Chest MRI or chest ultrasound scan or Mammogram?

[iamnothappy]

Hi Gyne Surgery Experts,
I have consulted several Plastic surgeons in my place for revision surgery. one doctor told me I still have some gland on right side. one doctor I only have some fat on right side. one doctor told me that I have loose skin and I don't have either gland or fat. one doctor told me I might have some scar tissue on right side. am so confused now. my pics are posted in other thread "Need your suggestion".
I would like to know if a MRI or an ultrasound scan or a Mammogram of my chest can help me in identifying whether I have gland or fat or scar tissue in my chest.
I am being very careful this time as  I don't want doctor to blindly remove something in my chest and make it worse
please let me know your opinion as to which one (Chest MRI/Ultrasound scan/Mammogram) can be helpful in my case?

[Dr. Elliot Jacobs]

If you have already had surgery, then by definition you have scar tissue present by default.  It truly doesn't make any difference whatsoever if you have gland, fat or both in addition to the scar tissue.  Thus having any type of diagnostic tests (MRI, mammogram, sonogram) will only deplete your pocketbook and provide absolutely no additional useful information.

Your best bet is to go to an experienced gyne surgeon who also has experience in revision surgery.  There are not too many of these guys around -- but do your homework and find one near you.  Or, be prepared to travel to find a true expert.

Dr Jacobs

[iamnothappy]

I totally agree with you that I should go to an experienced gyne surgeon who also has experience in revision surgery.  Unfortunately as you mentioned there are not too many of these guys around. I have consulted several PS and am not satisfied with consultation itself.
I have been talking to one PS recently. He told me he would do only liposuction and would try to suck out gland if any found during surgery. i felt instead if we can find out whether there's gland or fat or scar tissue before surgery, then it can help my PS plan better before surgery itself. my PS himself tells me that's closed procedure (done under the skin) and hence it's very difficult. i have seen many forum members having unsatisfactory results even after revision., that's why i am trying to be careful.

[Litlriki]

Dr. Jacobs' point about having revision surgery with someone who does revision surgery is really important--and also goes along with the issue that diagnostic tests are not especially helpful.  There is a lot of hot air blown about regarding various classifications, value of testing, and so on, but the bottom line with gynecomastia is that you want to correct the problem that is in front of you. If there is excess tissue, whether it's fat, gland, scar,  or skin, that tissue needs to be removed in a manner that results in a smooth and even contour with as little scarring as possible.  An MRI might show fat versus stuff that isn't fat, but that's readily palpable in the course of surgery, and any tissue that doesn't respond to liposuction probably needs to be removed by excision.  That tissue--be it gland or scar--is typically easily reached through the peri-areolar incision, rather than being at some remote location that would require additional scars.  If your surgeon gets a study that only shows fat with a little scar tissue, and that compels him to only do liposuction, when some excision is also required during the procedure, not only will the test have wasted your money, but it might also contribute to a bad result.  I only order tests when the outcome will change my course of action--and when doing revision surgery, my approach is based on what I find during the surgery, so pre-operative imaging would likely have no impact on my inter-operative choices.

Good luck,

Rick Silverman

[iamnothappy]

Thanks Rick for the detailed clarification. Both Dr.Elliot Jacobs and you are advising me to go to a surgeon who has done a lot of revision surgeries. Unfortunately that doctor I mentioned told me he hasn't done many revisions. not sure if i should go to him.

[Dr. Elliot Jacobs]

You will read in the media that when a ruler or VIP in a foreign country needs specialized care, they will often travel to the US for such expertise.  The same is true when you are looking for revision surgery, which is a true specialty as well.  If you are not fully confident in your surgeon and since this surgery is totally elective and can be done at any time, then use the time to do your homework and find an expert for your surgery -- even if it means traveling to do so.

Good luck!

Dr Jacobs

[iamnothappy]

Dr.Elliot Jacobs, that's true. i like your point "If you are not fully confident in your surgeon and since this surgery is totally elective and can be done at any time,then use the time to do your homework and find an expert for your surgery" it's somewhat an eye opener for all those who are so desperate to get revision surgery.. thanks for your advice.
I thank Dr.Rick for sharing his opinion on this.