Building muscle / fat loss BEFORE surgery?

[spooon]

I have seen a few doctors state that getting super lean and in shape does not really help with the surgery one way or another. On the other hand I have seen bodybuilding forums espouse the opposite view i.e. it is imperative to get lean and develop chest muscle beforehand. Would anyone like to throw light on this? Is it a psychological thing in that the recovery process is 'easier' if the immediate aftermath of surgery rewards you with a masculine look previously hidden by manboobs? Does getting super lean increase the likelihood of just needing to remove gland? Does this entail quicker recovery? I've seen some guys with a couple of band aids on each nipple and other guys that look black and blue. Why is that?

[Litlriki]

Unless patients are significantly overweight, I don't recommend weight loss prior to surgery, and I most certainly discourage patients from coming in "contest condition" for their procedure. The primary reason for this is that the surgery manages both "gland" and the surrounding fatty tissue.  If one is dieted down to an extreme level that's not easily maintained, then there may be fat accumulation in the chest as the patient's body fat percentage rises back to normal levels.  On the other hand, if the surgery is completed with the patient at his normal weight, any dieting afterwards will help to tighten up the chest and give an improved appearance, as is seen in competitive bodybuilders. 

[spooon]

That is an interesting viewpoint - thank you. 

[Dr. Elliot Jacobs]

I agree with Dr. Silverman.  I do not recommend extreme dieting prior to surgery but I do recommend that the patient be at his best and most stable weight prior to surgery.  For some guys, that may mean that they are still a bit overweight -- that's OK.  I can then perform surgery to leave them with a chest which is consistent with the surrounding areas of their body.  If they then choose to lose more weight, it will be more proportional.

Building muscle is always a good thing -- but taper down the exercise a few days prior to your procedure.

Dr Jacobs

[spooon]

Both, I am not sure I fully understand why you do not recommend getting super lean. If you perform surgery on someone with very low body fat, will the patient not just accumulate fat all over like anyone else?

[George Pope, M.D.]

What Dr. Silverman is saying is that if you intentionally get super lean before surgery, leaner that what is considered your normal, you may put on fat after surgery and have more fat on your chest that you want - fat that could have been suctioned during the surgery. Sure you'll gain fat all over, but you may end up with more fat on your chest than you want.
Dr. Pope, MD

[spooon]

ok thanks I get it now. 
on a different note is it fair to say liposuction destroys fat cells whereas natural fat loss just shrinks fat cells?

[Dr. Elliot Jacobs]

You got it.  Liposuction removes fat cells.  The remaining fat cells can either reduce or enlarge in size in accordance with your diet.

Dr Jacobs

[DrPensler]

I have seen a few doctors state that getting super lean and in shape does not really help with the surgery one way or another. On the other hand I have seen bodybuilding forums espouse the opposite view i.e. it is imperative to get lean and develop chest muscle beforehand. Would anyone like to throw light on this? Is it a psychological thing in that the recovery process is 'easier' if the immediate aftermath of surgery rewards you with a masculine look previously hidden by manboobs? Does getting super lean increase the likelihood of just needing to remove gland? Does this entail quicker recovery? I've seen some guys with a couple of band aids on each nipple and other guys that look black and blue. Why is that?

A couple of points ,1) I prefer patients are at the weight they typically will be post-surgery. If a patient looses weight after surgery they will still look good but if they gain weight it is difficult to predict exactly how things will look ,depends on the amount of weight change. 2)As far as competitive bodybuilders I always start by saying you will never be 100% happy. You compete in a sport where people judge you in a variety of positions and note every fault. I optimize the patient in a resting position standing with the arms at the sides. It is not possible to optimize each position a competitive bodybuilder takes during a competition with varying degrees of muscle flexion.

As far as the difference between bodybuilding forums and regular people forums people who post on serious bodybuilding forums want to absolutely optimize the individual at the time of the competition. Even for world class competitors the way they are at a competition ,body fat etc.,is not how they typically present.

[Litlriki]

Regarding the fat in your chest--Gynecomastia patients often have "abnormal" chest fat. It's the fat that gets fatter faster and loses mass slower with dieting than fat elsewhere on the body. Think "love handles" and "saddle bags," which are similar in that they're fat deposits that behave differently than other fat, thus resulting in big accumulations in those regions in affected individuals. Gyno patients seem to have that sort of fat in the chest.  Interestingly, some bodybuilders who get gyno but didn't have it during puberty will still show signs of this resistant fat, more typical of pubertal gynecomastia. In any case, you want that fat to be suctioned away as much as possible to allow for the more normal contour afterwards, which won't change too much with mild weight gain. 
One other comment in follow up to Dr. Pensler's remarks about competitive bodybuilders: depending on how lean a physique they maintain, I will leave a thinner sub-areolar remnant in those guys who stay lean all the time, otherwise they still look like they have gynecomastia.  I use suction to contour the surrounding fat to lower risk of a crater, though often there's very little fat to contour. I warn them that if their body fat levels go up significantly, they might require some additional liposuction, but I haven't really seen that happen. 

[spooon]

Thank you all for the continued discussion.
For what it's worth my original question was inspired by a youtube video of a gym goer who had gyno surgery and recommended getting lean as possible. To quote him it was so that the surgeon doesn't have to mess around with removing fat and associated risk of removing too much or too little, risking undesirable contours. I think the implication was that it is best to get to a point where the surgeon is removing breast tissue only and not much else.

[Miguel Delgado MD]

I agree with Dr. Silverman completely. 

[spooon]

Thank you good to know