Author Topic: Endocronoligist gave me go ahead for surgery  (Read 3457 times)

Offline charlie1821

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So I've been on Dostinex since January. My prolactin and Testosterone levels are normal now. Breast tissue is still there but lactation is gone (thank god). Today my Doctor said to go ahead and pursue surgery.

Surgery is the next step.

Is breast tissue something that once removed is gone forever, or can it come back?

Also does insurance cover this at all? It can be a potential breast-cancer hazard can it not? My parents will pay for this regardless, but it would be nice if insurance helped.

What is total cost, consult+surgery?

I want to get this done asap.

Offline Paa_Paw

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The breast tissue is not completely removed nor can it be completely removed without leaving a deformity. Hopefully one of the Surgeons will weigh in with a more complete answer.

The question about which medications to use is best discussed with your own Dr. and the choice could be influenced by many different issues.

Lactation is the production of milk.
Grandpa Dan

DrBermant

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So I've been on Dostinex since January. My prolactin and Testosterone levels are normal now. Breast tissue is still there but lactation is gone (thank god). Today my Doctor said to go ahead and pursue surgery.

Surgery is the next step.

Is breast tissue something that once removed is gone forever, or can it come back?

Also does insurance cover this at all? It can be a potential breast-cancer hazard can it not? My parents will pay for this regardless, but it would be nice if insurance helped.

What is total cost, consult+surgery?

I want to get this done asap.

Cost of Gynecomastia Surgery varies from doctor to doctor and around the world.  You also need to take into consideration how often that doctor needs to revise their patients' chest after surgery. It is quite rare I need to offer my patients revision for my sculpture. Jane is my office manager and can better discuss typical costs and fees in our office.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

If a pituitary problem remains stable, regrowth is usually not an issue from that mechanism.  Sometimes, the pituitary problem can recur.  Remaining breast tissue will then again be subject to the hormones in the body to regrow.

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

Offline charlie1821

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Thank you very much for your response Bermant. And I may indeed contact your office.

I may stay on dostinex indefinitely. I go back for a follow up with my endo in a few months, where I will then go off medication to see what happens with my levels. If they are stable I'll stay off, otherwise go back on dostinex for as long as needed. So hopefully that would prevent regrowth.

Offline Dr. Elliot Jacobs

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    • Gynecomastia Surgery
I have had several patients who were stable on Dostinex and were able to have successful gyne surgery.  While they remained on Dostinex, no re-growth of gyne occurred.  Of course, should you discontinue Dostinex after surgery, some re-growth is theoretically possible since the surgery does not remove all possible breast tissue on the chest -- and it is that remaining breast tissue which could possibly be stimulated to grow.  Therefore, staying on Dostinex is important.

It is possible that insurance could be helpful to you.  It would require letters from your endocrinologist and plastic surgeon.

Best of luck!

Dr Jacobs

Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
4800 North Federal Highway
Boca Raton, Florida 33431
561  367 9101
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.c

DrBermant

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Thank you very much for your response Bermant. And I may indeed contact your office.

I may stay on dostinex indefinitely. I go back for a follow up with my endo in a few months, where I will then go off medication to see what happens with my levels. If they are stable I'll stay off, otherwise go back on dostinex for as long as needed. So hopefully that would prevent regrowth.

Such issues can be very difficult to predict and are best explored with your endocrinologist.  I have had many such discussions over the years and understanding the limitations of the problem and solution options is part of how we help patients evolve realistic expectations about surgery and minimizing the possible need for Revision Gynecomastia Surgery

Hope this helps,

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


 

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