. One of them is the inherent biological difference in healing between the periareola and the chest skin. the chest skin is thick with a thick dermis and is more prone to scarring. further more, the lateral chest skin is designed to stretch more during arm movements compared to the areola skin. Stretching of a scar is a huge factor during healing, and leads to the occasional more widened and depressed scars that some men get with the technique.
when you work thru the lateral pull thru, you are far away (in surgical terms) from the majority of the gland. You are just not at the “center of action”. You are grabbing and cutting
The gland emanates from the areola. therefore when you are in the areola, you are directly over the source of the gland. When you work thru the areola you can follow the gland laterally and medially towards the edges and ensure a more complete removal of the tissues.
the periareolar scar is less visible and allows a more complete excision o tissue and better control of hemostasis. Perhaps the only advantage of the lateral pull thru is a potentially more preservation of nipple sensation (theoretical, most periareolar patients do retain sensation). Otherwise, in my experience, the periareolar incison is a much better choice for patients.