What is a good result? Do I have BDD?

[deckard]

I had gynecomastia surgery 3 years ago. I've never been particularly happy with the results. The left nipple is a little mis-shapen and seems to be in a different position on my chest that it use to be, but doesnt actualy bother me a great deal. The right nipple is a different matter, when Im relaxed there is a crease in the nipple - it kind of folds over. It will also sometimes stick out to a rediculous extent, and can be seen under a t-shirt.

Recently I went to see another surgeon about this. He told me that it was a good result for a gynecomastia surgery, and that the problem was basically in my head. He also told me that if I wanted to improve the appearance of my chest, I should excercise.

If I was absolutely sure that the surgeon was correct I might try to just live with it, but when I originally 'came out' with my gynecomastia problem, people told me (including doctors) that it was all in my head and that I should exercise more.

So I need some advice. Should I go to some therapist about body dysmorphic disorder or attempt to get more surgery? I'd prefer some surgery to flatten my right nipple, because it bothers me - and I honestly believe that I would be happy even with the slight imperfection in my chest that would likely remain after further surgery. Help!

[rcbrown23]

Post Pictures. That's how you'll get the answers your looking for.

[deckard]

Ok. Here are the pics. Sorry if they are not too clear, all I have is a webcam.

Relaxed..


Tensed

[jc71]

deckard.

You'll get guys say things like, "dude, i'd kill for your chest" and "what are you worried about, mine looks way worse."  At least in part, I agree with them.

If the Dr.'s who have a financial interest in you getting surgery are telling you not to do it, then I think that's a pretty good clue.

I can see how the nips (especially the right) sticks out.  Maybe you should ask if there's a technique where they knock you out and then basically take scissors and cut off the tip and then sew it back together.

If I personally had your chest, I wouldn't be scared to take off my shirt, but would still wear a couple shirts to hide the pointed nip.  

[Spleen]

Well, you don't have gynecomastia anymore, but I can see pretty clearly what you are unhappy with.  Is it perfect?  No.  Is it considerably better than what you started out with?  That's for you to decide.  

It is a "flaw", but it's so minor that you're probably the only person that notices, or maybe you're just the only person that notices that also cares about it.  To me it would be very liveable.  At the same time, a really skilled guy might be able to smooth it out.  Dr. Bermant has shown some very successful re-dos.  Still, you appear to be within the normal range of what my unpracticed eye would call a "realistic result".  They say you can't make a silk purse out of a sow's ear, so if it's an improvement maybe you can convince yourself that it's liveable?

Long story short you have two paths: change your mind about how you think about your body (maybe that's where a BDD consult might help) *or* change your body (more $$$ for the plastic surgeons, and possibly no guarantee of success).  Good luck bro.

[rcbrown23]

I have to agree with spleen for the most part...

If it was me...I'd probably go to Dr. Bermant, or another very skilled PS and see what he thought he could do. I'll bet it could be fixed up nicely, but it would cost money, and it really depends on if you can live with it or not.

It really does not look bad at all. Other's will probably not notice anything...on the other hand, if it was me I think all I could do is worry about it, and that constitutes doing something about it.

   -Brown

[vaio]

You need to hit the gym. That'll fix it.

[hypo]

I think you have BDD.  I don't see any gynecomastia whatsoever.

And I think your surgeon does not want to do anything becauce your A) there is no gynecomastia and B) what can be done is probably exceeded by your expectations.

I'm sure I'll get critisised for that opinion, but you did ask the question and it is an honest answer whether other people concur or not.

[Paa_Paw]

If Hypo gets criticized for what he said, I'm sure to get toasted for what I'm about to say.

My opinion is that the original Surgeon may have been a bit over-zealous and not left enough fat and fascia between the skin and muscle.  The skin has adhered to the muscle as a result.

That adhesion can be broken down.  It is time for another opinion. For this, even a GP should be able to help.   Repeat Surgery is probably not a good idea and may only make things worse.

My wife had some nasty adhesions following surgery on her knee which were greatly helped by a physical therapist.

In fairness to the original Surgeon, Adhesions are not necessarily anything they can absolutely prevent.  Some people produce this kind of scaring more than others.  It is all in how you heal.

[deckard]

Thanks for the comments guys. So I guess then that it is not entirely in my own mind.

Hypo, I guess I'm not claiming to have gynecomastia any more - since the breast tissue that was there has been removed. Just that the results of the surgery were'nt as good as they could have been. Would you not agree the right side is misshapen?

I think perhaps that the problem with the right nipple may be due to the fact that it was previously inverted. I asked the surgeon to 'uninvert' it. Perhaps he over compensated.

Can you have Body Dysmorphic Disorder, if your body really is dysmorphic? Prior to my surgery there was no doubt, I had breasts (glandular tissue + fat) which most people would agree is dysmorphic. Even now I think it is actualy dysmorphic - although to a much lesser degree.

[tonysoprano]

straightforwardly..

my opinion is that you do not have gyne at all.

there is however certainly something wrong/different about that right nipple..

I think that you will never be able to settle for living with it that way, and I think it will take a nipple procedure to be fixed... and I believe such a procedure would significantly improve if not completely rectify the thing (while running the risk of making things worse rather than better)

its a gamble ....thaTS FOR SURE.

If it was me I would deinitely be looking into nipple-specific cosmetic procedures that can be performed

[Spleen]

I think BDD applies to not just situations where the person's body is "normal", but also when then tend to exaggerate flaws.  Example, I have really crooked bottom teeth.  I don't like 'em, and clearly they are not nice, normal straight teeth.  However, if i refused to leave the house and live like a hermit because I never, ever want anyone to get a glimps of my lower chompers, then I'm a BDD candidate.  I wouldn't be excluded because I do in fact have "dysmorphic" teeth.  Here's a definition from an abstract on BDD:

Body dysmorphic disorder (BDD), a distressing and impairing preoccupation with an imagined or slight defect in appearance, is an "OCD-spectrum disorder" that appears to be relatively common.

About half of BDD patients are considered "delusional" which basically means there is no problem.  The other half have *something* going on, but are overly preoccupied with this aspect of their appearance.

[hypo]

Hi deckard,

I can see what you are talking about, it's not like I can't see it or am denying what what you are referring to.

But it is a question of degree.  

Most people are not 100% happy with all aspects of the way they look but few go in for surgery unless there is a significant problem.

I do not see what you are refering to as a significant problem, I see it as very, very minor one that anyone other than yourself would be hard pushed to notice.

(I is the operative word in the above paragraph).  

So much so that I would be amazed if anyone would ever give you so much as a second glance when you had your top off.

If I was stood on the beach and you walked past, I wouldn't dream you ever had gynecomastia or think anything apart from Lucky guy- good chest.

None of this means that you shouldn't get surgery on the nipple.  Because the fact is these things are subjective not objective and it is how you feel that matters most.  But what I do think it that your expectations may exceed what could be done in which case no surgery will make you feel better about yourself.

And so I wonder whether or not you couldn't live with your near perfect chest?

I think you do have BDD, I think you should see a counselor and a surgeon and get them to speak to each other and see what is in your best interests, whether that is a touch more surgery or help in dealing with negative thoughts about your own body.

[vaio]

I agree with you about the surgery. Your right nipple does stand out. Its noticabley longer than the left one.
I would go back to the plastic surgeon who did the original gynecomastia surgery and tell him you want that fixed. It simple. They just cut some of it off. He may not even charge you anything.

All in all, he did a decent job, but there are some butcher marks where it looks like he too out too much fat.

Body building in the pec region will deffinetly make things look better. It will help level things out.  

[jc71]

One correction Spleen.  Technically, in the US at least, Body Dysmorphic Disorder is a Somatoform Disorder and not an "OCD-spectrum disorder."  Obsessive-Compulsive Disorder is an Anxiety Disorder.  This according to the Diagnostic and Statistical Manual of Mental Disorders (DSM).  The standard in Psychiatric diagnosis.