Having gynecomastia surgery in 1 month by general surgeon

[sectorjeff]

Hi I will be getting gyno surgery in 1 month the date is already set. He will not be performing liposuction. The doctor already told me that there might be a indent. He also told me that he would be putting small tubes for about a week to drain any fluids that build up. I had a couple questions for the gynecomastia experts.

1) will my puffy nipples still be present?
2) is it necessary to leave tubes in to drain fluids?
3) id the indents are still present after my recovery phase could heavy lifting help hide the indents?

Thanks in advance

[Litlriki]

First off, you need to post some photos and perhaps a little history, so that we might be able to even consider your questions.  Second, you should find out if your general surgeon has experience doing gynecomastia surgery, and ask for photos of his results.  If you're going to the trouble and risk (and possibly expense) of having an operation to correct a cosmetic deformity, only to end up with a new and more difficult to correct cosmetic deformity, then you should think twice.  Read through some of the posts about revisions and disappointments, and you'll certainly want to reconsider your plan.  You may get rid of puffy nipples, only to have a crater deformity, which doesn't look better and is more difficult to fix.  Heavy lifting will not fix it.

Rick Silverman

[Dr. Elliot Jacobs]

Totally agree with Dr. Silverman.  Would definitely investigate your surgeon's experience in performing gyne surgery.  If he says you may end up with an indent (we call it a crater), I would think twice about having him operate upon me.  Experienced gyne surgeons are aware of possible crater deformities and can take steps during surgery to reduce the risks.

Dr Jacobs

[sectorjeff]

Here is a picture of my chest at the moment. I have had gynecomastia since puberty and have always been embarrassed to take my shirt off in public or even wear thin shirts. The only reason why a general surgeon will be doing the procedure is because my insurance company will pay for it.

[Dr. Elliot Jacobs]

This is what gets me very angry.  Your insurance company is dictating to you who will do your surgery?  What kind of nonsense is that?

If you needed open heart surgery, would you accept your insurance company's dictum that it be performed by a dermatologist??

You PAY for your insurance.  You have a right to determine who operates on your body -- not some bureaucrat at the insurance company.

And while I do not know the credentials or expertise of your general surgeon, I do know that in general, plastic surgeons are much more skilled at performing gyne surgery.  I say this because I would not want you to have surgery and then find out that the results are sub-par.  Will the insurance then pay for a plastic surgeon to rectify the situation?  Yours is a straight-forward case in my hands -- routine and reasonably predictable.  Will your surgeon make the same statement?

Be smart and ask questions and assert yourself.  If the insurance company is willing to provide coverage for your surgery, then they should agree to pay a plastic surgeon to do it.  And if not, then get them to commit -- in writing -- to pay for a plastic surgeon to revise any (hopefully not) improperly performed surgery.

Unfortunately, we have seen too many guys on this forum who have had gyne surgery done by general surgeons -- and then needed revision surgery. And sometimes, nothing can be done for a poorly placed scar or a poorly performed operation.   Do not become one of those guys!

Dr Jacobs

[DrPensler]

I suspect you will get what you will be paying for.You are being told prior to surgery that  you will definitively have a complication that we as surgeons attempt to avoid.

[Litlriki]

Dr. Jacobs is right on on this--If your insurance will pay a general surgeon to do the surgery, they should pay a plastic surgeon as well.  This isn't normally based on the specialty of the surgeon, but rather based on the coding provided.  A general surgeon should code the procedure the same way as a plastic surgeon, if he is truly coding for gynecomastia surgery.  I have had patients tell me that a general surgeon would bill for "breast biopsy" rather than gynecomastia treatment in order to get it paid for.  Unfortunately, a breast biopsy will not correct your condition, which, as Dr. Jacobs pointed out, is a routine case for most of us.

RS

[sectorjeff]

The doctor that will be doing the procedure has actually done multiple gynecomastia procedures. He also told me that when he does the procedure he always tries his best to not make the chest look deformed.

[George Pope, M.D.]

The general surgeon may well have done a number of gynecomastia surgeries, but you state in your initial post that he is not going to perform liposuction and he is going to use drains.  General surgeons are not typically trained in liposuction, yet almost every plastic surgeon who performs gynecomastia surgery will use liposuction as a tool to get the best result.  In addition, although some plastic surgeons may routinely use drains after gyne surgery, most do not.  Use of a drain will leave a permanent scar where the drain exits the skin.
So you have a general surgeon who says he may leave a crater deformity, will not use liposuction, but will use drains.

I agree with Dr. Jacobs that you need to tell your insurance company that you want a plastic surgeon to perform your surgery.  If there is not a plastic surgeon in your community on your insurance panel, you need to go "out of network" to get approval for a plastic surgeon.

Dr. Pope, MD

[sectorjeff]

I appreciate all the info from all the doctors. All had me thinking and looking more into it.