Scheduled for surgery with Dr. Pope on Sep 15....

[letsfixthis]

Dr. Michael Bermant claimed to have a zero revision rate with gynecomastia patients due to his dynamic technique and fat flaps to prevent creator deformation and nipple depression.

Regardless of cost, surgery should be avoided at all cost. I have had to push myself for years to even consider such a drastic measure. I certainly would not want to have to do it twice in a year because a surgeon is not confident with their abilities and never removes correct amount of gland/fat.

I want this to be a one time thing and be done with it.

I wish some doctors would learn from mistake and improve their abilities with time but unfortunately I see certain doctors continue to make the same mistakes over and over.

Its like with a marriage, you can't really change someone.

[Dr. Elliot Jacobs]

Dr. Michael Bermant claimed to have a zero revision rate with gynecomastia patients due to his dynamic technique and fat flaps to prevent creator deformation and nipple depression.

If a surgeon is busy enough, he will eventually need to do some revisions -- that is inevitable.  Some surgeons simply fail to see or honestly acknowledge the need for a revision.  I have revised a number of Dr Bermant's cases -- 'nuf said.

Dr Jacobs

[letsfixthis]

Dr. Michael Bermant claimed to have a zero revision rate with gynecomastia patients due to his dynamic technique and fat flaps to prevent creator deformation and nipple depression.

If a surgeon is busy enough, he will eventually need to do some revisions -- that is inevitable.  Some surgeons simply fail to see or honestly acknowledge the need for a revision.  I have revised a number of Dr Bermant's cases -- 'nuf said.

Dr Jacobs

Were the revised cases due to nipple depression/creator deformity, asymmetrical appearance or simple to remove a little additional fat?

If I remember right, Dr. Bermant had a philosophy of leaving a small amount of fat behind on purpose so the skin was not up against the muscle. Something about how the chest would look while the person was running or in motion. 

I remember they were not quite as flat looking at your surgeries. So I can see if someone was really looking for a perfect flat chest and did not subscribe into the chest looking better while in motion/running with a small amount of fat left behind, I can see then perhaps going in for a revision in that regard.

However, as far as nipple depression/creator deformity, asymmetrical appearance, pointy nipples or anything in terms unexpected results may be a different story?

Please let me know.

Thank you.

 

[fsugrad]

Dr. Michael Bermant claimed to have a zero revision rate with gynecomastia patients due to his dynamic technique and fat flaps to prevent creator deformation and nipple depression.

Regardless of cost, surgery should be avoided at all cost. I have had to push myself for years to even consider such a drastic measure. I certainly would not want to have to do it twice in a year because a surgeon is not confident with their abilities and never removes correct amount of gland/fat.

I want this to be a one time thing and be done with it.

I wish some doctors would learn from mistake and improve their abilities with time but unfortunately I see certain doctors continue to make the same mistakes over and over.

Its like with a marriage, you can't really change someone.


[/quote

I can give you some personal experience with Dr. Bermant as I had a remote consult with him as well.  He is extremely picky in the cases in which he chooses to take. He seemed almost to be picking his patients instead of the patient picking him.  Therefore, it would make sense that his revision rate would be lower than other docs if he is selecting only the most "ideal" cases from which to perform.

The way I look at it is not whether my result will be perfect, but whether or not I will have a decent improvement from where I am today.

[letsfixthis]

I can give you some personal experience with Dr. Bermant as I had a remote consult with him as well.  He is extremely picky in the cases in which he chooses to take. He seemed almost to be picking his patients instead of the patient picking him.  Therefore, it would make sense that his revision rate would be lower than other docs if he is selecting only the most "ideal" cases from which to perform.

The way I look at it is not whether my result will be perfect, but whether or not I will have a decent improvement from where I am today.

Did Dr. Bermant also tell you that he has a zero revision rate when you did your consolation with him?

To be honest, I never knew quite what to think about Dr.Bermant. It seemed from his website that he knew a lot about gynecomastia but I could not tell if it was more marketing hype machine or genuine knowledge. People said he was very difficult to talk to and deal with.

I heard a story once that he demanded a patient fly across the country to come in to get the Suture removed but then revealed that he just wanted to take pictures for the website and the Suture were dissoluble.  

It is possible that his claims of perfections were exaggerated?

I like Dr.Pope, I really do. I feel that his method is good however it seems like he is on the road to a perfect result but then stops about 90% of were he need to be in some of the case.

When someone is laying down on an operating table and gravity and body position makes the chest look much flatter then when someone is standing upright. He probably feels that he liposuction enough fat or removed enough gland when you are laying down but then when you are upright, it look totally different.

To be honest, I don't know how some doctors are able to judge the correct amount to remove when it is so difficult to see the gynecomastia when you are laying flat down like that. Maybe they take better notes while you are standing up on how much fat to remove and where whereas other doctors try to eyeball it during surgery? I wish I knew.  

[fsugrad]

I can give you some personal experience with Dr. Bermant as I had a remote consult with him as well.  He is extremely picky in the cases in which he chooses to take. He seemed almost to be picking his patients instead of the patient picking him.  Therefore, it would make sense that his revision rate would be lower than other docs if he is selecting only the most "ideal" cases from which to perform.

The way I look at it is not whether my result will be perfect, but whether or not I will have a decent improvement from where I am today.

Did Dr. Bermant also tell you that he has a zero revision rate when you did your consolation with him?

To be honest, I never knew quite what to think about Dr.Bermant. It seemed from his website that he knew a lot about gynecomastia but I could not tell if it was more marketing hype machine or genuine knowledge. People said he was very difficult to talk to and deal with.

I heard a story once that he demanded a patient fly across the country to come in to get the Suture removed but then revealed that he just wanted to take pictures for the website and the Suture were dissoluble.  

It is possible that his claims of perfections were exaggerated?

I like Dr.Pope, I really do. I feel that his method is good however it seems like he is on the road to a perfect result but then stops about 90% of were he need to be in some of the case.

When someone is laying down on an operating table and gravity and body position makes the chest look much flatter then when someone is standing upright. He probably feels that he liposuction enough fat or removed enough gland when you are laying down but then when you are upright, it look totally different.

To be honest, I don't know how some doctors are able to judge the correct amount to remove when it is so difficult to see the gynecomastia when you are laying flat down like that. Maybe they take better notes while you are standing up on how much fat to remove and where whereas other doctors try to eyeball it during surgery? I wish I knew.  

I can't recall if he even mentioned what his revision rate was.  I just know that he wants it to be stable for a really  really  long time before he will consider it.  However, my view is if you have eliminated all endocrine causes and you are not using anabolic steriods that gyno doesn't just happen overnight.  Its a slow but continuous process. For example say that today you are a B cup but your Dr. wont operate because you are not "stable".  Are to wait another 5 years and slowly progress to a D cup??  Now your surgery is going to be that much more complex due skin issues.  I would rather cut out the offending tissue and at the very least I would slow the entire process way down and save myself the stress of sitting by watching myself turn into a woman and being powerless to do anything about it.

I would rather Dr. Pope be a little conservative that be overly aggressive and suck out all the fat of my chest. Now that would not appear natural.

Back to Bermnt his attitude was fine, at least on the phone. Never saw him in person.

[letsfixthis]

I can't recall if he even mentioned what his revision rate was.  I just know that he wants it to be stable for a really  really  long time before he will consider it.  However, my view is if you have eliminated all endocrine causes and you are not using anabolic steriods that gyno doesn't just happen overnight.  Its a slow but continuous process. For example say that today you are a B cup but your Dr. wont operate because you are not "stable".  Are to wait another 5 years and slowly progress to a D cup??  Now your surgery is going to be that much more complex due skin issues.  I would rather cut out the offending tissue and at the very least I would slow the entire process way down and save myself the stress of sitting by watching myself turn into a woman and being powerless to do anything about it.

I would rather Dr. Pope be a little conservative that be overly aggressive and suck out all the fat of my chest. Now that would not appear natural.

Back to Bermnt his attitude was fine, at least on the phone. Never saw him in person.

I can't remember if he said he had a zero revision rate for creator deformity/nipple depression or a zero revision rate for all gynecomastia procedures. Why did you decide against Dr. Bermant?

Sure it will be an improvement but why not get it done right the first time? You don't want to take general anesthesia lightly if you can avoid it? Why have 2 operations if you can get it done in 1?

If you are 100% committed, would you post before & after picture to allow us to see the results?

I wish you the best of luck. No man should have to live life like this and I am glad there are people who are willing to help people with this problem.

Thanks.

[George Pope, M.D.]

Dear Letsfixthis

Regarding Quote:
"When someone is laying down on an operating table and gravity and body position makes the chest look much flatter then when someone is standing upright. He probably feels that he liposuction enough fat or removed enough gland when you are laying down but then when you are upright, it look totally different."

With all due respect, you can't presume to know what I do in the operating room and shouldn't speculate as much in a public post. Of course I set up all of my patients to a full sitting position on the OR table and examine them before closing. I think you are oversimplifying the entire operative procedure. There are a number of factors that can lead to the need for revision surgery. And no surgeon can honestly boast a zero % revision rate.  I revise a lot of other surgeons' patients because their surgeon said they looked fine and didn't need it. I take great pride in my work and will oblige a patient's request for a revision if I truly think I can help him, even if the issue is a very minor one.
Dr. Pope, MD

[Viking75]

Dr. Pope,
Great post!

For all of you out there searching for gyno surgery. This is not an easy operation. Doctors like Dr. Pope, Dr Jacobs and Dr Delgado, Dr. Silverman are dedicated to this. They know that if it does not look good leaving the OP table it will not stand a chanse to have o good result in the future.

What some do not understand is that your own body can be your worst enemy! after a successfull operation swelling, scar tissue, stress can have such a bad effect that you might ruin a great result. And yes once in a while a doctor has a bad day.

I know that many of you miss the doctor with the fat flaps! Let me tell you, I have had fat flaps too, All of the obove Doctors use them if nessesery!!!!! The difference is they do not market It as the solution of gynecomastia surgery.

Even if you start with lipo, Pope,Jacobs and so on will leave enough tissue to make flaps to support the areola.
(Doctors that do not do this kind of operations enough might miss this part) Dr B.used to love to point this out. This is hardly the case of the obove doctors. The difference Is that they tend to have the guts to help people that are a bit overweigh, they are not rude, and the above doctors are more aggressive because they remove more tissue to get a better end result. This will cause some more swelling and so on, but this is normal and most people will look so much better then not having surgery.

And if you meet a surgeon that has 0 revisions, use your head.....But to be fare You will not be pamperd if you need a revision. Money is important.....

[Viking75]

EdmondDantes,

You have a great surgeon, you will come out of this looking great!

[letsfixthis]

Dr. Pope,
Great post!

For all of you out there searching for gyno surgery. This is not an easy operation. Doctors like Dr. Pope, Dr Jacobs and Dr Delgado, Dr. Silverman are dedicated to this. They know that if it does not look good leaving the OP table it will not stand a chanse to have o good result in the future.

What some do not understand is that your own body can be your worst enemy! after a successfull operation swelling, scar tissue, stress can have such a bad effect that you might ruin a great result. And yes once in a while a doctor has a bad day.

I know that many of you miss the doctor with the fat flaps! Let me tell you, I have had fat flaps too, All of the obove Doctors use them if nessesery!!!!! The difference is they do not market It as the solution of gynecomastia surgery.

Even if you start with lipo, Pope,Jacobs and so on will leave enough tissue to make flaps to support the areola.
(Doctors that do not do this kind of operations enough might miss this part) Dr B.used to love to point this out. This is hardly the case of the obove doctors. The difference Is that they tend to have the guts to help people that are a bit overweigh, they are not rude, and the above doctors are more aggressive because they remove more tissue to get a better end result. This will cause some more swelling and so on, but this is normal and most people will look so much better then not having surgery.

And if you meet a surgeon that has 0 revisions, use your head.....But to be fare You will not be pamperd if you need a revision. Money is important.....

I am not sure if I agree with your assessment. Dr. Bermant said that he used his own dynamic technique. A gynecomastia surgical procedure may not be copyrighted however I think you are kind of putting words in doctors mouth who may not actually use this.

For Example, I have seen that a Dr. Cruise in California and I think Dr Jacobs said they use a method of leaving a small amount of gland attached to the underside of the areola for support.

Other doctors have said that they are able to smooth out the surrounding fat so there is not left with a hole/crater under the areola.

I posted another thread on this forum asking doctors to share their methods of preventing the crater deformity/nipple depression and basically was told that every doctor may have their own unique method, there is not a standardized protocol learned in medical school or board certification process to handle the crater deformity/nipple depression or gynecomastia for that matter. As well as that it was a very complicated issue that you need to refer to your own surgeon.

The contributing doctors had a chance on the tread to share their method and say if they used fat flaps for this deformity as you suggested but they did not.

I don't think a blanket statement like that is true from what I have read. If they do use fat flaps, or some other method. They should state that themselves. You may be assuming something that is not true.

[letsfixthis]

[quote author=Dr. Pope link=topic=23988.msg177163#msg177163 date=1359232526]
Dear Letsfixthis

Regarding Quote:
"When someone is laying down on an operating table and gravity and body position makes the chest look much flatter then when someone is standing upright. He probably feels that he liposuction enough fat or removed enough gland when you are laying down but then when you are upright, it look totally different."

With all due respect, you can't presume to know what I do in the operating room and shouldn't speculate as much in a public post. Of course I set up all of my patients to a full sitting position on the OR table and examine them before closing. I think you are oversimplifying the entire operative procedure. There are a number of factors that can lead to the need for revision surgery. And no surgeon can honestly boast a zero % revision rate.  I revise a lot of other surgeons' patients because their surgeon said they looked fine and didn't need it. I take great pride in my work and will oblige a patient's request for a revision if I truly think I can help him, even if the issue is a very minor one.
Dr. Pope, MD
[/quote]

In regards to the note taking vs eyeballing it. I was talking about plastic surgeons in general not trying to imply anything else.

I think I watched a video of Dr. Delgado a few years ago talking about how much different the gynecomastia looked while standing up vs laying down because of how the fat compresses.

For example, in this before & after picture it appears to me that the person had a lot of gynecomastia remaining in the left breast. Assuming this is remaining fat and not gland, if he were to lay down, the gravity would compress the fat to make it look much more flat.



However standing up, it still seem to be a lot of gynecomastia in terms of shape and size especially on the left breast. All I was trying to say is that it is a difficult process and does not stand out as obvious when someone is laying down vs standing up.

I personally would think a flat chest looks better but maybe that is just me.  I do not want to speculate or puts words in someone's mouth but I am also curious about what may be causing the appearance of that left breast in the after picture as well as if this individual would be considered a good revision candidate?

[Viking75]

Letsfixthis,

I have my own surgery report stating that after lipo and removal of gland and scar tissue not responding to lipo, fat flaps where used to further support my areola. No big deal, Dr Jacobs did not even tell me about It. He was more focused on making me understand how to deal with the recovering and long whait for the final result. (I was nervous so you can imagine he had more problems with my mind then the result of my surgery)

The thing is that you do not have to start removing the gland under the areola to make sure you do not have the crater problem.
I do not think any doctor would start this discussion on the forum again. The use of fat flaps is too common in plastic surgery.
Try to find a surgeon that have lots of experience. Try to focus less on the tecnic/machine or cannula he/she uses.
In fact my first consultation was with a local plastic surgeon 40 minutes away from my home performing the procedure starting with the gland and the use of fat flaps.
Try to find a doctor that has lots of pictures with results that you like, and If It feels good go for It.

 

[letsfixthis]

Letsfixthis,

I have my own surgery report stating that after lipo and removal of gland and scar tissue not responding to lipo, fat flaps where used to further support my areola. No big deal, Dr Jacobs did not even tell me about It. He was more focused on making me understand how to deal with the recovering and long whait for the final result. (I was nervous so you can imagine he had more problems with my mind then the result of my surgery)

The thing is that you do not have to start removing the gland under the areola to make sure you do not have the crater problem.
I do not think any doctor would start this discussion on the forum again. The use of fat flaps is too common in plastic surgery.
Try to find a surgeon that have lots of experience. Try to focus less on the tecnic/machine or cannula he/she uses.
In fact my first consultation was with a local plastic surgeon 40 minutes away from my home performing the procedure starting with the gland and the use of fat flaps.
Try to find a doctor that has lots of pictures with results that you like, and If It feels good go for It.

  

I still don't know how common the fat flaps are. If you went to Dr. Jacobs, then he is not a common doctor. He has developed his own instruments, and probably seen a lot more gynecomastia patient that most plastic surgeons.

Just because he is able to do something does not necessary mean that other plastic surgeons know how to do it either.

I am not sure if the plastic surgeons don't talk about how to prevent crater deformity because they consider it a trade secret(like a magician revealing their tricks) or because they are not entirely sure how to prevent it in some cases. 

It seemed like an uncomfortable subject.

So with your story, you had the surgery done but then when to Dr. Jacobs for a revision?  

Thanks.

[Viking75]

Dr Jacobs did the first surgery as well!

I was one of those few unlucky that needed revision! Sometimes life gives you lemons. I am now 3 month post op and looking good!

I think a have remowed a total amount of 2000cc of fatty/fibrous tissue and about 20 grams of stubborn gland and scar tissue. I will never reach perfektion but If I can look like I do right now I would be a very happy camper.
I doubt anybody could tell I had surgery looking at my chest from 1 meter.

Letsfixthis, I have been In your shoes. It probably is an old post here somewhere when I ask doctors to come up with all the complications that could possible happen! I got no answer!
Pleae take my advice. Stop searching for a way to prevent damage. Turn It around look at possibilities. The thing is that the worlds best gynecomastia surgeons are on this forum.

I was very nervous the second time around, It is a major decision. The thing is: A lot of people walk back to the surgeon saying they want a revision. I can tell you straight up, Dr Jacobs would never perform a revision If It he did not feel It was necessary. He looked at me and did a very careful evaluation. He said we are going to revise both sides period.