Surgery now even though the gyno is still actively creating tissue or wait?

[spow9236]

Hi Doctors,

I came here as a last resort. I've had steroid induced gynecomastia now for 3 years. I stopped my cycle immediately (haven't used steroids for 3 years) but it has continued to get worse. I've seen 4 different doctors in my area and non seem to know much about gynecomastia. I've been prescribed/taken everything from letro to nolvadex and all got rid of the gyno but as soon as I came off it would come back within a few days. I have even tried coming off of the meds slowly to control the estrogen rebound but still no luck.

I've had mammograms, ultrasounds, etc. only to find out what I already knew. I've also had blood work several times and each one showed my hormone levels were normal and that my thyroid was fine. I have now been off all medicines for a year (advice of an endocrinologist) but my mammary glands are still inflamed and very swollen (pea sized to half golf ball size at times) causing me a lot of pain. I have no discharge from the nipple just very sore. The breast tissue is still very slowly being created as well and it is now becoming noticeable to a normal person. I've also tried dieting, getting my body fat down to 10% at one point. It definitely seems to flare up even worse when I eat unhealthy and start gaining weight back. Currently, I'm 25 years old, 5"11, 185-190lbs at 13-14% body fat. I've never been overweight. I’ve actually always struggled to put on weight which is why I got into bodybuilding 7-8 years ago.
My question to the doctors: Is it possible that after the surgery, since my gynecomastia is still so active, my glands will flare back up and begin creating tissue all over again. The surgeon said he cannot completely remove the glands because it will leave a depression behind the nipple so I’m worried what is left may grow back. Obviously, I don't want to throw $4,200 down the drain and be stuck with painful breasts the rest of my life.

I appreciate your help. I don't know where else to go....

-Thanks so much

[Litlriki]

If there is no ongoing stimulus causing the gynecomastia to flare, it shouldn't.  Discomfort, however, may persist long after the gynecomastia has first appeared and the stimulus has resolved.  This is often improved with surgery, though there is no guarantee (i'm sure your surgeon told you that).  One reason you notice worsening with increased body fat percentage is that the fat in the breasts in men with gynecomastia is often a preferential point of storage, making the appearance fuller with even minor weight increases. So you may not be seeing the results of "active" gynecomastia (described as the "florid stage"), but rather just an increase in the fat content.  Presuming your hormone levels are all corrected and there are no other factors stimulating your gynecomastia--and you don't take steroids or supplements that might cause recurrence--you should be able to avoid a recurrence.

Rick Silverman

[DrPensler]

I would concur with Dr. Silverman said,in addition I would note steroid induced gynecomastia is predominantly glandular in nature. Typical ratio of glandular to fat ( adipose) is 9 to 1  or greater. Any treatment that does not remove the vast majority of the glandular component will NOT be effective at reducing the cosmetic component of the problem or the sensitivity.
Complete removal of the glandular component requires removal of the nipple and areola which is not advisable,aggressive removal of the glandular component is necessary for a good result.