Highly prone individuals, how would you handle?

[patrickwkimball]

I was curious to know how you doctors would handle an individual who was highly prone to gynecomastia, who had multiple revision surgeries, multiple comprehensive hormone/blood tests done by multiple endo's that show no indicators, changed his lifestyle to include everything that supposedly increases testosterone (high intensity exercise/weight training/cutting out hormone fed foods/eating more cruciferous veggies, etc..) and yet gyno continues to reoccur. 

If this happened to be a rare case of an individual HIGHLY prone to gyno is there a procedure you would be comfortable attempting that would remove any and all glands or is that just not possible and something this individual may just have to come to terms with as a condition that will never go away?  Obviously this person is me. 

[Litlriki]

It's very difficult to say how to address a chest that had undergone multiple operations without knowing what was done and what tissue remains.  We alter the blood flow to the skin and subcutaneous tissue of the chest when we do gynecomastia surgery, and revisions, options for "fat flaps," and potential to decrease target tissue to a minimum can only be considered with an understanding of what pattern of blood flow is present in the remaining tissue of the chest.  One could really reduce the amount of tissue under the nipple to a very thin wafer of tissue, and then mobilize fat flaps if needed to prevent a crater deformity under the areola. As long as the nipple is present, there will still be target tissue, which could develop into recurrent gynecomastia.

It's possible that you haven't really ever had an adequate resection if you've never been seen by a surgeon who focuses on gynecomastia in his or her practice.  In any case, as you go forward, you should see someone who specializes in this type of treatment.

Rick Silverman

[Dr. Elliot Jacobs]

Agree with Dr. Silverman.

I have never encountered a patient in my practice who was "prone to recurrence of gynecomastia" -- particularly if all hormonal tests are normal and one is not taking any anabolic steroids or taking medications which have gynecomastia as a side effect.
 
It is altogether possible that you never had proper surgery in the first place -- and the revisions were perhaps attempts to make things better but which were not successful.

If you ever consider surgery again (and I can easily understand your reluctance), it would be best to invest in a consultation with a very experienced gyne surgeon.  If you do go for consultation, you should bring the operative reports of all your prior operations so that the consulting surgeon will know what was previously done.

Good luck!

Dr Jacobs

[DrPensler]

While reading your story I said to myself I suspect either you never had adequate surgery or there is not much there and you are being obsessive about something none else can visualize.I would suggest you provide some photos of your current state.