Go ahead with Gyno surgery or not ?

[miramar]

Hello Doctors,

Still undecided whether to proceed with Gynecomastia surgery ! Would much appreciate your opinions and advise.

I'm a 49 yr old guy, 175 cm and 71 kgs and taking statins to keep cholesterol at bay.

Hormones tests done way back 12 months showed all is fine. 

Had two consultations with 2 different plastic surgeons recently.

First surgeon was the most positive, discussed removal of both fat and glandular tissue through a small incision under the aerola. He could feel the glandular tissue ( sort of rubbery tissue as described by him ) during physical examination, even though a breast ultrasound done at the local state hospital 12 months earlier stated " no signs of Gynecomastia. No solid or cystic lesions detected. There is no axillary LNS enlargement. ". 
His response to my question about excess / sagging skin, which is one of my main concerns, was that in my case this would be unlikely.

Second surgeon, which is well renowned locally and more experienced, seemed to be more realistic. During physical examination, his first comment was about excess / saggy skin post surgery. If i understood well, he suggested removing excess skin from the outer side around the aerola, but not sure whether this would be done through a separate surgery or not.
Also mentioned the possibility to remove all glandular tissue if need be and replace with fat taken form somewhere else to avoid cratering, even though he was informed that the breast ultrasound showed no signs of Gynecomastia, adding that one cannot rely on such tests.  
Since he also mentioned liposuction, I asked what would be the best option for me, liposuction only vs gynecomastia surgery, and he was very positive about gynecomastia surgery through a small incision under the aerola and borderline with the skin.

I have to admit that going through this forum, seeing so much complications post surgery is quite scary to be honest !

Uploaded some pics as well, hoping these might help for your feedback. No idea of the grading level of my gynecomastia, but i would say my main concern is excess / sagging skin.

Would much appreciate your feedback and thanks for your continued contribution to this forum.

[Miguel Delgado MD]

You basically have nearly to a grade 3 gynecomastia. This by definition is a skin problem.  Also, your age is not in your favor because older skin does not contract as well.  

I agree more with the second consult. However, it must be done in two stages and 4-6 months apart. No fat injections are needed you have plenty in your chest but it must be contoured properly.

Your case is one of the more difficult and a highly skilled gynecomastia expert is critical.  I would make the decision based upon who you go to, how confident you are in their skills, reviewing your doctors before and after photos, and how much your gynecomastia bothers you. Good luck

[miramar]

Thanks for your feedback Dr Delgado, truly appreciated.

Unfortunately we don't have Gynecomastia experts locally. 

The second consult was with a consultant plastic surgeon forming part of a reconstructive surgery team in the breast unit of the local state hospital and was referred to me by 3 different doctors, also regarded as one of the top plastic surgeons in the area. The before and after photos seemed quite satisfactory to me.

If at 49 I'm almost grade 3, I'm on a perfect route to be a grade 4 within the next few years and skin wise it will be even worse then.

If my reasoning is correct, in my case, the sooner the better for gynecomastia surgery.

That once again for your valuable advise.

[Dr. Elliot Jacobs]

I agree with Dr Delgado.  You are large and there is a lot of work to be done.  Your skin has lost some of its elasticity but in the hands of a gyne expert, your results should be acceptable.  At worst, you might have an accentuation of the fold under the breast but I doubt if you would have any hanging skin.

Dr Jacobs

[miramar]

Thanks Dr. Jacobs, appreciate your input.

When you mentioned the accentuation of the fold under the breast you mean the final result after the first or second intervention ?

Thanks again for your time and advise.

[Dr. Elliot Jacobs]

I am talking about a possible result after the initial operation.  Many times this will not occur and thus no second procedure is needed.

Dr Jacobs

[miramar]

That's quite encouraging.

Fingers crossed.

Thanks once again

[Dr. Schuster]

Gynecomastia is more of a clinical diagnosis. It can be the result of glandular enlargement (true gynecomastia), fat (pseudo gynecomastia) or a combination of both. The treatment requires removal of the gland and fat and then relies on the skin to shrink. If the skin is not in good enough condition to shrink, due to genes, weight loss, aging, than there are some additional procedures that can be done. These involve the removal of some skin. A peri-areolar skin reduction would fit into this category. Based on your photos you might benefit from this but an exam is really needed to best advise. Make sure you have a consultation with a surgeon who performs gynecomastia correction on a regular basis. Good luck.

[miramar]

Thanks for your detailed input Dr. Schuster.  

Unfortunately it seems that there is no gynecomastia expert locally so i have to rely on what we have and hope for the best.