Lifting nipples / restoring side balance

[runner47]

Hello,

I recently found that I had a prolactin secreting pituitary adenoma (I'm on dostinex now), and due to this condition I unfortunately also developed a case of gynecomastia. I'm interested in having it removed surgically, but I'm still a bit uncertain and have some questions:

- is it possible to remove the gyno tissue in its entirety?
- Can the nipples/skin be lifted back up as to restore a normal appearance?
- One side is lower than the other, is it possible to fix this?
- What would the entire cost of such an treatment / operation be?

Thanks a lot!

[Dr. Elliot Jacobs]

Glad you found the cause of your gyne and that it is being treated.  (Not all patients are "lucky" enough to find out the real cause of their gyne -- for most, it remains idiopathic, which means the cause is unknown).

I have operated upon several patients with prolactinoma-induced gynecomastia.  The key is to have your hormone levels very stable for a while -- while on Dostinex.  Surgery can then be performed -- but you will probably have to remain on Dostinex and with endocrine monitoring to prevent possible gyne recurrence.

The surgery can remove all the excess tissue to restore a normal appearing chest.  I usually approach this surgery conservatively to minimize scarring.  Hence, I would do my usual aggressive gyne surgery thru minimal incisions.  When this is done, most of the time, the body restores itself to a symmetric or near-symmetric appearance -- which makes additional work to "move" a nipple or to tighten skin unnecessary (doing this would result in additional and objectionable scarring).

If you would like to pursue this further, send me an email at: info@drelliotjacobs.com for a free email evaluation.  Whatever you do, make sure you go to a properly experienced plastic surgeon for your operation.

Good luck!

Dr Jacobs

[runner47]

Many thanks for the prompt and helpful reply, Dr. Jacobs!

I have just started taking Dostinex in June and, while my prolactin levels are back to normal (and it's a case of a microprolactinoma), it makes great sense to wait a bit longer to see how my hormone levels stabilize first, as you say. My first control is this month and I'm curious to hear what my endocrinologist will recommend (he said he might try taking me off the medication all together to see if prolactin levels remain low).

I am very, very happy to hear all the excess tissue can be removed; this new saggy and asymmetric appearance isn't entirely pleasing to the eye.

Thanks again for all the information and advice! I will keep your contact info handy!

[DrBermant]

Hello,

I recently found that I had a prolactin secreting pituitary adenoma (I'm on dostinex now), and due to this condition I unfortunately also developed a case of gynecomastia. I'm interested in having it removed surgically, but I'm still a bit uncertain and have some questions:

- is it possible to remove the gyno tissue in its entirety?
- Can the nipples/skin be lifted back up as to restore a normal appearance?
- One side is lower than the other, is it possible to fix this?
- What would the entire cost of such an treatment / operation be?

Thanks a lot!

Dostinex (Cabergoline) is a medication that can be used to treat prolactinomas (tumors of the pituitary gland).  When effective, glandular growth is sometimes stabilized, and sometimes regresses.  A Prolactinoma tumor makes too much Prolactin a hormone that causes breast growth to make milk for pregnancy.  Prolactinoma in men can be large enough to press on the optic nerves restricting vision.  It is one cause of gynecomastia.  Gynecomastia surgery is better deferred until such problems are stabilized.

Fingers of gland disperse through fingers of fat in the normal Anatomy of Gynecomastia. No surgical technique removes all the gland, even radical mastectomy in men (a deforming surgery). I prefer to target the gland elements first with my Dynamic Technique.  Less gland means less target organ for future hormonal stimulation.  That way, in combination to stabilizing problems first, my patients have a very low recurrence rate and revision rate for surgery (less than 1%).

The normal chest has some asymmetry. Options depend on many factors.  Low Nipples Do Not Look Good on a Male Chest. However, images with one arm partially up and shadows does not have enough information about possible uneven issues or loose tissues.  If there has been a great deal of gland shrinkage after medical treatment, waiting until the skin contracts is another issue for stabilization before considering surgery.  If there are subtle drooping issues at that point, I can sometimes offer my Internal Lift Male Mastopexy to balance the chest.  This sculpture will not address uneven muscles nor underlying bone structure.  However if you check the examples on my site, this sculpture is usually best used for patients with a much larger degree of sagging.

My patients awaiting stabilization for such issues as an endocrinology problem as a prolactinoma have expressed how helpful No Surgery Body Shaping Garments have been to temporize a natural chest contour.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction