Mild cases and degree of removal

[headheldhigh01]

i like to think this question is technical enough to deserve to be on this board, i like the category, though i hope it doesn't get so popular it diverts the entire content of the boards  here's my questions.  

1.  i assume milder cases have the potential to be harder in a way than severe ones, because in a severe one the improvement's much more obvious compared with where it started from.  in the mild case there's probably more contouring work that has to be done to avoid leaving it looking only marginally improved versus where it started.  i guess if you can minimize swelling and maybe compress it as it heals that helps, but does the mild case present more difficulty in being harder to improve?    

2.  i understand the concern for cratering, but since it still seems since like the gland normally never should have been there in the first place, it'd be possible (in theory) to take it all out somehow and either do the fat flap technique dr bermant talks about and/or reduce the outlying areas somewhat to sort of bezel it.  probably most people in a mild case wouldn't want to be just shaving a layer off, they'd hope for complete removal.  does the gland sort of permanently deform/displace the normal mass that would otherwise be there?  is full removal still possible with other adjustments?  can cratering be less of a concern in the mild case?  

3.  i understand there's always going to be trace fingers or threads left, and it probably varies some by case, but is gyne normally well enough defined that it mostly still removes kind of neatly as a mass, or is it not that well defined?    

the reason i ask is that people with the non-severe cases would probably feel more concerned about the risk of minimal visible improvement or only winding up with a partial excision and still feeling some of that annoying mass in there.  obviously the ps shares the concerns if the risk is unrealistic expectations on the patient's part, but it'd be interesting to hear the professional perspective on these details, so thanks for any answers.    

[DrBermant]

i like to think this question is technical enough to deserve to be on this board, i like the category, though i hope it doesn't get so popular it diverts the entire content of the boards  here's my questions.  

1.  i assume milder cases have the potential to be harder in a way than severe ones, because in a severe one the improvement's much more obvious compared with where it started from.  in the mild case there's probably more contouring work that has to be done to avoid leaving it looking only marginally improved versus where it started.  i guess if you can minimize swelling and maybe compress it as it heals that helps, but does the mild case present more difficulty in being harder to improve?

Mild Puffy Nipple Gynecomastia is different than other cases in that there is typically a larger gland to fat ratio. Leaner bodies have less fat and gland is usually a bigger component of the deformity as you can see in this Anatomy of Puffy Nipples.  That is why I evolved my Dynamic Technique to target the gland first and then use available resources to rebuild the defect.  When doctors leave a layer of gland under the nipple as their method of minimizing craters, this residual gland often still stands out.  The problem is that neither remaining gland nor scar look, feel, or move like fat.  In the individual with little fat, both gland and scar show up especially on animation.  That is why I work so hard to target both the gland and minimize scars after surgery by using a technique that minimizesswelling after gynecomastia surgery, Scar Care, and compression garments.

2.  i understand the concern for cratering, but since it still seems since like the gland normally never should have been there in the first place, it'd be possible (in theory) to take it all out somehow and either do the fat flap technique dr bermant talks about and/or reduce the outlying areas somewhat to sort of bezel it.  probably most people in a mild case wouldn't want to be just shaving a layer off, they'd hope for complete removal.  does the gland sort of permanently deform/displace the normal mass that would otherwise be there?  is full removal still possible with other adjustments?  can cratering be less of a concern in the mild case?  

Actually gland does belong there, it is part of being a mammal.  Both male and female mammals will have gland.  It is just a question of how much.  However, even a small button of gland can distort a flat male contour, especially on animation.  Full removal of gland is not practical even in radical mastectomy cases which result in terrible deformities.  A Crater Deformity Gynecomastia Surgery Complication is a possibility for any operation where the surgeon does not pay careful attention to rebuilding the chest contour.  In subtle gynecomastia with a greater gland to fat ratio, removing the gland without this reconstruction has a higher chance to result in a crater.  Incomplete removal of the gland (leaving a layer under the areola) just does not look good on animation.  That may be one reason why many doctors do not show photos that tend to show this issue such as muscles tightening or arms up over the head.  Movies are even better at showing this problem and I have been taking movies of my patients for years now before and after surgery.

3.  i understand there's always going to be trace fingers or threads left, and it probably varies some by case, but is gyne normally well enough defined that it mostly still removes kind of neatly as a mass, or is it not that well defined?    

the reason i ask is that people with the non-severe cases would probably feel more concerned about the risk of minimal visible improvement or only winding up with a partial excision and still feeling some of that annoying mass in there.  obviously the ps shares the concerns if the risk is unrealistic expectations on the patient's part, but it'd be interesting to hear the professional perspective on these details, so thanks for any answers.    

The majority of the gland is located behind the areola as demonstrated in these Anatomy of Gynecomastia Drawings. The fingers of gland remaining can range from significant to negligible.  Check out Male Mammograms to see some examples.  I like to use my finger in the wound to feel if there are any significant remaining gland that can be felt.  That is one reason for my tiny 1.6 cm lower limit for the scar at the edge of the areola.  It is the smallest size hole I can make and yet still get my small finger in the would to feel if there is any significant gland fingers left.

The goal is to have a male contoured chest that looks good at rest and in animation with as minimal a scar as possible.  Trying to help patients with realistic expectations is very important for a happy outcome.  That is why I post so many before and after surgery examples on my website to demonstrate what my surgical sculpture skills offer.

Hope this helps,

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