Revision advice Help needed after excision only surgery

[november2012]

I am 5'8"
146 lbs

I had a noticeable case of gynecomastia.  The doctor did excision surgery only (over 1.5 years ago).  He said since I was thin, liposuction was not needed.

There was noticeable improvement.  However, gyne is still evident.  I later learnt that liposuction is used by surgeons to contour the nipple??  So it should have been done whether I was thin or not.

Previous doctor was overseas. I went to a different surgeon for in my country (because flight+hotel would add up to cost).

He said I still have gland.  However, he informed me that he didn't want to remove it in order to avoid any concavity.  Instead he just wants to do liposuction and says this will further improve my nipples.

I am newish on this forum, but I have read many posts and it seems no one was happy with liposuction only.  However, since I have had some gland removed previously, would only liposuction some how help flatten the nipples and give me a better chest?  Please keep in mind that I am 5'8" and 146 lbs (thin).

If any doctor's could help it would be great.  Similarly, anyone who has same case as me could give information.

[Dr. Elliot Jacobs]

It would be best if your could post some before and after photos of your chest.  We could then chime in and discuss the situation.

Dr Jacobs

[november2012]

Dr. Jacobs,

I'm afraid I don't have any before pictures as this was nearly two years ago.  Although I can post some after (current) photos later today.

In the meanwhile, could you shed some light on the matter based on the details in my earlier post?

I can feel the hard gland.  I can also feel softer (fat) just on and right around the nipple area.

Another follow up question, in you experience, has excision only ever worked well for your patients in the past, or do you always do liposuction as well?

Have you ever done revisions which are lipo only (and left gland in the chest) or is it advisable to completely remove the gland.

[Dr. Elliot Jacobs]

First, please post whatever photos that you can.

Second, feeling for fat or gland is a fool's errand.  Even the most experienced surgeon's hands cannot tell the difference between hard fat, gland and scar tissue.

Third, every revision case is different and what is to be done has to be determined, in essence, during the actual operation.

Fourth, I very rarely do excision alone.  Usually, some type of lipo or skin undermining is necessary to allow the skin to re-distribute,

Dr Jacobs

[Litlriki]

Photos would be helpful in addressing your questions.  I have done revision with just liposuction when the problem was contour of the periphery--away from the nipple--and this is generally something that's more common in someone who is carrying a little extra weight.  But, as Dr. Jacobs has indicated, it is difficult to determine the composition of the breast tissue by palpation only.  Modification of the surgical plan is sometimes required to address the issues one encounters during the surgery, and your surgeon should be prepared for whatever is necessary.

Rick Silverman

[november2012]

Thank you.  I will post pictures today.

You mentioned you have done revision with lipo only.  Have either of you gentlemen done gynecomastia surgery with excision only?  Or always with liposuction as well?

In a thinner person with minimal fat, is it ever possible to achieve results of a flat-ish chest with just excision.  Because even though I completely agree with you, that until surgery begins it is difficult to tell 100 percent regarding fat verus gland, I can still feel a lot of hard glandular tissue under and beneath the nipple.  Particularly, on the side below the nipple going towards my arm pit.

Thanks..

[november2012]

pictures

[november2012]

more pictures

[november2012]

photo

[november2012]

pic

[DrPensler]

It appears there is some residual gland.I would most likely combine an excision of the residual gland with some liposuction. As you read through  this strand I think the most important piece of insight you can glean is Dr. Jacobs comment "Third, every revision case is different and what is to be done has to be determined, in essence, during the actual operation."

[november2012]

Thanks doctor.  have you ever had success with just excision?
or have you ever had successful result with only lipo (in revision case when only excision was done)

would you have any pre&post op photos that could help me see the results in the above cases?

[Litlriki]

Based on appearance, I would anticipate some excision and liposuction for a revision. I have had success with revisions only involving excision OR liposuction, but that was what I anticipated would be needed in each instance.

RS

[november2012]

thank you.

and based on my photos (i understand its not the same as being there in person), would you also anticipate excision + lipo?  The reason I ask is because price would be significantly lower if I only did one.  Ofcourse, I don't want to be a fool and go through this whole procedure again just because I tried to save some money. However, if it was possible I would, and I've heard the recovery from just lipo is a lot quicker than excision.. is this true at all?

[Dr. Elliot Jacobs]

I've heard the recovery from just lipo is a lot quicker than excision.. is this true at all?

Absolutely wrong -- recovery is the same!!!!!

I can understand your concern re cost -- yet what would the cost be if you had to have a second procedure?

Honestly, I don't understand surgeons who may have one fee for lipo only and another fee for excision and a third fee for lipo plus excision.  A surgeon absolutely cannot be certain of what would be necessary until he is in the middle of surgery -- that is why I always argue that any surgeon beginning a gyne operation be prepared to do anything and everything to achieve the optimal result in one procedure.  Anything less is doing a disservice to the patient.

When I operate, I charge one fee for my surgery -- and that includes whatever is needed to get an optimal result.

Guess other surgeons have a different philosophy.

Dr Jacobs