Author Topic: Gynecomastia reappearance?  (Read 3095 times)

Offline thebattleisover

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Ok, so I'm not overweight or chubby. 2 years ago I was noticing this lump in my right pec, beneath the nipple. Talked to the doctor, learned about the condition (but I thought it mainly happened to overweight people-true?) and etc. Had surgery through the insurance company for free and hey, it was gone. But then it sorta came back, first with fluid (which the doc drained) and then another lump. She told me she never removed the lump that was waay back there, against the bone, because it would invert my nipple. Later, (6 months) I had surgery again (insurance also covered it again, which was good) and then it was gone. But I could feel a small part of the lump still there, way back. So that was almost a year ago. Now, for the 3rd time, my nipple is puffy and that's really the only place it's noticeable. I don't have a breast. But I don't just mean puffy, I mean like sticking out 1/4 an inch, round, smooth, and a lump behind it. My conclusion is that whatver was still there has moved to fill the gap behind the nipple.

What can I do?? I don't know that the insurance would cover it again. But I don't mean I'm against surgery. My regular doc said it could go away as I get older (I've just turned 16) or when I hit a growth spurt. But I don't know that I can wait. It looks so ugly- one nipple larger and puffy, and the other side normal. I avoid any place like a pool. Also, I feel tingly pain when I press on it - but it's very dull and remote (severed nerves during surgery?). It doesn't get hard even if I put like ice against it or anything, no feeling on the surface.

So..I need help and it seriously makes me feel like shit b/c I can't even wear like an underarmor shirt or anything like that.

Offline Dr. Cruise

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Your  reappearance could be several things. First of all, it is rare for  to return after proper removal. Hormonal imbalances and medications can do this. Are you taking any medications and have you had your hormone levels checked? Another possibility relates to the fluid collection that you said was occurring. It is certainly possible for this fluid collection (aka seroma) to have formed a wall within your chest. This seroma can fill with fluid or sometimes be replaced with scar tissue.

Any repeat surgery should be preceded by hormone level lab work. While I always hesitate to make surgical recommendations on patients I have not examined I can make the following recommendations. The surgery should include complete removal of the lump including complete removal of the seroma wall and/or all scar tissue. I would then recommend suturing the skin to the underlying pec major muscle to prevent re-accumulation of fluid/scar tissue.
Dr. Cruise
Board Certified Plastic Surgeon
2081 San Joaquin Hills Road
Newport Beach, CA 92660
949-644-4808
Before and After Pictures
Types of Gynecomastia

DrBermant

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Ok, so I'm not overweight or chubby. 2 years ago I was noticing this lump in my right pec, beneath the nipple. Talked to the doctor, learned about the condition (but I thought it mainly happened to overweight people-true?) and etc. Had surgery through the insurance company for free and hey, it was gone. But then it sorta came back, first with fluid (which the doc drained) and then another lump. She told me she never removed the lump that was waay back there, against the bone, because it would invert my nipple. Later, (6 months) I had surgery again (insurance also covered it again, which was good) and then it was gone. But I could feel a small part of the lump still there, way back. So that was almost a year ago. Now, for the 3rd time, my nipple is puffy and that's really the only place it's noticeable. I don't have a breast. But I don't just mean puffy, I mean like sticking out 1/4 an inch, round, smooth, and a lump behind it. My conclusion is that whatver was still there has moved to fill the gap behind the nipple.

What can I do?? I don't know that the insurance would cover it again. But I don't mean I'm against surgery. My regular doc said it could go away as I get older (I've just turned 16) or when I hit a growth spurt. But I don't know that I can wait. It looks so ugly- one nipple larger and puffy, and the other side normal. I avoid any place like a pool. Also, I feel tingly pain when I press on it - but it's very dull and remote (severed nerves during surgery?). It doesn't get hard even if I put like ice against it or anything, no feeling on the surface.

So..I need help and it seriously makes me feel like shit b/c I can't even wear like an underarmor shirt or anything like that.

Posting a series of Standard After Gynecomastia Surgery Pictures starting with before the first surgery, then after each subsequent surgery can better help others understand your concerns. Options depend on if the current situation is one of:

  • Regrowth
  • Residual Scar Gland After Surgery
  • Unrealistic Expectations such no external deformity but remaining firm tissues that do not show


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 Revision Gynecomastia and Chest Surgery

Offline 1234567

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Here is my situation:


I've suffered from gyne for so long and at the same time been so depressed and ashamed about the whole thing that I've failed to ever go through with surgery. Now I've set events in motion to finally do it, and in the next couple of days I plan to confirm the details of my consultation with a surgeon and my flight for that consultation.

The problem is that maybe a little less than a month ago my gyne, along with other problems such as anxiety, listlessness, and chronic thirst and diarhea, and other strange little maladies, led me to suspect that I have some sort of hormonal problem. I told my GP about my concerns, and after giving me a bloodtest and finding that I had a testosterone level of 9.8 (just under the normal range of 10 to 30), he referred me to an endocrinologist.

However, my appointment with this endocrinologist is not until April of 2010!

I've already had what were supposed to be the best years of my life stolen from me by gyne. Over the years I have twice before resolved to get this surgery and begun the process, only to back down. I don't want to waste anymore of my life by delaying my road to surgery, but I fear that I will end up having surgery before seeing an endocrinologist, and that some sort of undiagnosed and untreated endocrinological problem will cause my gyne to grow back! I don't know what to do.

I am 22 years old and have had gyne since I was 12.


Is there some way to get to see an endocrinologist in a hurry? Can you tell me about your Red Flag System?
« Last Edit: October 20, 2009, 04:38:04 PM by 1234567 »

DrBermant

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Here is my situation:


I've suffered from gyne for so long and at the same time been so depressed and ashamed about the whole thing that I've failed to ever go through with surgery. Now I've set events in motion to finally do it, and in the next couple of days I plan to confirm the details of my consultation with a surgeon and my flight for that consultation.

The problem is that maybe a little less than a month ago my gyne, along with other problems such as anxiety, listlessness, and chronic thirst and diarhea, and other strange little maladies, led me to suspect that I have some sort of hormonal problem. I told my GP about my concerns, and after giving me a bloodtest and finding that I had a testosterone level of 9.8 (just under the normal range of 10 to 30), he referred me to an endocrinologist.

However, my appointment with this endocrinologist is not until April of 2010!

I've already had what were supposed to be the best years of my life stolen from me by gyne. Over the years I have twice before resolved to get this surgery and begun the process, only to back down. I don't want to waste anymore of my life by delaying my road to surgery, but I fear that I will end up having surgery before seeing an endocrinologist, and that some sort of undiagnosed and untreated endocrinological problem will cause my gyne to grow back! I don't know what to do.

I am 22 years old and have had gyne since I was 12.


Is there some way to get to see an endocrinologist in a hurry? Can you tell me about your Red Flag System?

With the help of endocrinologists over the years, I have evolved a Red Flag system of Gynecomastia Symptoms.  This methodology was received well during my invited Gynecomastia lecture at a recent American Association Of Clinical Endocrinologists national meeting.

Canadian endocrinologists are few and far between.  We work with several endocrinologists here in the United States for our patients who schedule them in a timely fashion. They do not participate in the Canadian health care system. A few of these doctors have adopted variations of our Preliminary Remote Discussion to minimize travel and to offer second opinions for those with complex endocrinology problems.

Hope this helps,

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

Offline thebattleisover

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No medications now or in my lifetime (other than the normal sickness/allergies).

What I really wonder about is my hormone level. I know everyone has estrogen, and that's probably why I have this lump to begin with, but I don't know why I didn't have it symmetrically. Can I lower my estrogen and raise my hormone?

And the doctor did say she didn't remove it all b/c she believed it would have inverted the nipple. I think whatever she didn't take out forced its way into the opening.

So is it that serious or will it go away? I lift weights and it's odd since I have muscles and this thing jutting out. Makes it hard to wear smaller shirts or white shirts... Believe me I'm not being vain or any dumb shit like that. I just dread the kinds of questions it would raise..and when I have a girlfriend I'm always aware of it (like it's in the back of my mind). I can take a photo if it would help
« Last Edit: October 26, 2009, 08:30:18 PM by thebattleisover »


 

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