To leve some gland or not?

[Viking75]

I am about to go to my first consultation in Sweden and would like some help.

The surgent use lipo tohether whith removal of gland for good resoults. I would like to ask you before I ask my dr, if it is best to remove all possible gland behind the areola or just some?

 From this site I belive Dr Bermant removes all gland and somehow fills the cavaty with fat and then sculpter the fat aroud the rest of the chest with lipo for a realy natural look. I dont anderstand how the fat behind the areola stays in place? I have never heard of this in Sweden but perhaps the surgeons does the same thing. If i ask my Dr to do this can I ask him if he is familiar whith this method?

 In sweden I belive the most common way is to leave some of the gland to avoid cavatys. From the few people in swedish forums that talks about this surgery I hear complains about puffy nippols because of it. But most surgeons still wants to keep gland because of the risk of deformation.

One more question! my nipples are a little bit to female long when the areola is contracted. Is this something that is often fixed? And what happens when the areola relaxes and the nipples are just puffy if you correct the problem?

So should I ask for full removal or just let him do his thing? (it could be that he removes all gland to)

[Paa_Paw]

Just as you would not be so bold as to instruct a Michelangelo how to sculpt, remember that your surgeon is a professional sculptor as well

Because the glandular tissue is actually a series of ducts that penetrate the skin it is not possible to remove it all without leaving a crater deformity.

Use great care in selecting your surgeon, then trust your decision and their skill.

[Viking75]

I am always careful not to tell other people how to do their job. My problem is that in Sweden no plastic sergeon does this operation more then maximum perhaps 10 to 20 times a year.

I truly belive most of them are good anyway, but it is hard for a patient like me to select one.
And now when i have decided to go on my first consultation I just wanted to know if there where a standard for this operation and if my surgeon follows it.

I stumbled across this forum and read a lot about Dr Bermant and thougt that perhaps this is the new and best way of doing this operation. But as you say my sureon might do it another way with the same result.

This is truly hard and I just want it overwith.

[DrBermant]

I am about to go to my first consultation in Sweden and would like some help.

The surgent use lipo tohether whith removal of gland for good resoults. I would like to ask you before I ask my dr, if it is best to remove all possible gland behind the areola or just some?

 From this site I belive Dr Bermant removes all gland and somehow fills the cavaty with fat and then sculpter the fat aroud the rest of the chest with lipo for a realy natural look. I dont anderstand how the fat behind the areola stays in place? I have never heard of this in Sweden but perhaps the surgeons does the same thing. If i ask my Dr to do this can I ask him if he is familiar whith this method?

 In sweden I belive the most common way is to leave some of the gland to avoid cavatys. From the few people in swedish forums that talks about this surgery I hear complains about puffy nippols because of it. But most surgeons still wants to keep gland because of the risk of deformation.

So should I ask for full removal or just let him do his thing? (it could be that he removes all gland to)

How to pick your gynecomastia surgeon:
http://www.gynecomastia.org/smf/index.php?topic=16474.0

Each surgeon has his / her own skills and techniques. However, not all methods work to the same degree. If you need to tell a doctor how to perform this operation, then you have picked the wrong doctor. Actually, I do see many Gynecomastia Patients from Europe and around the world who prefer my techniques. It is so much easier performing this sculpture before some other less experienced doctor's misadventure.

Just as you would not be so bold as to instruct a Michelangelo how to sculpt, remember that your surgeon is a professional sculptor as well

Because the glandular tissue is actually a series of ducts that penetrate the skin it is not possible to remove it all without leaving a crater deformity.

Use great care in selecting your surgeon, then trust your decision and their skill.

Gland tends to be firmer than fat and does not compress the same way. Removing as much gland as possible helps minimize recurrence and optimizes how results move. That way when the areola muscles relax or muscles flex, the natural contour is preserved. The true test of how effective a sculpture is that it still looks good from all angles and while playing sports and living life, not just an acceptable contour in selected photos the views of which change from one patient to the next.

My Dynamic Technique does start out targeting gland first. It is starting with the gland sculpture that is the hallmark of my Dynamic Technique that I have been describing for years. While no technique removes every trace of gland, take a look at the sizes of some of the Gynecomastia Glands Removed with this method. The other elements of my artist's pallet then use the remaining tissue to contour the chest. Although I have managed many Crater Deformities from Bad Gynecomastia Surgery done elsewhere, I have never had such a complication for one of my own sculptures.

I am always careful not to tell other people how to do their job. My problem is that in Sweden no plastic sergeon does this operation more then maximum perhaps 10 to 20 times a year.

I truly belive most of them are good anyway, but it is hard for a patient like me to select one.
And now when i have decided to go on my first consultation I just wanted to know if there where a standard for this operation and if my surgeon follows it.

I stumbled across this forum and read a lot about Dr Bermant and thougt that perhaps this is the new and best way of doing this operation. But as you say my sureon might do it another way with the same result.

This is truly hard and I just want it overwith.

I work with up to 8 gynecomastia patients a day and have been doing this sculpture for decades. Perhaps that is why patients chose to travel for my work. Our Preliminary Remote Discussion is how our patients typically start to minimize travel to Virginia.

Hope this helps,

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

[Dr. Elliot Jacobs]

I take a different approach.

Men who do not have gyne still have some gland behind their areolas -- it is just not too thick.  That is the way Mother Nature designed us.

When I do gyne sugery, I also do a combination of aggressive lipo as well as gland excision.  However, I thin the gland, leaving some gland tissue behind the areola to prevent cratering.  Remember, this is not a cancer operation in which you have to remove every cell of breast tissue.  In essence, when I am completed with my operation, I believe I have replicated nature, leaving a smooth and contoured chest with just enough gland under the areola to make it look natural.

Dr Jacobs

[Viking75]

I have called 3 more clinics in Sweden and asked if they do this surgery on regular basis. among these clinica is one among the largest privat clinics in Europe. I will probably go to consultation to 1 or 2 of them. They do operate gynecomastia about 10-20 a year max. I will look carefully at their pictures and ask a lot of questions but if I am not sure I will have to wait för the operation.

The good thing is that I have checked the doctors, and they are considerd the best plastic surgeons in Sweden and are members in the right places and have very few complaints to the healt board in Sweden

I have talked to my family about traveling to US for the surgery. The way things are now its not possible for me.

[DrBermant]

I have called 3 more clinics in Sweden and asked if they do this surgery on regular basis. among these clinica is one among the largest privat clinics in Europe. I will probably go to consultation to 1 or 2 of them. They do operate gynecomastia about 10-20 a year max. I will look carefully at their pictures and ask a lot of questions but if I am not sure I will have to wait för the operation.

The good thing is that I have checked the doctors, and they are considerd the best plastic surgeons in Sweden and are members in the right places and have very few complaints to the healt board in Sweden

I have talked to my family about traveling to US for the surgery. The way things are now its not possible for me.

I work with up to 8 gynecomastia patients a day. Here is my new resource explaining the Anatomy of Puffy Nipple Complication After Gynecomastia Surgery. It explains why targeting gland first is so important when you care how tissues look while doing activities.

I just reviewed my past few years of experiences of patients unhappy after other surgeons' gynecomastia surgery. There were over 500 patients asking for my help, many with residual puffy nipples. That is why surgeon selection is so critical.

Good luck with your consultations.

Hope this helps,

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

[Viking75]

Dr Bermant. I am greatful for your help and have read almost everything on website and learnd so much. If I have doubts I will not have surgery and wait and contact you later on.
By the way I have posted some pictures under Users photo

[DrBermant]

Dr Bermant. I am greatful for your help and have read almost everything on website and learnd so much. If I have doubts I will not have surgery and wait and contact you later on.
By the way I have posted some pictures under Users photo

That Anatomy page is brand new, I just uploaded it today. Thank you for your kind words about my resources I built on the internet. Again good luck on your consults.

Hope this helps,

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

[Viking75]

First consultation did not go well! Not a single photo to show! They perform the operation every 2 mounth. I didnt get to see the surgeon but a nurce. Let me tell you that I am a bit dissapointed. 2 more Swedish consultations left!

[DrBermant]

First consultation did not go well! Not a single photo to show! They perform the operation every 2 mounth. I didnt get to see the surgeon but a nurce. Let me tell you that I am a bit dissapointed. 2 more Swedish consultations left!

That is why I prefer to post many examples of my sculpture skills on my website such as my Gynecomastia Gallery of Before and After Surgery Pictures. (This gallery is only a subset of what is on my site). That way patients do not need to wait until they come into my office to find out what my techniques have to offer. My consultations are with me, not a nurse. Each doctor has their own ways to manage their practice.

Good luck on your search!

Hope this helps,

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

[Dr. Cruise]

Your best advice is to go to a Plastic Surgeon who has significant experience with gynecomastia surgery. Plastic Surgeons are like anyone else they learn through experience. I would certainly express my preferences to the surgeon, but I wouldn't tell him how to do the procedure. Doing something new may lead to poor results as there is always a learning curve with any surgery.

Personally I remove the vast majority of the gland, but this has much to do with patient preference. Often the gland encroaches directly upon the areola, therefore removing all gland would create a crater deformity. Every patient is different. This is why experience is so important.