Preliminary health/medical questions

[chestquest]

due to age and pre-existing factors, I have questions I would like addressed before getting too deep into considering surgery to improve my chest contour. 

First of all, i am a relatively healthy 47 y/o male with (based on what i see here) a mild to moderate level of gyne.  I am on a TRT dose of 200mg test cyp every 2 wks, no AI. Estridol has always been in the normal range, never any "nipple" issues (pain, itchiness,etc).  I *think* i might have developed it about a decade ago when using Propecia and not realizing that gyne could be a side effect. I seem to remember some tingling sensations during that time, but came off the meds due to sexual side effects. Anyway...

Fast fwd to recent years...About 2 yrs ago went to doc with symptoms of low T.  Tested in the low 200's, put on TRT. With the new energy and T levels, I got back in the gym and eventually became more "body concious" with improving physique.  Now I realize that my chest appearance is not in synch with other muscular development due to gyne.  Now here is where it gets troublesome for me...

about 8 years ago, I had a totally unexplained PE.  Was put on warfarin for 6 months. Everything was cool until about 1 year to the exact day of the original PE, I had another PE.  Things were cleared up, but I was put on lifelong RX of warfarin, 5mg per day.  No issues since. I am also on 20 mgs of lisinopril for pre-HT. Don't drink, don't smoke. 5 10, 190lbs, not obese or overweight (approx 15%BF)

Does my age and med history w/r/t PE put me at any higher risk for post-op complications?  Can surgery "cause" PE, or is it usually the lack of movement inherent with some surgeries that lead to this condition?  Is it the tissue trauma that changes the blood chemistry?  I'm sure I would have to be off warfarin for a period of time pre and post op?  I was off for 6 months the one time without an event, and it has been years.

Also, I offer a disclaimer to any doc that would respond, as ultimately it would be a decision made between myself, my spouse, and potential doc.  Thanks in advance for any input on this.

[Litlriki]

Based on your history, I would think that you are at some increased risk of complications, and the two biggest concerns I'd have would be recurrent DVT/PE, or possibly bleeding, depending on how your anticoagulation is managed peri-operatively.  That said, I think your risk is elevated compared to someone who is otherwise young and healthy without a past history like yours.  I would also wonder about some underlying condition that led to the two PEs, and I trust you've had a work-up to determine the presence of such an abnormality. 

Presuming all of these issues are managed carefully, the risk from the procedure itself is probably reasonable.

Rick Silverman

[DrPensler]

You are obviously at increased risk for surgery.You would need to consult with both your internist and surgeon to establish the extent of the risks involved versus the benefits of the procedure.

[chestquest]

I would also wonder about some underlying condition that led to the two PEs, and I trust you've had a work-up to determine the presence of such an abnormality.

I did have a battery of tests (ultrasounds and blood) during both hospital stays and all were inconclusive.  I had no previous trauma, no leg pains or other extremity pain. They ruled out cancers and lupus, as well as other blood disorders. It remains a mystery to this day. Sounds as though even though surgical trauma had nothing to do with the previous episodes, i would be probably more susceptible than the average joe to have an issue.   

You are obviously at increased risk for surgery.You would need to consult with both your internist and surgeon to establish the extent of the risks involved versus the benefits of the procedure.

risks/benefits.  Well i said mild to moderate, but after looking at other pics, i would say mine is mild.  It is more along the lines of pointy nipples (the flat, smooth contour is interrupted from the side and slight puffiness of lower pec - not "square").  there is no tissue in the nipple itself (like it appears in some photos). Maybe at 47 going in to fifties, I should focus on just being in the best shape i can be and give myself a pass on the chest of youth.

Thanks for your replies.

[Dr. Elliot Jacobs]

Maybe at 47 going in to fifties, I should focus on just being in the best shape i can be and give myself a pass on the chest of youth

Part of the "beauty" of growing older is that one develops a bit of wisdom, an ability to assess a situation from afar and decide what might be the best (if not ideal) course.

A PE is nothing to fool around with -- and you have had two episodes -- due to unknown causes.  The best treatment is continuous anti-coagulation.  If you were my relative or friend, I would be extremely reluctant to interrupt that anti-coagulation unless it was a life or death situation.  Gyne surgery doesn't fall into that category.  Hence, your thoughts of just being in the best shape you can and living with a little bit of gyne may not be a bad idea.

Dr Jacobs

[Litlriki]

I'd have to agree with Dr. Jacobs, particularly as it sounds like your condition is very mild.

RS

[chestquest]

I thank you all for your advice.

Although somewhat disappointing, my gut feeling was that elective surgery would likely not be for someone with a history of PE. Sometimes I get really down on my chest, but at least the mental dithering of whether to actively pursue surgery can be put to rest.

I hope this is not out of line, but I have A couple of more follow up questions in an attempt to keep things in check.  Thanks for your patience with me!

Do i need to get my doc to follow my E levels more closely (since I am on TRT) - Are E2 levels the only concern, or do E1 and E3 play a role? (my doctor doesn't really seem to be concerned about E at all).

Are there always symptoms if E is high? (pain, tenderness, etc) or can tissue develop stealthily?

Lastly, is there any other non-invasive procedure in this specialty to "tighten" the skin?  When I get chilled, my contour problem is actually much improved, as the area around my areola contracts very tightly.  It would be nice if one of you guys would come up with a procedure to contract areola musculature for mild cases such as mine. Not sure if that would help or hurt your business  .

Thanks if you choose to reply!