Holes or Cratering?

[unilateral]

Hi all,

I have unilateral gland only gyne, which I have had for the last 8-10 years (now early 20's).

The gland itself is probably 1/2" thick at about 1x2" extending from the nipple inwards. Because it has been there so long slowly changing over time, it doesn't protrude the surface of the pectoral muscle shape, only causing the nipple to protrude. I have had enough of taping my nipple down to hide the protrusion, and would like to get the gland excised.

However, I am concerned I will wind up with a massive hole post surgery. Will the muscle adapt to fill the space? or must it be filled during surgery? What is it filled with?

Any idea how the unilateral surgery will affect the expense of the surgery 2/3rd cost of both sides?

[Grandpa Bambu]

However, I am concerned I will wind up with a massive hole post surgery. Will the muscle adapt to fill the space? or must it be filled during surgery? What is it filled with?

With todays GRS techniques and highly skilled surgeons, 'massive' concavities are very rare...

Do your homework and choose a PS who performs GRS regularly and has good credentials...

GB

[deftone]

I kind of have the same problem,bro! I would think Dr. Bermant is a good choice  for this kind of problem.

This is off his sight:Surgical Details of Fat Flap Sculpture for Gynecomastia
Dr. Bermant prefers a dynamic technique to sculpt the male chest when dealing with gynecomastia. Glandular tissue removed by excision can leave a significant defect: a crater with surrounding walls of fat. Liposuction alone or excision with liposuction manage most problems. At other times, loose fat can be sculpted into the defect with sutures. Sometimes there is just too large a gland compared to the amount of easily movable fat. Just what is needed can vary from patient to patient, and from breast to breast.

Improvisation is the artistry of surgical sculpture.
One of the many tools he may use involves moving vascularized fat to fill in significant defects after gland excision. Instead of removing the fat walls with liposuction, Dr. Bermant sometimes moves parts of the wall to fill the cavity. Fat needs a blood supply to survive. Trying to keep a blood supply to the fat can be tricky. A fat graft (transferred tissue without a vascular supply) must regain new blood source from surrounding tissue. A fat flap is attached to the body by blood vessels. Chest fat gets its blood supply from tiny vessels of the skin above and the muscles below. Fat flaps are held in place with sutures

Heres the link:http://www.plasticsurgery4u.com/procedure_folder/male_breast/fat_flap_sculpture.html

[Dr. Elliot Jacobs]

It has been my experience that oftentimes, when a patient sees one breast much larger than the other, that he will concentrate on the larger breast only.  Often there is some excess breast tissue on the "normal" side as well.  Early in my career, I operated only on the larger side and tried to make it the same as the "normal" side.  This is very difficult!  I frequently ended up with a terrific looking post-op result on one side, which then made the patient aware that indeed there was some excess tissue on the "normal" side which should have been addressed at the same time.

At present, even when confronted with a patient's complaint of unilateral gynecomastia, I will examine the "normal" side as well and if I find excess tissue, I will recommend surgery on both sides.  It is easier to make both sides "perfect" than to try to match the much larger side to the smaller side.

This points out the necessity of proper examination by a surgeon in order to choose the best course of treatment.

Elliot Jacobs, MD, FACS

[MSJ108]

However, I am concerned I will wind up with a massive hole post surgery. Will the muscle adapt to fill the space? or must it be filled during surgery? What is it filled with?

With todays GRS techniques and highly skilled surgeons, 'massive' concavities are very rare...

Do your homework and choose a PS who performs GRS regularly and has good credentials...

GB

Amen to that

[MSJ108]

Oh I would like to add that if you do have some cratering they can take fat from other areas and inject it into the area. This can fix the issue if it occurs

[unilateral]

Thanks everyone and especially Dr Jacobs.

Had the consultation with my surgeon today, very happy with the discussions both +ve and -ve re the operation. No sugar coating of the situation, despite me playing "dumb" at the start.

The "normal" side has apparently only 2-3mm depth of breast tissue gland (from ultrasound), which apparently is within the normal range.
I discussed this in detail with the surgeon and he recommended leaving this side as is.

I am happy enough with this side, it is normal in appearance. My body seems to keloid scar readily, which leads me to believe I may be better off leaving this side as is? opinions please?

The offending side is as expected, requiring filling of the cavity left by the gland, with little to no fat b/n the gland and muscle.

For reference of other Brisbane Aussies, performed in hospital, $1000 out of pocket after Medicare and Private Health.