The flanks are another very important area to take into consideration. They may be treated together with the lower abdomen or sometimes as a single procedure. Fat deposits in this area are a secondary sexual trait in males. It is frequent to observe these fat deposits deposits even in skinny patients. The presence of fat in this area, especially for women, may be very unaesthetic. Patients are marked and photographed in the usual way. Tumescent fluid is infiltrated in the same amount that we think we will remove. Tunneling should always be done in a vertical manner. The technique does not differ very much from that of other parts of the body.
The back or dorsum is a very large area but excellent results can be observed after liposculpture of this area. It is usually done as a single operation and not combined. In women, the bra makes the fat deposit look even worse. When fat is present in the back it tends to deposit in a “curtain manner”. The technique in general does not differ from that of other areas of the body except for certain points. In this case I use real Klein infiltration by infiltrating twice as much as I think will be taken out. Four incisions are made. Two are underneath the area to be treated (one on the left and one on the right) and two are over the area to be treated. In this way the tunnels can be made in a crisscross fashion. The direction of the ribs must be followed and one should not tunnel perpendicularly to them. Care must be taken to stay away from the muscle since it is very vascular and we do not want excessive bleeding. This is the main reason why I infiltrate so much in this area. The back is not an area I do in one single session. Patients are always told that they will need a second operation. In the first operation deep liposculpture is done and in the second procedure superficial liposculpture is done. This is an area where skin retraction is of the utmost importance. For this reason I consider it both an intervention of debulking and of superficial refinement. Superficial liposculpture gives the skin the opportunity to retract. At the end of the operation the treated areas are massaged with a steel tube so that they can even out. I finally pinch and roll test the area in order to evaluate any irregularity. The wounds are sutured and 3M Reston foam is applied. The patients must start massage sessions on the fourth postoperative day. The massages have to be very deep. Since very little subcutaneous tissue will be left after the operation, if they do not undergo massage, adherences may come especially in the costal areas, after the postoperative edema has resolved.
Another area that can be treated as being part of the trunk is the brachial area. Women really do not like fat deposits in this area. One incision is made under the axillary area and one near the elbow. Tunnels are made in the classical manner. The results for this area can be very satisfying. It is very important in this area not to debulk excessively because of the skin relaxation that can occur. Patients should be instructed to do gymnastics after the operation.
The mammary region is also part of the trunk. In this region fat deposits are frequent in men and are called gynecomastia. True gynecomastia in which the mammary gland is hypertrophic must be distinguished from a false one in which the gland is normal and only fat is present. Before treating gynecomastia, it is very important to establish if it is a symptom of a disease. The presence of estrogen-producing tumors, hepatic cirrhosis, and even drug abuse may be responsible for gynecomastia. A complete hormonal screening should be prescribed for the male patient. Before the advent of liposuction all gynecomastias were treated surgically. The results of these operations were not very pleasant and ended up in very irregular surfaces, hematomas, and also necrosis of the areolar complex. Liposculpture has eliminated a number of these complications. Liposculpture is indicated in all cases except in true gynecomastia. The gland in fact cannot be removed through liposculpture. When there is presence of both fat and gland, the surgical removal of the gland can be performed together with liposculpture or after several months in a second session. The patient is marked and photography are taken. Infiltration is done with the modified tumescent technique. Incisions are made in the sternal region, one on the left side and one on the right. In this way we can tunnel following the course of the pectoral muscles. If some gland is present, a periareolar incision should be made. Reston foam and bandages are always applied after the operation and kept in place for 3 days.
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