Lipo or removal

[Massifnips]

I've seen a couple of surgeons and a lipo expert and I have been told by them all that I have mild Gyno. They can't be certain I have all fat or gland so I'd like to ask if a safe way to proceed is to have lipo first and if I'm not happy go for gland removal afterwards. This has been recommended by one surgeon but the other said not as it would be harder to remove the gland after lipo. I'm a little confused so any advice would be great. I have mostly fat at the sides and under arms. I have always had puffy nipples which is the main problem for me which I'd mainly like to get rid of.

[Dr. Elliot Jacobs]

You would best be served by consulting with a gynecomastia expert -- or consider travelling for such expertise.

I can assure you that most experts will recommend both lipo and excision performed at the same time.  There is nothing gained by doing it in two separate operations -- in fact, doing excision after lipo (or vice versa) is harder to do and harder to get a good result than if done at the same time.  If your doctor is afraid or concerned about doing that, then he is not expert enough to do your surgery.

This is elective surgery -- get it done right by a surgeon who has sufficient experience to get it right the first time.

Good luck!

Dr Jacobs

[DrPensler]

The logic you present is incorrect and is based on several false assumptions. Every patient has a combination of glandular tissue and fat. The first issue is to assess the amount of glandular tissue and fat that is present. The second issue is to asses the skin elasticity.The surgeon then needs to create an operative plan that takes the two previous issues into consideration in a way to optimize a successful outcome. An unsuccessful initial  operation will require a secondary operation.Secondary surgery has a much higher complication rate and depending on the exact situation it is often  not be possible to obtain the same optimal result which was possible at the first operation. Any individual surgeon who does not have the expertise to asses the initial status of a patient to a reasonable degree and develop and execute a plan to address the situation is not someone who should be treating that patient.

[Dr. Schuster]

You should have complete removal in one, and hopefully the only, operation. You should go to a real gynecomastia surgeon. usually liposuction and excision is performed together.