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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring
By Dr. Leon Forrester Tcheupdjian, M.D.
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Dr. Leon Forrester Tcheupdjian, M.D., respected scientific researcher, teacher innovator and surgeon. As the Medical Director / Chief Surgeon of a Chicago, Illinois Plastic Surgery Practice, Dr. Tcheupdjian has supervised and performed probably more liposuction procedures than any other American doctor.

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Chapter XII

Liposuction of the Chest and Breasts

Both men and women can benefit from liposuction of the chest and breast areas.



1. The circle focuses on a pad of fat sometimes called "double breast."

2. The pinch test gives an indication of the amount of fat buildup.

In women, there are three major problem areas where liposuction can help. The surgery is used to reduce the size of large breasts, to reduce the tail of the breasts (the fatty pad at the side of the breast), and to equalize breasts that are not the same size.

In the early days of liposuction, most physicians hesitated to suggest that particular operation as a remedy for breasts that were too large. Instead, breast tissue was removed surgically in a procedure called reduction mammoplasty. Unfortunately, the operation often resulted in undesirable scarring, and sometimes in breast deformities.

Liposuction is still considered by many surgeons to be an experimental procedure in breast reduction. Many physicians who perform the operation do so on a research basis, rather than as a routine procedure. In my opinion, however, liposuction can be beneficial, since it does not result in unsightly scarring. I believe liposuction may soon replace the conventional reduction mammoplasty operation.

When liposuction is used to reduce the tail of the breast, we at The Liposuction Institute, and other surgeons, have had good results from the operation. Women who have undergone the procedure have told us that the operation has made it much easier for them to move their arms. The large fatty pad at the side of the breast, (the tail), had previously interfered with the way in which they moved their arms forward or to the side. Of course, this fatty pad is removed during liposuction.

For women who have asymmetric breasts-breasts that differ markedly in size and shape-liposuction provides a successful way to reduce the size of the larger breast so that it matches the smaller one.

It is important to realize that in liposuction of the breast it is the fatty tissue surrounding the breast, and not the mammary gland itself, which is reduced. Later, we will also discuss the augmentation of the breast by using the injection of fat cells (removed from areas where it is unwanted in the patient's own body) for the addition of more mass where that is desired. This procedure is called breast augmentation.

Augmentation of the breast by use of transplantation of the patient's own fat cells is discussed in Chapter XXII.

LIPOSUCTION OF THE MALE CHEST AND BREASTS
When Ron, a skilled auto mechanic, first came to our offices, he was embarrassed to talk about his problem. Only with encouragement was he able to discuss his condition. When he removed his shirt, it was easy to see why he was concerned. Although Ron was successful in work, and had a number of male friends, he was shy with women, and felt uneasy about beginning an intimate relationship. Ron had a condition called pseudogynecomastia, in which his chest and breast area was considerably enlarged and sagging. His chest looked almost like that of a woman.

*INSERT IMAGE 12-4

1. Accumulation of fat in male breasts can produce a feminine appearance."

2. This patient's breast contours had become rounded.

It is difficult for someone who has not been afflicted with this problem to comprehend the emotional pain and anguish such a condition can bring.

However, I was quickly able to reassure Ron that many men suffer from the same condition. Having this type of breasts was no reflection on his masculinity. "In addition," I told him after the physical examination, "liposuction has an excellent chance of improving your condition."

Before liposuction, the standard approach for problems with large, sagging "female-type" breasts in men called for traditional plastic surgery to cut out a good deal of fatty tissue. Since this tissue was supplied abundantly by blood vessels, bleeding was often difficult to control, and there was a substantial risk of infection after surgery.

In addition, the traditional plastic surgery approach meant that the skin of the chest and breast area did not always heal smoothly. Patients often found they had "waves" or irregularities in their skin. Although traditional plastic surgery reduced the size of the breasts in such cases, the appearance of the skin afterwards was often unsatisfactory.

Liposuction can do much to improve the shape of enlarged male breasts by getting rid of the extra fat cells; and because the incisions are extremely small and can often be placed in a fold line of the body, the skin is less disturbed and tends to heal more smoothly. If the liposuction surgeon thinks it is advisable in a particular case, he or she can remove some of the breast tissue just below the nipple at the same time the liposuction is performed.

The nature and extent of the surgery will depend upon the needs, medical condition and history, and ultimate results desired by the individual patient. These factors should be thoroughly discussed before surgery.

THE OPERATION ITSELF
Depending upon the extent of the surgery which is planned as well as your medical history and condition, local anesthesia, combined with IV sedation, is most commonly used. The surgeon will make an incision 3 to 4 mm. long (1/8 inch), will insert the blunt cannula, and begin the operation.

AFTER SURGERY
While you are still in the operating room or surgical suite, the surgeon will bandage your chest and breast area with special tape that promotes healing by keeping the tissues tightly compressed. You will usually be asked to keep the tape on constantly for about a week, although your own doctor will give you specific instructions which you must follow. It is extremely important that you leave the tape on until you are given permission to remove it.

Women who are having liposuction in the breast area are usually asked to wear a brassiere continuously for several weeks after the surgery. "Continuously" means just that-the bra stays on, even during the time you are lying down or sleeping. Wearing the brassiere compresses the tissues, and helps them to heal properly, in a more symmetrical fashion.

*INSERT IMAGE 12-5 *INSERT IMAGE 12-6

1-2. Photos of this patient show the improvement in his breast contour from before liposuction (above) and after (below).

*INSERT IMAGE 12-7 *INSERT IMAGE 12-8

3-4. Three-quarter view of same mate patient's breasts protruding, before liposuction. Enlarged breasts can be extremely embarrassing.

*INSERT IMAGE 12-9

5-6. Here are side views of the same male patient, taken before (above) and after (below) liposuction surgery.

Your surgeon will give you instructions on the type and size brassiere to wear. He or she will usually want to see the brassiere before the operation is performed, to be sure it is appropriate for your particular case. Sometimes the surgeon will furnish you with a special brassiere.

You will want to have more than one brassiere of the appropriate type, so you have at least one to wear while another is in the laundry. Usually they can be washed gently in lukewarm water with a mild soap or detergent.

RESUMING NORMAL ROUTINE
Since the liposuction incisions are usually placed under your nipple, or are hidden in body folds, there will be few, if any, suture marks. You may not even be able to see them.

Within 24 hours after surgery, most patients resume their normal routine. You will probably see your doctor at least once before you go back to work, depending on your type of job, and what physical tasks you are required to perform. You should not do construction work, factory work, heavy lifting, or work with machines such as vibrators or air hammers until your surgeon specifically says you can. Be sure to discuss your job duties and activities with her or him frankly and completely, so that he or she can advise you appropriately. Follow your surgeon's specific advice and timetable on returning to full physical activity.

MASSAGE
You can begin massage of your chest and breast area within three or four days after surgery, unless told otherwise by your physician. Use your fingers or the flat of your palm-whichever is more comfortable for you.

1. Circular massage. Use both hands to make gentle, circular motions all across the chest and breast area. Press only as intensively as is comfortable for you, at first. Then, within a few days, you can gradually increase firmness and pressure, but only moderately. Do this massage for two minutes. Repeat many times a day.

2. Arm rest massage. Another form of massage can be started within three or four days after surgery. Rest your arm on a flat surface, like a desk. Then massage your chest and breast tissues with your opposite hand. Don't pinch. You will find this is a good massage for liposuction of the tail of the breast, or enlarged male breasts.

This massage should also be done for two minutes at a time, and repeated many times a day.

Do not be afraid to massage over your incision, but do it gently.

After your bandages have been removed, continue massaging your chest and breast area frequently-certainly, many times a day. Your doctor will give you specific directions.

EXERCISE
Exercising-with your surgeon's permission-will help improve circulation, thus speeding up healing. You'll also strengthen your muscles.

We will refer to all the motions of one exercise as a "set." The number of times you do a set is called a "repetition."

HOME EXERCISE
Begin your exercising three to four days after surgery, unless your doctor has other instructions. Start gently at first. Your bandages will still be on.

Begin by gentle stretching exercises. Move your arms up and down. Move your hands. Do not wear weights. Never force your body.

1. Put one hand on your waist. Raise your opposite arm as high as you can comfortably go. Alternate left and right arms. Do this slowly and comfortably, until you have stretched each arm 10 times. This is considered one set. When you first start to exercise after surgery, do one set. Then rest one to two minutes. Do another set. Later in the day, do two sets again-resting one to two minutes between them.

As time passes after the surgery, increase to three sets at a time, separated by a one- to two-minute interval between sets.

2. Hold your hands in front of you, palms down, at shoulder height so your fingers are touching. Gently and slowly, open your arms, taking them back as far as they can comfortably go. Do this 10 times for one set. Rest one to two minutes. Repeat the set, for a total of 20 times in all.

When it is comfortable for you, work up to doing four sets of this exercise, with a one-to-two minute rest in between.

3. Swinging circles. Start with hands at your sides. Raise your arms. Then swing them backwards in large circles, as if you were doing the backstroke in a swimming pool. You can alternate your arms-first one, and then the other. Ten circles is one set. Rest one- to two-minutes, and repeat.

You can do this exercise several times a day.

Usually your stitches will be taken out by your physician in 10 to 14 days after liposuction. Your bandages may be removed as early as a week after surgery. After your stitches have been removed, you can gradually work up to doing more strenuous exercising.

Two weeks after liposuction, do the exercises described above, wearing two-pound wrist weights. Get your doctor's approval first.

You can also do the exercises while holding dumbbells.

The main reason most men have liposuction of the breast area is that they are ashamed of their fatty, enlarged female-type breasts. They want to look more masculine, with more sharply defined muscles.

After liposuction, you no longer have the excess fat. The exercising you do will help to define and shape the muscle. Exercise is the fastest and surest way to make the most of the "second chance" liposuction has given you. You will want to continue to exercise long after the surgery. The muscle tone you develop will give your pectoral muscles a better, more attractive shape.

EXERCISE FOR HEALTH CLUB/GYM
With your surgeon's approval, you can begin to exercise at a health or fitness club as early as two weeks after liposuction.

If you have not previously been an active member, or if you have not used the various health dub machines, it is a good idea to ask the fitness instructor at the health dub for specific instructions on the particular equipment. Make sure he or she is aware that you have recently had surgery.

Most health clubs will have machines like the ones listed below.

Always be sure to warm up slowly and gradually before beginning to work on the machines. Your warm-up exercises can include swinging your arms in circles, and stretching-like the exercises you did at home.

When you first, go to the health dub after surgery, only do one set of exercises. Wait a day in between visits, to give your muscles time to heal and recuperate. On your second visit, do two sets. Again, wait a day. On your third and subsequent visits, try to do three sets of each of the exercises.

1. Flat bench press. This exercise will help you develop the general overall thickness of your pectoral muscles.

Lie flat on the bench. Push the weight up as high as you can. Lower it to your chest, and take it back up again. This is considered one repetition.

Watch your breathing. Inhale as the weight comes down, and exhale right before the weight gets to the topmost position.

Ten repetitions equal one set.

If you cannot do 10 repetitions at a time, you are using a weight that's too heavy.If you can do more than 12 repetitions, the weight is too light.

You should do three sets, each with 10 repetitions. Rest two minutes between sets.

This exercise can be performed three ways:

-on a bench with a free barbell

-on a bench with dumbbells

-on a special bench press machine

If you use free weights (like the free barbell or dumbbells), you should have another person watching you, in case the weight slips or you get so tired you can't get the weight back to where it belongs.

After completing your bench press work, rest two to three minutes before starting work on the incline bench press.

2. Incline bench press. This exercise is used to develop the upper part of your pectoral muscles. It helps lift up your sagging chest, and helps pull up your skin after liposuction of your breasts.

The machine is similar to the flat bench press, but its bench is at an angle of 30 degrees or 45 degrees from the floor.

This exercise can be performed three ways:

-with a free barbell

-with dumbbells

-on the machine

Do three sets of 10 repetitions each, just as you did for the flat bench press. Watch your breathing. Rest two minutes between sets. Rest two to three minutes before beginning the next exercise.

3. Flies. You can use the flat bench press or the incline bench press for flies. Lie on your back on the bench. Hold the dumbbells in your hands, and place your hands close together. Lower the dumbbells down as close to the floor as you can reach, while you spread your arms apart, like a butterfly unfolding its wings.

Close your arms again, while raising the dumbbells to their original position. That is considered one repetition.

Breathe in as you go down; exhale as you get close to the top. If you cannot do 10 repetitions, your weight is too heavy. If you can do over 12 repetitions, your weight is too light. One set is 10 repetitions. Do three sets of 10 repetitions, resting two to three minutes between sets.

4. Pec-Deck. This machine is available in almost every health club. It helps to develop the outer pectoral area, giving shape and definition to the male chest, and is extremely beneficial to those who have had liposuction of the breast and chest area.

Sit at the Pec-Deck. Reach your hands behind the two arm pads. Squeeze them together and open them up. That is one repetition. Fifteen repetitions equals one set. Do three sets, resting one minute between sets.

5. Chest pullovers. For this exercise, you are squatting with your back against the bench. Using both hands, hold a dumbbell above you. copyright-dr.leon tcheupdjian/liposuctionLower it as far back as you can without raising your buttocks. Inhale as you do this. Then come back to the starting position, exhaling just before you reach the top. That is one repetition. Do 10 repetitions per set, with three sets. Rest one minute between sets.

6. Exercises for men only. As soon as your bandages have been removed, you can do five to ten wall push-ups, two times a day. Two weeks after surgery, lower your push-ups down to a chair. As you get stronger, start doing floor push-ups-five at a time, two times a day.



1-2. The physician indicates the type of fat that can be helped by liposuction.



3-4. Another male patient with enlarged breasts before (left) and after (right).



5-6. A third patient before (left) and after (right).



7. Shown during liposuction surgery is a male patient with unusually large fat deposits in his breast area. The right breast has been recontoured, and surgery is continuing on the second breast.

8. The diagram indicates the direction of the liposuction process taken from the small incisions (arrows) under the arms.
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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring - By Dr. Leon Forrester Tcheupdjian, M.D.
ISBN 0-9621284-1-4 | Library of Congress registration #: 2-414-199
copyright © 1988-2006 Dr. Leon Forrester Tcheupdjian M.D.
Published by Dr. Leon Forrester Tcheupdjian M.D. 875 Rush Street Chicago, IL 60611


All rights reserved. No part of this book may be reproduced in any medium whatsoever, including photocopy or other electronic medium, without the express written permission of Dr. Leon Forrester Tcheupdjian M.D..