Surgery questions

[rrr]

I have done some research, and it appears there are 4 pretty standard criteria.

1) Be overall healthy
2) Be of a healthy weight
3) Growth must have stabilized
4) Non-smoker

1 and 2 are covered - I am very healthy for being in my 50s (more like 30s according to my doctors), so no problem.

3 has not happened yet and I don't know when it will. I understand this criteria, as I don't want to have one surgery let alone having to repeat it.

#4 I do not understand. I am a smoker, but it has not effected previous surgeries - including abdominal. Is being a non-smoker really required? If so, can someone explain why? Does it forever rule out the choice of surgery?

Thanks

[Dr. Elliot Jacobs]

No, having been a smoker doesn't rule out surgery.  The problem is the nicotine in the smoke, which narrows blood vessels and diminishes blood flow.  Nicotine stays in the body for a while so many surgeons will recommend that you stop smoking for about two weeks prior and two weeks subsequent to your surgery.  That also means no nicotine gum -- it would cause the same problems as if you were smoking.

This is recommended for your safety and to promote the best healing possible.

Dr Jacobs

[rrr]

But I am a current smoker. If I could quit for 6 weeks, I would have by now - so it does rule out surgery.

I don't understand, it was not an issue for prior surgeries - they healed just fine.

[Dr. Elliot Jacobs]

As I mentioned, nicotine has a known adverse effect on the micro circulation of the skin.  To be blunt -- it adds risk.

I have had patients who continued to smoke up to the time of their gyne surgery.  I have simply asked them to sign a statement attesting to the fact that they have been cautioned to stop smoking and if they refuse to do so that they are willing to accept certain risks.  And to be truthful, none of these guys have had any serious adverse complications.

Just being careful.

Dr Jacobs

[DrPensler]

I operate on smokers but you need to understand that smoking increases the risk of complications.The specific complications that occur are related to wound healing.A young otherwise healthy smoker can have surgery. As an aside, as you know smoking is bad for you and I try to get patients to stop as a service to their overall health.

[Dr. Schuster]

Smoking would not interfere with correction of gynecomastia, unless the gynecomastia is severe and a mastectomy type of procedure needs to be performed.

[rrr]

Mine has not stabilized yet, so I have no idea what I will end up with. I am currently a pretty solid 34B. At what point does a more involved surgery become needed? If a more radical surgery is required, what downsides does nicotine use have? My recent hernia surgery has healed just fine, so I am curious about the differences between healing in the abdomen versus healing in the chest area. Is it a difference between a "medical" procedure versus a cosmetic procedure?

Thanks

[George Pope, M.D.]

Regarding the smoking, comments made here pertain to any and all surgeries, whether on the chest or on the abdomen or elsewhere.  Smoking around the time of surgery can lead to delay in wound healing and/or tissue loss.  It is really more critical in other surgical procedures that we do where skin is lifted and/or stretched, like in facelift or breast lift surgery.  I agree with the other docs here; I will perform gynecomastia surgery on someone currently smoking, because the risks there are less than the risks of skin loss in a facelift or breast lift, for example.

I'm a little confused about why your gynecomastia hasn't "stabilized" since you're in your 50's.

Dr. Pope, MD

[rrr]

The answer to the stabilization question is: It just started a little over a year ago. I am assuming my free T had been declining (tired more easily, ED getting more common, body hair thinning) and it just reached a point where it triggered an imbalance. All my blood work came back fine other than a free T of 1.1%.

I have worn a 34-36 shirt since my early 20s (it used to be a medium, but now it's a small grrrrr - but I digress), and now they are getting tight  around my chest. In the last 12 months I have gone from puffy nipples to a b-cup, and from what I have read, the entire process can mimic female breast development which can last 3-5 years. If that is true, I have another 2-4 years before it will be stable.

I appreciate all the answers from you and the other doctors here - it's good to hear from experts in the field.

Thanks.

[Dr. Schuster]

The vast majority of the time, gynecomastia begins around the time of puberty and worsens over a few years. Unless you always had gynecomastia and it is worsening now because of weight gain than I would ave a complete workup. Late onset gynecomastia wold most commonly be caused by weight gain or medications. If these don't apply to you than I think a complete workup should be done. This might need to include additional blood work, a good testicular exam (and possible ultrasound) and CT scan if certain lab results are abnormal. A good endocrinologist should be able to help you.

[rrr]

I have already had a full workup with my GP and an endocrinologist - the result is I am in the 25% with no known cause. T, E, liver, thyroid, pituitary, and adrenal functions are all normal (other than low free T %).

I am a normal healthy weight and only weigh 5 lbs more than I did at age 25.

I do not take any medications and never have, yet I am listed as Tanner stage 3.

The doctors say I am a VERY healthy person for my age, so you got me why I am cursed with gynecomastia...

B

[DrPensler]

You have what is referred to as idiopathic gynecomastia. It is quite common in patients who present with gynecomastia.By definition, there is no known cause.

[rrr]

Yes, there's the word I didn't really listen to, since I was expecting a treatable answer :-(

Oh yay, lucky me.

Summer is approaching and I will be unable to go anywhere in a t-shirt. I guess I stay home or only go places I can wear a sweat shirt (air conditioning). Last summer I was merely on my way to an A-cup and my shirts weren't so tight, so I could still do things. Yes, I can always wear over sized shirts (and look stupid with them hanging down like a dress), but even that is limited if they continue to grow. Hence my user name.

The ONLY unhealthy thing I've ever done is smoke cigarettes. I'm healthy as I can be as far as weight, blood pressure, blood sugar, and all chemical tests, yet I get this.

B

[Dr. Schuster]

marijuana can cause gynecomastia - just fyi.

If you get your surgery done in the next month or so you will be looking great for summer. Something to consider if you are so unhappy.

[rrr]

A) It is not yet stable. It could be another 2-4 years before it's stable.

B) I do not have the $5-$10k for surgery.

C) I do not even know if there is a competent surgeon within day trip distance. If there is not, add another $2-$5k for travel and hotels - consults, surgery, and followups.

D) This surgery looks like it can be quite debilitating for several weeks (if it's more than lipo - which mine will be), and then quite uncomfortable for up to 6 weeks with having to wear a compression vest. Since I do not work in air conditioning, the surgery would have to be during cooler weather in any case.

FYI, why would you even mention marijuana when I specifically stated the ONLY unhealthy thing I have done is smoke CIGARETTES?

My only hopes at this point are that it stabilizes sooner rather than later, and stabilizes at a smaller rather than larger size. Once stable, I can seriously contemplate surgery.

B