Please Help...Which procedures to opt for??

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Hi Doctors,
I have been facing with the Gynecomastia problem for quite a long time. May be since i was 10 yrs old. Today i am 25 yrs old. I would like to understand first wht exactly my problem or the extent of the problem is. I have attached pics of my chest. Hoping to receive a reply from you soon.

Weight : 85-90 kgs
Height : 5'11
Never been operated.
No Medical History
Was 100-110 kgs before, wen i was in high school and junior college. Went to the gym and reached 75 kgs in about 1.5-2 years. Have put on little weight approx 10-15kgs again.
Rest Fit & Fine

[Litlriki]

I'm not sure about your question regarding "the extent of the problem," since you quite clearly have gynecomastia that is likely a combination of fat with some glandular tissue, as well as skin excess and laxity and large areolae.  There are classification systems to describe the appearance of your chest, but those have meaning only to plastic surgeons (and only a few who actually remember that there are classification systems!), so that's not helpful. 

As far as how to approach your problem, there are a few options.  The first thing that I would say, however, is that you should be treated by a surgeon who does a lot of gynecomastia surgery in order to get your best result.  A surgeon who doesn't treat gynecomastia regularly may get a good result, but the challenges your case presents will make it difficult.  Some surgeons would address your problem in two stages, performing liposuction and excision of glandular tissue in one procedure, and then doing peri-areolar skin removal in a second procedure.  This is a safe approach, particularly for someone who doesn't do much of this surgery, since the skin removal does add risk to nipple viability.  Alternatively, the procedure could be done in a single stage with liposuction, gland excision, and peri-areolar skin tightening, all done at once.  In the hands of an experienced surgeon who does this with frequency, it should be reasonably safe, and the outcome should be fairly good.  It's sometimes difficult to get perfect symmetry (particularly since it looks like you're asymmetric to begin with), and a revision might be necessary.  Be sure to understand your surgeon's revision policy, so that you're not looking at big expenses down the line when you think everything is covered, but a revision is required.

 I hope that's helpful.

Rick Silverman

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Thank you Dr. Rick Silverman for your reply. Appreciate it. I have approached a few surgeons in my city and sent them the pics and asked for a feedback. Will surely share it here as i get them. I had approached a surgeon about a year and a half ago and he advised Lipo+Excision+skin tightening all in a single surgery. The surgeon is pretty experienced and famous (this is what i have learnt from this forum and lot of people on this forum have had their surgeries done from him). But there are few who arent happy with the surgery results. so im a bit confused whether which surgeon to choose. I also cant afford having an expensive one as the money is pretty tight. May be if i plan to have the surgery after a year or so ill be able to gather enough money for it. So my choices as of now are pretty few. I'd like to know from you the important things to keep in mind while selecting a surgeon. Secondly, you mentioned "peri-areolar skin removal" and "nipple viability" .I would appreciate if you could explain these things. I read many posts in this forum and i came accross "crater deformity". Are the chances of have it high in my case??...Lastly, i wanted to know if working out and bodybuilding after the surgery would help in achieving a more natural and fuller chest as i know after the surgery the chest would be flat and saggy(if crater deformity occurs). Gaining chest muscle would make the appearance more natural??...Once again i thank you for your reply...appreciate it

[Litlriki]

As surgeons, we must always be prepared for less than perfect results.  But as a patient, you are looking for the perfect result.  Clearly, not every patient will get that perfect result, even from a surgeon who is experienced and skilled.  If imperfect outcomes are managed well, patients tend to be satisfied with their care, though perhaps not 100% happy with the end result, possibly because their expectations were too high, or possibly due to surgical challenges.  If you have found a qualified surgeon who has mostly good outcomes with a few unhappy patients, that's probably a reasonable choice.  It's the surgeon who claims great results with no photos or patients to back that up, who should be suspect and avoided.

Regarding the "peri-areolar skin removal," that's just what it says--taking skin from around the nipple, and by doing that, the blood supply of the nipple may be compromised, which could cause the nipple to die.  We discuss this possibility with all gynecomastia procedures, but in most cases, a short peri-areolar scar won't cause a problem.  An incision the entire way around the areola has greater potential to have problems with the nipple viability or survival. Crater deformity is adequately described on this site, and something that's rare when a procedure is properly executed. 

Any activities that provide improved muscularity with decreased subcutaneous fat will give better shape following the surgery.  I don't know what "natural" means, but certainly well developed pectorals muscles give better appearance to the chest.

RS

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Thank you so much for the explanation Dr. Silverman. Will surely keep this in mind while selecting my surgeon.