Considering Surgery

[pjworth]

Hey everyone, I'm a new member here. I discovered this site a couple weeks ago and have been reading over things people are talking about and I've got some questions, so I decided to make a user name and ask for some thoughts/advice.

I've had gynecomastia since I was 13, the summer before I entered eighth grade. I remember noticing a change in my nipples and chest and did some research and came across a bunch of websites saying that it's completely normal during puberty, and usually goes away within a year or two. I patiently waited for it to go away, and was constantly looking for signs that it was going away, but never saw any. I am now 20, and needless to say, I still have gynecomastia, and from what I have read on here and other sites, considering I've had it for seven years now, it's probably never going away on its own.

Having gynecomastia has been frustrating for me. My case isn't anything extreme or anything; if I wear the right types of shirts I can usually make it so that people don't really notice most of the time. However, with some shirts it is somewhat obvious, and I'm always worried that people might be looking at my chest. Obviously, this feeling is even worse when I take my shirt off.

I am tired of wondering if people are looking at my chest and being reluctant to take off my shirt. Therefore, I am now seriously considering surgery. I have some questions though. First of all, I'm wondering when would be the best time for me to get the surgery done? I'm a student at Ohio State and we have spring break coming up soon; at first I thought that this would be a good time because I thought I could get the surgery done without having to worry about missing class, but I recently read posts by a few people saying that the vest you have to wear after surgery is noticeable if you are only wearing a t-shirt on top, and with spring right around the corner, I'll be wearing t-shirts, and I'd like as few people to know about me getting surgery as possible. So I then considered waiting until next winter break--that break is longer anyway, and I would then be wearing thicker shirts, in addition to hoodies and jackets. Does anyone have any thoughts on this? Are the vests fairly obvious under t-shirts? Is it worth waiting another 9 months for the surgery? I'd like to get it done ASAP, but if it'd be worth waiting I could wait. I'm thinking I'd rather get it done one of these two times so that I wouldn't have to miss school or work.

Another question I have is that I have a fairly active lifestyle. I realize I'll have to quit working out for about a month after surgery, and I can deal with that. Also, seeing as I'm a college undergrad at OSU, partying is a fairly big part of my life as well. I know this question sounds superficial and superfluous, but I have a busy social life and partying is a big part of it. Hey, I'm young, I have to live it up while I can get away with it haha. Anyway, would I be pretty much good enough to start going out and partying again after about a week or so from the date of surgery? Partly related to that, how long do you have to wait until you start being sexually active again? I'm assuming it would coincide with the time that I could start working out again, but I don't know, I haven't really heard anyone talk about this.

Lastly, does anyone have any estimates on what percentage of people who undergo surgery are completely happy with their results, how many are somewhat happy, and how many are unhappy? My biggest fear is that I'll get surgery and not be satisfied, and I will have spent thousands and gone through an extensive healing process for nothing. Also, I live in Columbus, Ohio; does anyone know of any good surgeons around here? And last but not least, I have heard about testosterone therapy treatment, how does this compare to surgery?

Dr. Jacobs, I've noticed you posting here and you seem quite knowledgeable--if you could answer some of my questions it would be greatly appreciated. Anyone else who wants to chime in is more than welcome as well, of course. I am very thankful for any feedback. I know this was a long post with a lot of questions--sorry about that, I just have a lot on my mind at the moment. Thanks in advance everyone.

[Dr. Elliot Jacobs]

The best time of year to consider surgery is when it works for you.  Wearing the compression garment is a pain in the neck -- so whenever you have the surgery it will be annoying.  You just have to put the time aside.  Re hiding it?  Most of my patients are quite inventive -- baggy shirts, loose clothing, etc to conceal the garment.  I usually recommend at least 3 full weeks of firm compression and, at the same time, avoidance of all strenuous activity.  After three weeks, you can return to the gym, etc, and you can switch to a tight garment like Underarmor.

I would not toy with your hormones unless a doctor had tested you and found abnormalities.  And then  treatment should be done under a doctor's supervision.

Elliot Jacobs, MD, FACS

[pjworth]

Thanks for the quick reply. How much do your surgeries cost, on average? And how far in advance do patients have to schedule?

[Dr. Elliot Jacobs]

My fees range from $4500 to $8400 (approx), depending on complexity, with the average fee at $6900.  Surgery is performed on an outpatient basis in my fully accredited office operating suite.  These fees include surgery, anesthesia by an anesthesiologist (deep sedation), operating room fees, photos, compression garment and all follow-up care. 

Once I have seen the patient in consultation, we can usually schedule within the following 2-4 weeks.

Elliot Jacobs, MD, FACS

[jacksonx]

I have a question for the doc.  How can I tell if I really have gyne. I'm 5'9 169lbs.  Is it possible to loose all the fat or breast tissue, whichever I have by loosing more weight?  Can a person loose the fat or tissue under the nipple by loosing as much weight as possible.  Will the breast tissue decrease as I loose more weight?

Thanks,
Jackson

[Dr. Elliot Jacobs]

Most men have a combination of fat (oftentimes resistant to change) and breast tissue on their chest. If you lose weight, the fat component of your chest tissue may decrease -- but the breast tissue remains unchanged.  At your height and weight, there is a limit as to how much weight you can lose before it affects your general health.

I think the best diagnostic means to assess if you have gyne is the pinch test.  Pinch your skin/fat just below the collarbone and then do the same pinch in the nipple area.  If you have gyne, the pinch of the nipple area will be significantly thicker. 

Elliot Jacobs, MD, FACS

[angelofdeath]

a question for the doc..ive posted witha couple of pics of mine and jus thought if you could pls suggest and help me out ?

http://www.gynecomastia.org/smf/index.php?topic=13330.0

[Dr. Elliot Jacobs]

From your photos (obviously without a physical exam), it does appear that you have a mild to moderate case of gynecomastia.  There is always more tissue underneath that you would imagine -- just like an iceberg! 

My best advice would be lipo and excision.  Your areolar diameters would also spontaneously shrink in size.

Good luck!

Dr Jacobs

[angelofdeath]

is the lump underneath my left nipple anything to worry about and will the scars show after my surgery?

[Dr. Elliot Jacobs]

Without the benefit of an examination, I cannot tell you what the lump is that you are feeling.  If an incision is made around the edge of the areola, it tends to heal quite well and it will be permanent.  Everyone heals in their individual way so I cannot predict how visible your scar would be.

Dr Jacobs

[Grandpa Bambu]

How long do you have to wait until you start being sexually active again?

Dude....  just have your partner on top (my favorite pos). However, make sure she does not put her hands on your chest and you'll be Good-to-Go....

My biggest fear is that I'll get surgery and not be satisfied, and I will have spent thousands and gone through an extensive healing process for nothing.

Unfortunately, surgery is like a 'box of chocolates'.... You never know what you're gonna get. Geeze, where have I heard that line before?     Seriously tho dude, surgery is a gamble... GRS is just a 'fix' and not a 'cure'. There is no guarantee that you will get results that meet/exceed your 'ideal'.....

GB