Weightloss before surgery (Dutch healthcare rules)

[mike80]

Hi there doctors,

I have pseudo-gyno since my puberty when I started to gain a lot of weight. I am 39 years old, 1.83m and since I was 21 my weight is pretty constant between 115 and 120kg (BMI around 35). I have diagnosed pseudogynecomastia, probably grade 3.

When I was 14 my parents took me to a doctor who was checking my breasts out so the awareness started there. Since I got teased for it at the pool with 16 I was now pretty aware of it and suffering from emotional problems. It also prohibits me from visiting the pool, was a big contributor to stress and anxiety which didn't help with health and weight control. Needles to say that this has impacted my life way too long.

It is not like I did not try to get help, but here in the Netherlands there seems to be a rule, that if your BMI is over 30 surgeons will not operate. Over the years (starting when I was 22) I had 3 consults and all of them tell me first I qualify based on physical examination, but when it comes to the pre-surgery prep and they calculate my BMI they just cancel everything, citing the rule that they will not operate on gynecomastia if the BMI is over 30. I went to a doctor in Belgium who was willing to operate but I cancelled after I heard he had bad aftercare. I talked to some doctors in Germany but didn't yet plan to go since most of them seem to specialize in female breasts and they don't seem to know what I am talking about.

Since end of last year I started to change my life, reducing stress, improving sleep, changing my diet and increasing sports. So far, this hasn't resulted in any significant weight loss, which is fine for me since I see my vitals improve (heart rate variability and VO2 Max increasing significantly). However, a major part of stress and a huge blocking part is the gyno.

I really would appreciate some expert oppinions on the following:

• Is there any scientific merit to the BMI > 30 rule?
• Could it have a negative impact if I have a gyno operation now?
• Do you have experience with doing multiple steps (i.e. doing some lipo first and after significant weightloss a bigger operation)?

Sorry for the long post and I am looking forward to any questions, facts, opinions.

Thank you.

Mike

[Dr. Elliot Jacobs]

It is, of course, ideal to have a BMI of 30 or less.  And many surgeons adhere to that idea.  However, it is not written in stone.  Many guys just can't drop the weight and would be content with a reduction in the size of their gyne.  

I often operate on guys with BMI's slightly higher than 30.  However, one must realize that properly done gyne surgery will reduce the tissue on the chest so that it is similar to surrounding areas of the body.  Otherwise, you would be paper thin on the chest and the rest of your body would be a bit chunky -- and certainly this would not look good.  

Bottom line is that you must realize that with a BMI of 35, you are not an ideal candidate and any gyne surgery performed on you at that weight will improve the situation -- but not provide you with the taut, chiseled chest that you might imagine and desire.  In essence, you have to be realistic about anticipated results.

Dr Jacobs

[Dr. Schuster]

Correction of gynecomastia deals with not only the removal of the excess gland and/or fat but also the extra skin. Losing large amounts of weight generally end up resulting in some loose or sagging skin. I would recommend getting down to a weight that you can maintain before the surgery. Otherwise if you lose a lot of weight after the sugery you might end up with some sagging which otherwise could have been dealt with had you waited. I am not aware of any study that states an improved outcome if your BMI is a certain number. Having a high BMI however can place you at higher risk of other complications such as delayed healing, DVT and possible breathing problems.