Is it likely that I'd need to get surgery again?

[Alt Solution]

I'm planning on getting surgery for my gynecomastia, but I hate the idea of paying for the surgery only to have to get another one.  All I know is that some people's gyne comes back after surgery, and thus would need a second one.  That's all I know.  I don't know how likely it is or anything.

My main question would be this: IF the cause of gynecomastia is no longer in the equasion, will the gyne still come back?

It would also help to know what the cause is.  Is it usually just a hormonal imballance during puberty, or is it other things too? I heard eating certain things can cause it.  I also heard that meds can cause it too.  I took anxiety meds as a teen (I think it was Celexa), but was off it for a long time, and never noticed my chest looking better.  After taking nothing for a few years, I now take Luvox, which isn't quite like Celexa.

As far as I know, my chest has been the same for as long as I can remember.

Last question: Can a doctor check my hormone levels to make sure it's as it should be? It'd help to know that before getting surgery.

I'd really appreciate any information you can give me. 

[Squish33]

Hey man

Firstly, I have seen in a few vids and read in a few places that it practically never comes back of course they can't 100% claim that it won't. The cases you probably hear of is if it was psuedo gyno (fat) and you simply put on weight again.

I also took anxiety meds (Zoloft) from the age of 13/14ish and strangely that's when my gyno kicked in aswell? Havn't used in 4-5 years tho hmmmmm

I had my testosterone levels checked out of curiosity a few months ago (simple blood test) before I seen any plastic surgeons and turns out I was in the 'normal range'.
I hear orange coloured veggies such as carrot and sweet potato can naturally increase testosterone levels. But I think maybe pumping some iron and going fishing maybe the best solution

Good luck! My operation is in 2 days so I'm very nervous/ excited.

[Raider Fan]

Welcome to gyne.org, Alt Solution. 

No one can say what the future holds when talking gyne surgery, but the odds are with you.  Assuming you go to a very experienced board certified plastic surgeon and get good quality surgery right off the bat, then in all probability, you won't be needing anymore surgery. 

What would make it MORE likely to need surgery again?  One thing has already been mentioned....gaining too much weight.  Also, certain meds have been associated with gynecomastia, and if you take them, you could begin to grow again.  Of course, the main thing to stay off of would be the steroids.  But the main thing you need to make sure of prior to having surgery is that your gyne is STABLE.....as in, make sure it has been the same for at least several months (i.e, no growth/swelling/tenderness) prior to surgery.  If someone with active (growing) gynecomastia has surgery too soon, then the tissue will continue to be stimulated after surgery and growth can return.  Then, you've wasted all the time, money and trouble you went to.  So you want to make sure that your condition is stable before considering surgery. 

As far as the anti-depressants you listed, I don't believe I've ever read anything that says those types of meds increase gynecomastia. 

Sure, a doctor can check your hormone levels, and they probably need to be checked prior to surgery.  Your family physician should be willing to do all the usual blood tests when it comes to looking at hormone levels, however, some docs don't feel comfortable doing it and may want to send you to a specialist that deals with such matters (endocrinologist). 

[jojo82]

This is why it's NECESSARY to see an endocrinologist BEFORE seeing a plastic surgeon! It should be malpractice to perform gyne surgery on a man who hasn't had his testosterone/estrogen levels checked. It is absolutely possible to have regrowth if your hormone levels are out of balance because even the most invasive incisions do not remove all gland.

[Paa_Paw]

Sorry jojo,
But I think you are a bit out of line.

The surgeon cannot be blamed for a patients lack of patience.

Surgery for Gynecomastia is purely elective. Well usually. I bet the surgeons here cannot tally up more than a few cases where there was actual breast pathology that caused the Gynecomastia.

To complicate matters further, people intentionally hide things that should be in their medical history.

If a person is totally honest with their surgeon, the surgeon should be able to make a reasonable evaluation without consulting an Endocrinologist in a high percentage of the cases. Any that are questionable should be referred, obviously.

As patients, we need to take some responsibility for our treatment and we owe it to ourselves to be informed.

If you are thinking of a malpractice case you might hope that I'm not on the jury.

[DrBermant]

This is why it's NECESSARY to see an endocrinologist BEFORE seeing a plastic surgeon! It should be malpractice to perform gyne surgery on a man who hasn't had his testosterone/estrogen levels checked. It is absolutely possible to have regrowth if your hormone levels are out of balance because even the most invasive incisions do not remove all gland.

Actually that is not correct. Over the years many Endocrinologists worked with me to develop my Red Flag System of just which patients should be evaluated before surgery. Sending everyone is too expensive and the yield become prohibitively small. The methodology was very well received at a recent national meeting of Endocrinologists that I was invited to lecture at as "Ask the Expert."  Yet, I have seen patients with recurrence from other doctors who never bothered to perform the screening we perform in my office. Surgery on such patients without evaluation is not appropriate medical care.

You are correct that no surgery can remove all traces of gland as I have said here on this forum for years: shreds of gland remain behind with any surgeon's technique.

Sorry jojo,
But I think you are a bit out line.

The surgeon cannot be blamed for a patients lack of patience.

Surgery for Gynecomastia is purely elective. Well usually. I bet the surgeons here cannot tally up more than a few cases where there was actual breast pathology that caused the Gynecomastia.

To complicate matters further, people intentionally hide things that should be in their medical history.

If a person is totally honest with their surgeon, the surgeon should be able to make a reasonable evaluation without consulting an Endocrinologist in a high percentage of the cases. Any that are questionable should be referred, obviously.

As patients, we need to take some responsibility for our treatment and we owe it to ourselves to be informed.

If you are thinking of a malpractice case you might hope that I'm not on the jury.

As usual, you are right on target except for one point. My practice tends to collect many patients with actual breast pathology. Regrowth after other surgeons' surgery, hypogonadism, undiagnosed congenital adrenal hyperplasia, Thyroid issues, Pituitary tumors, undiagnosed Klinefelter Syndrome patients, chemical spills contaminating the body in hormones, bodybuilders on anabolic steroids, seem to find me on a regular basis. I have only put up a small percentage of such unusual cases on my site. But all of those patients and others that got flagged during my evaluation, then went on for that Endocrinologist's evaluation. Sometimes that evaluation by the Endocrinologist can be quite a challenge and some patients need a tertiary specialist Endocrinologist to help discover the underlying issues.

About the patient themselves needing to take part in the process, that is right to the point. Give your doctor all of the details to be able to make an accurate evaluation.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[DrBermant]

I'm planning on getting surgery for my gynecomastia, but I hate the idea of paying for the surgery only to have to get another one.  All I know is that some people's gyne comes back after surgery, and thus would need a second one.  That's all I know.  I don't know how likely it is or anything.

My main question would be this: IF the cause of gynecomastia is no longer in the equasion, will the gyne still come back?

It would also help to know what the cause is.  Is it usually just a hormonal imballance during puberty, or is it other things too? I heard eating certain things can cause it.  I also heard that meds can cause it too.  I took anxiety meds as a teen (I think it was Celexa), but was off it for a long time, and never noticed my chest looking better.  After taking nothing for a few years, I now take Luvox, which isn't quite like Celexa.

As far as I know, my chest has been the same for as long as I can remember.

Last question: Can a doctor check my hormone levels to make sure it's as it should be? It'd help to know that before getting surgery.

I'd really appreciate any information you can give me. 

Surgery does not prevent gynecomastia from recurring. You can find my detailed explanation about this topic by searching this forum with "Bermant Gynecomastia Recurrence." There are many examples and details about why working on stable gynecomastia is such a critical issue, yet why no surgeon can safely say that the problem will never recur. I have seen too many cases of recurrence when surgery was done by other doctors on patients with unstable hormone situations or cases where a patient developed problems that made gland grow again years after surgery.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[amethyst tint]

This may sound like an obvious question, but at what point can I be confident that my condition is sufficiently stable for surgery?

I've had gyne for 6.5 months, my hormone levels are normal, and my condition seems to be more or less unchanged over the last 3-4 months (I think there were some minor changes in the first couple of months after the triggering event).

However, I can't say for sure that there have been *no* changes over the last few months. Sometimes I get paranoid that there has been some additional (if very slight) growth. And while the initial achiness has mostly subsided, I can "feel" my chest occasionally, sometimes as a slight ache or discomfort.

I've been taking photos every month or two, but it's not always easy to tell if there have been changes.

[DrBermant]

This may sound like an obvious question, but at what point can I be confident that my condition is sufficiently stable for surgery?

I've had gyne for 6.5 months, my hormone levels are normal, and my condition seems to be more or less unchanged over the last 3-4 months (I think there were some minor changes in the first couple of months after the triggering event).

However, I can't say for sure that there have been *no* changes over the last few months. Sometimes I get paranoid that there has been some additional (if very slight) growth. And while the initial achiness has mostly subsided, I can "feel" my chest occasionally, sometimes as a slight ache or discomfort.

I've been taking photos every month or two, but it's not always easy to tell if there have been changes.

That is something I help my patients explore during their consultation. I vary my suggestion based on many factors learned during this process. Forum postings are insufficient basis to make a valid clinical recommendation.

Patient education is key to successful surgery. Issues like when to operate and risks of recurrence are components of good patient education which we pride ourselves starting on my website, continuing during the consultation, and then during after care.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Paa_Paw]

Doctor B.

I stand corrected. But I suspect your reputation attracts a higher than average number of cases involving pathology.

I have found the degree of care and understanding exhibited by the Doctors who frequent this site is impressive. That says a lot considering that  I've been around long enough that I'm no longer easily impressed.

[DrBermant]

Doctor B.

I stand corrected. But I suspect your reputation attracts a higher than average number of cases involving pathology.

I have found the degree of care and understanding exhibited by the Doctors who frequent this site is impressive. That says a lot considering that  I've been around long enough that I'm no longer easily impressed.

Thank you for your kind words.

I do take pride in my surgical sculpture. That means, in the case of gynecomastia, trying to get to a stable problem first before jumping the gun to rush to the operating room. Unfortunately, I frequently find patients with Red Flag symptoms needing Endocrinology stabilization had already been offered surgery by other doctors they saw first. Yet other patients with regrowth after surgery done elsewhere, no attempt at diagnosis nor stabilization. My years of trying to educate the public on this critical issue by posting in forums like this one may attract such pathology to my practice. For fun try a search here:

https://www.gynecomastia.org/smf/index.php?action=search

Set the
  oldest topics first
  show as messages
put in the search field
  Bermant Recurrence

to see the difference in current postings set for
  most recent first

The search tool here is a very neat way to see the history of a particular subject and follow a particular topic here in the forum.

Again thank you for the comment,

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[mikey1984]

I noticed my gyne when I was about 15 or 16 over the years it did bother me....I waited until I was 21 to have surgery. I talked to my family doctor about it and we did do some blood work to check hormones and such....They also sent me to an endocrinologists to have everything checked...All of my hormone levels checked out in the normal range but it was explained to me that during puberty my hormones could have been out of whack and at that time my estrogen levels may have been higher and testosterone levels lower. I then consulted with my plastic surgeon Ram Kalus in Columbia, SC and he felt like I would be ok to go ahead with surgery. I had my surgery October 18th 2005 and to this day I have never had any regrowth. I have never been happier and felt so confident. The main thing I suggest is know your plastic surgeon!!!! I have seen some butchers out there! I saw 3 plastics surgeons before I decided who I was going to use. Ask to see pictures of previous patients. They should be willing to do that and if they don't run!   

[DrBermant]

I noticed my gyne when I was about 15 or 16 over the years it did bother me....I waited until I was 21 to have surgery. I talked to my family doctor about it and we did do some blood work to check hormones and such....They also sent me to an endocrinologists to have everything checked...All of my hormone levels checked out in the normal range but it was explained to me that during puberty my hormones could have been out of whack and at that time my estrogen levels may have been higher and testosterone levels lower. I then consulted with my plastic surgeon and he felt like I would be ok to go ahead with surgery. I had my surgery October 18th 2005 and to this day I have never had any regrowth. I have never been happier and felt so confident. The main thing I suggest is know your plastic surgeon!!!! I have seen some butchers out there! I saw 3 plastics surgeons before I decided who I was going to use. Ask to see pictures of previous patients. They should be willing to do that and if they don't run!   

Even better, look for a surgeon who demonstrates his / her skills with many before after pictures (many views, not just one or 2 for each patient) on the web. It is so much easier checking out a doctor's sculpture skills before paying for a consultation!

Remember, it is also critical to understand how a doctor's results move. What may look OK in a limited set of photos, can look really mediocre or terrible on a complete set of views, flexing muscles, and in animation.

Yes, when working with an unstable hormone issue, an endocrinology evaluation is critical. The many cases of regrowth after surgery I have seen have been on patients with unstable conditions not worked up by other doctors. That is why it is also important to give your doctor an honest accurate history about the condition. That also can result in regrowth when you blindside your doctor without the details asked about.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[BodyBuildKid213]

Hey I have seen your name on countless sites while looking for a surgeon. I'm in St. Louis so I'm choosing a doctor here. But I definitely had a question I wanted to ask you.
My gynecomastia came in a very embarrassing situation where I did not read at all what I was buying. Just looking for a muscle enhancer and didn't pay attention to the ingredients whatsoever (learned my lesson) and all in all came to find out after realizing my chest was growing how I did not want it to decided to see what this enhancing product was. Come to find out it is not a muscle enhancing product whatsoever, its an overloaded breast enhancer cream.
Used it for maybe 10 days till I noticed what was happening. Contacted the company they claim great diet, and workout would be sufficient to minimize and even possibly get rid of any tissue growth due to lack of time of use. I used it from december 9th-19th
I work out 7 days a week, in great shape, and diet has always been high protein, low carb, fiber, the works. I take high pride in my body and now am embarrassed to take my shirt off.
It isn't bad by any means, definitely noticeable though without an undershirt to compress.
Question is in the 3 month span, even though there has been absolutely no change far as growth since I stopped, would the glands/tissue still be stimulated by such product to where growth would re occur? Would something like that change my hormone levels and be necessary to see an endo? Plus would I need to see my personal dr. to get a slip to an endo? I've been to him 3x already in this time span and just feel like I'm a bother now.
Anyways, I did endless research to try to jump in and fix the problem researched studied on surgeons in my area and found one I am in agreement with and have a consultation in april. Planning on setting the date for surgery in July or August (intentions are to join the military in october so want it done by then) question is again, do you think this is too early for surgery? I want it gone 100% and have my normal flat sculpted chest again but definitely do not want to spend 5-7k just to have the breast effect come back again.
Love to get your opinion on when a stable period could be considered and thoughts.

[DrBermant]

Hey I have seen your name on countless sites while looking for a surgeon. I'm in St. Louis so I'm choosing a doctor here. But I definitely had a question I wanted to ask you.
My gynecomastia came in a very embarrassing situation where I did not read at all what I was buying. Just looking for a muscle enhancer and didn't pay attention to the ingredients whatsoever (learned my lesson) and all in all came to find out after realizing my chest was growing how I did not want it to decided to see what this enhancing product was. Come to find out it is not a muscle enhancing product whatsoever, its an overloaded breast enhancer cream.
Used it for maybe 10 days till I noticed what was happening. Contacted the company they claim great diet, and workout would be sufficient to minimize and even possibly get rid of any tissue growth due to lack of time of use. I used it from december 9th-19th
I work out 7 days a week, in great shape, and diet has always been high protein, low carb, fiber, the works. I take high pride in my body and now am embarrassed to take my shirt off.
It isn't bad by any means, definitely noticeable though without an undershirt to compress.
Question is in the 3 month span, even though there has been absolutely no change far as growth since I stopped, would the glands/tissue still be stimulated by such product to where growth would re occur? Would something like that change my hormone levels and be necessary to see an endo? Plus would I need to see my personal dr. to get a slip to an endo? I've been to him 3x already in this time span and just feel like I'm a bother now.
Anyways, I did endless research to try to jump in and fix the problem researched studied on surgeons in my area and found one I am in agreement with and have a consultation in april. Planning on setting the date for surgery in July or August (intentions are to join the military in october so want it done by then) question is again, do you think this is too early for surgery? I want it gone 100% and have my normal flat sculpted chest again but definitely do not want to spend 5-7k just to have the breast effect come back again.
Love to get your opinion on when a stable period could be considered and thoughts.

Actually I see many patients from Missouri and around the world who prefer my techniques. Most start out with our preliminary remote discussion to minimize travel and start the education process early. This is especially critical when there is an underlying issue needing stabilization and possible Endocrinology evaluation. Check out my Red Flag System about such issues.

I prefer to individually evaluate each patient and problem to establish time needed for stability before considering surgery. Some problems are transient and a limited time is appropriate. Others need more time for the situation to stabilize. Jumping into surgery too soon is a sure formula for disaster and recurrence. I have seen so many such examples from patients unhappy after other doctors' surgery done without a careful look at this issue. Check out:

https://www.gynecomastia.org/smf/index.php?topic=20885.msg142015;topicseen#msg142015

where I discuss many such examples I have seen. The main point is that surgery does not prevent recurrence. Getting the problem stable first is the most critical factor.

Specific advice given on forums can also establishes a doctor patient relationship, that is why my answers here and in other venues has to be generic. So if you are looking for my specific advice, Jane is my office manager, and can explain the process.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737