Had surgery twice and gyno still returning.

[Zim]

Hello,

I've had painful gynecomastia since 2015. I've never been on medication that could cause it and all my bloods/hormone levels have shown as normal. I've had surgery twice at the Noa Clinic in Poland, once in 2016 and once again in 2021. Each time the surgery looked successful but the pain returned and soon after the gyno would start to grow again. I've tried both Raloxifene and Tamoxifen for the pain but neither worked. I thought that maybe nerve damage would explain the constant pain, but that doesn't explain the gyno constantly re-growing.

My question is - which type of doctor is best to talk to about this in person? Would it be an endocrinologist? I'm aware that surgery is the last-resort option and all a plastic surgeon would be able to do is recommend surgery again. Do I even have any options left? Will I just have to live with the pain and get gyno surgery every 5 years (I'm assuming that the aesthetic results will degrade every time I have surgery).

Any advice would be greatly appreciated. Thank you.

[Miguel Delgado MD]

I would consult with a endocrinlogist to make sure all is normal.  I would also go to a gynecomastia specialist for an exam and re-do the surgery making sure all of the gland is removed.  I would say if all labs check out as you say, then previous incomplete excision may be possible.  If all gland is removed the target organ to enlarge is removed.  Idiopathic gynecomastia ( unknown reason) can certainly happen but usually resolved by complete gland excision.  GOOD LUCK.

[Zim]

Thank you Dr. Delgado, your reply is appreciated. I was under the impression that "complete gland excision" did not really exist - there must always be a tiny amount of glandular tissue remaining, as it is attached to the nipple itself, and if you were to remove that the nipple itself would not survive. Therefore surgeons can generally remove as much as possible but there will always be a small amount remaining, leaving the possibility of recurrence. 

[Miguel Delgado MD]

As I explained, it is usually due to incomplete gland excision. I remove all gland from underneathe the nipple.  If you fell a lump of some sort removal is the only option.  You need to see a gynecomastia expert for evaluation. Good luck.