hormone question

[robos111]

I wanted to check myhormone level prior to booking surgery. My family doc says that he has to check it himself. Will his results be sufficient for determining if this will be a future post surgery issue?
thanks

[Dr. Elliot Jacobs]

The vast majority of men with gynecomastia saw it begin sometime around puberty.  If the gyne has been stable for over two years or more, one is usually a candidate for surgery.  And for these patients, it is usually not necessary to go through hormone testing.

I usually restrict hormone testing to patients in which I have some questions:  has it started recently (in an adult), is it one-sided, is there tingling/pain/tenderness, etc?  In essence, is something going on?

If you are simply curious about your hormone status, then by all means do the tests.  But if you are looking for a cause for your gyne and you have been stable for years, then your hormone levels will probably not be the answer.

Dr Jacobs

[robos111]

I'm a little confused? I just don't want it to grow back post surgery. I already had lipo 10 years ago and it did not fix. Now I want to try removal of gland and don't want it to re-grow?

[Dr. Elliot Jacobs]

Your "re-growth" may not be breast tissue.  If you had lipo alone, it may/probably have left some residual gland under the areola.  Or, you may have some scar tissue present, which mimics new breast growth. Or both.

I am not saying that you shouldn't have your hormones checked -- but in my large experience, I have never seen re-growth of breast tissue after adequate removal at the first operation.

If it makes you feel better, then certainly check your hormones.

Dr Jacobs

[DrBermant]

I wanted to check myhormone level prior to booking surgery. My family doc says that he has to check it himself. Will his results be sufficient for determining if this will be a future post surgery issue?
thanks

Hormone testing is not needed for most stable gynecomastia patients. With the help of endocrinologists over many years, I have evolved a Red Flag system of Gynecomastia Symptoms.  This methodology was received well during my invited Gynecomastia lecture at the American Association Of Clinical Endocrinologists national meeting recently. It sets a balance between testing every patient and no testing. Such testing is best done under the direction of an experienced Endocrinologist, a doctor who specializes in the body system of hormones. While general practitioners have to deal with many different problems, specialists have extra expertise. It would be something like having a general surgeon perform gynecomastia surgery. Unfortunately, I have seen too many disasters from General Surgeons performing gynecomastia surgery.  For my patients with a positive Red Flag, I ask for the analysis by an Endocrinologist, a much better choice.

I'm a little confused? I just don't want it to grow back post surgery. I already had lipo 10 years ago and it did not fix. Now I want to try removal of gland and don't want it to re-grow?

I caution each of my patients that surgery does not typically stop male breast growth.  If there is a problem with growing breasts, recurrence can happen.  Any of these medical problems and or these medications can cause gynecomastia. So, if you want to get worried about regrowth, you could get yourself evaluated for each of these conditions to see if they could be a factor. 

If you are using something that can stimulate breast regrowth, shreds of gland remain behind with any surgical technique.  It is just not practical to remove all elements of gland.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest. Take a look at the Anatomy of Gynecomastia to see what I mean.  Even with a radical mastectomy (a disfiguring technique used for some male breast cancer problems), some gland can remain.  Surgery also does not prevent weight gain in the chest.  Men tend to put weight on the belly and chest regions.  I educate each of my patients that this surgery will not prevent further breast growth.  It is like changing/fixing a tire with a nail.  Fixing/changing the tire will not prevent you from getting a new nail in that tire.

Regrowth of gland from stimulation can occur where shreds of gland remain behind. This can be behind the areola, along the deeper edges or margins of a zone of excision. 

I take care of many patients with gynecomastia, as many as 8 in one day alone.  With all the gynecomastia surgery I have done, it is very rare to have regrowth for patients I have sculpted.  One patient (who had surgery on only side by another doctor) came to me with pro hormone induced gynecomastia that only came back on the side that had no surgery.  His growth was massive on the one side and none on the other.  His surgery by that other doctor had left a massive crater - the skin was adherent against the chest wall with normal fat surrounding the ugly deformity.  One side looked like the deformity seen here.  The other side was almost a B cup breast so tender that I could barely examine it.  As with each patient who presented to me with current breast growth, he was referred for an endocrinology evaluation and stabilization before considering surgery.  I do not know if such radical surgery was a factor or not.   Even if it did, removing all fat under the skin just gives an unnatural look.

Here is another example of Gynecomastia Breast Regrowth on my site.  Caution this is a graphic picture of the massive gland regrowth removed on the operating table.

This patient is rather unusual. He was a misdiagnosed genetic female who has lived his entire life as a male.  His birth certificate says male as does his driver's license. Yes, a terrible mistake labeling him male made from birth and early on not recognizing his Congenital Adrenal Hyperplasia.  His body has been exposed to high levels of androgens and estrogen since within his mother's womb. This results in an a condition better called Intersex than the older phrase Hermaphroditism.

I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and my Red Flag Evaluation System before surgery, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention and stabilizing the problem(s) causing gynecomastia, when possible, is much better. We help patients explore such issues during consultations or preliminary remote discussions.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[robos111]

Thanks for your responses.
My concern is that my GP is saying that he is able to check my hormones exclusively and that he sees no need to refer me to an endocrinologist. He has sent for my overall testosterone check.
This concerns me if there are limitations with his check.
As I mentioned, I had lipo only 10 yrs ago and it did not really do anything to resolve my problem.

Will the results that I get back for the testosterone be sufficient from the GP to see if there are any "red flags" as you mentioned prior to surgery?

thanks,
Robos

[DrBermant]

Thanks for your responses.
My concern is that my GP is saying that he is able to check my hormones exclusively and that he sees no need to refer me to an endocrinologist. He has sent for my overall testosterone check.
This concerns me if there are limitations with his check.
As I mentioned, I had lipo only 10 yrs ago and it did not really do anything to resolve my problem.

Will the results that I get back for the testosterone be sufficient from the GP to see if there are any "red flags" as you mentioned prior to surgery?

thanks,
Robos

When I perform my patients' evaluation, if there are concerns that I want evaluated, I prefer not to operate until that patient has been evaluated by an Endocrinologist. Some GP's are trying to control the cost of medical care which is admirable. Unfortunately, this in my opinion, is not enough for someone with problem needing stabilization before surgery. There are many conditions that can cause gland growth with a normal testosterone level. That is why I ask for the specialist's opinion.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[robos111]

yes, thanks

[Grandpa Bambu]

robos,

When did you first notice your G, and how old are you now?

Do you have any recent pics posted?

GB...

[robos111]

I first noticed the gynecomastia at about age 14/15. I am 38 yrs old now. I had lipo 10 yrs ago and it did little or nothing. I want to get gland removal now and have a concern that it may come back.
thanks,
Robos

[Paa_Paw]

There are a few things that come to mind that would be reason for the tests to need to be ordered by your primary care physician.

Some states require that diagnostic tests be ordered by and/or be reported to a physician. The intent would seem to be to prevent self diagnosis and treatment which is inappropriate.

Another possibility might be stipulations in your medical insurance that a provisional diagnosis be made by the primary care physician prior to making a referral. Some tests, that can be quite expensive, are sometimes used for screening when the symptoms do not really warrant the costs of the tests. Insurance companies naturally want to limit excessive unwarranted costs so some tests to cases only where symptoms indicate that the tests would actually be of value.

Having the primary care Dr. order the tests initially will not hurt anything. If you have asked for tests which the doctor is reluctant to order because there is little or no evidence that the tests will be of value, you may still get the tests done but you'd most likely have to pay cash up front.