Surgery in the UK with the NHS

[radio-boy]

Has anyone had Surgery in the UK under the NHS?

I have been refered to a breast surgeon, which is certainly more encouraging than being refered to a general surgeon like i was last time  

Also, i have had no hormone tests etc, is this normal? as i see many of you talking in great deal about chemicals i have never even heard of!

Cheers

[phantom]

Hello radio-boy.

If you go to the home page of this forum and scroll down to the bottom area, you will see the UK section.  If you read through the pages of threads, you will spot a few about guys being treated under the NHS.

Yes it is generally better that you are being referred to a breast (plastic) surgeon.  However, the result of your surgery comes down to a number of factors.  What your personal circumstances are with regard to gynaecomastia but as importantly the skill and experience of the surgeon in question.  Your surgeon will probably have done hundreds of female mastectomies (breast removal usually because of cancer), augmentations (for bigger boobs or again, to replace cancerous tissue, usually on the ladees) and female breast reductions - which is a very different procedure to male chest reduction (MCR).

My (private) surgeon that did my MCR said that the majority of NHS plastic surgeons may do between 2 to 6 MCR per year.  This is compared to his caseload of around 100/year.

This is not to say that your NHS surgeon is any less competent at performing this kind of surgery, but it is essential that you ask as many questions, particularly about yours and his/her expectations.  Ask them what they intend to do such as just lipo or lipo and gland excision.  Some surgeons are more aggressive than others with MCR so it depends on what you have and what you'd like.  Find out if your surgeon has any before and after photos to help you manage your own expectation.

Regarding tests.  They are not always important.  Most men (around 60%) have some degree of glandular or breast tissue.  Some men have varying degrees of glandular tissue and excess fat to give breast-like appearance.  On the whole this is normal and really just comes with what God happened to give you which is why it can be difficult to get MCR on the NHS and is hardly ever covered by private medical insurance.

There can be pathological causes of gynaecomastia, often hormonal or due to drug use (both prescription and recreational).  If your General Practitioner suspected that it may have been hormonal then he or would probably have done a blood test to see if your testosterone levels were in the normal range.  If those results gave any cause for concern, then you would have been referred to an endocrinologist (sometimes a urologist) for further investigation.  But it seems that like me, just unlucky and grown up with female-like breasts.

Hope that helps a little.

[radio-boy]

Thanks Phantom, you are the man.

Well my Doc said he would refer me to a breast surgeon because he/she will be more "cosmetically aware" than a general surgeon.

To be honest, the thing that scared me the most was that a surgeon would have NEVER doen a MCR before. I guess i will just have to speak to the surgeon about their past experiences. I can definately tell that there IS gland, so i guess if i make it pefectly clear that the gland is a problem, i guess they will be more aware that this is an important issue for me.

You have put my mind at rest with regards to the tests at least. Thanks again.

[radio-boy]

Oh, and im just guessing here, but i think my Gyne is a result of 3 years at university and all the alcohol that comes with it  

[Hypo-is-here]

radio-boy,

You REQUIRE hormonal testing by an endocrinologist in the UK before you have any surgical procedure.

It is VERY important that you have this done.

Only by having such pathology can certain underlying conditions be ruled out.  People who have these conditions (25% of men with gynecomastia) have a real possibility of gynecomastia returning post op if these conditions are not diagnosed and treated.  Furthermore some of these underlying conditions are serious and need to be diagnosed and treated in their own right.

So as routine practice you need to see an Endcocrinologist and have these conditions ruled out.

Phantoms post was excellent but I must raise issue with the information on the importance of seeing an endocrinologist and having hormone pathology;

Hello radio-boy.
Regarding tests.  They are not always important.  Most men (around 60%) have some degree of glandular or breast tissue.  Some men have varying degrees of glandular tissue and excess fat to give breast-like appearance.  On the whole this is normal and really just comes with what God happened to give you which is why it can be difficult to get MCR on the NHS and is hardly ever covered by private medical insurance.

There can be pathological causes of gynaecomastia, often hormonal or due to drug use (both prescription and recreational).  If your General Practitioner suspected that it may have been hormonal then he or would probably have done a blood test to see if your testosterone levels were in the normal range.  If those results gave any cause for concern, then you would have been referred to an endocrinologist (sometimes a urologist) for further investigation.  But it seems that like me, just unlucky and grown up with female-like breasts.

Hope that helps a little.

Phantom.

Like I say I concur with most of your post, it was on the whole VERY good and I do not want anything I say to detract from the quality of it..

However I must take issue with some of your comments.

Pathology/endocrine testing should be routine in ALL instances of gynecomastia in order to confirm/rule out various aetiologies/underlying causes of the condition.

This is confirmed by Ismail and Baths 2002 white paper “The Endocrinology of Gynecomastia”.

It is standard good practice for a full hormonal evaluation of ALL patients with gynecomastia.

25% of all those with gynecomastia have an underlying causative condition and 25% of all those with gynecomastia are taking a drug (medicated or otherwise) that is responsible for causing the condition.

Given then that 50% of gynecomastia suffers (relative frequencies detailed by Ismail and Bath) having an underlying causative issue, the need/requirement for pathology/endocrine testing is abundantly obvious.

Such testing reveals a whole host of underlying conditions in a significant minority of sufferers some of which if left undiagnosed can lead to SERIOUS consequences.

With regard to the comments about the gp and what he would have/could have tested for.

Most gps are sadly lacking in the expertise required to diagnose hormonal issues in men.

This is something that is detailed by the AACE (American Association of Clinical Endocrinologists) in their 2002 guidelines on hypogonadism (low testosterone).

I quote them verbatim.

The recognition, evaluation, and treatment of hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician.
Unquote

This fact is further detailed by the UK support group The Testosterone Deficiency Center.

It says quotes verbatim

Home page
The testing method used by the UK's National Health Service, prevents early detection and possibly prevention.
unquote


Testing Page
The potential of early detection of significant long-term health issues is an enticing prospect. The following tests can point to hidden issues which tend to be discovered later in life. We recommend early testing for prevention, rather than crisis intervention in older people, which appears to the case today.
The following tests are recommended by the AACE in their new guidelines.1
It is important to test at the same time of day.
•  Serum Testosterone - The total Testosterone produced by the body
•  Luteinising Hormone (LH) - The "messenger" between Pituitary gland and the "Testosterone Factory"
•  Follicle Stimulating Hormone (FSH) - The "fertility hormone" for men and women
•  Prolactin - Measures the Pituitary Gland Function.
•  Sex Hormone Binding Globulin - Binds Testosterone completely. Elevated SHBG can mean an underlying condition.
The new "Testosterone Profile", has the effect of redefining Hypogonadism. Instead of relying on unreliable Serum Testosterone values, other elements are included, in order to provide a complete picture.
Unquote
http://www.androids.org.uk/

At the gp level very often the doctor lacks the expertise and resources to test for anything other than serum testosterone and this is a fundamentally flawed if all those with hormone conditions are to have their conditions correctly diagnosed.

In short 10% of all those with gynecomastia have low testosterone (hypogonadism).  This is a significantly percentage of people who need to have their conditions diagnosed if they are to live normal healthy lives and if they are to be able to get rid of their gynecomastia and not see it return post op.


NOTE:
(relative frequencies as stated by Glen D Braunstein M.D in his 1993 white paper Gynecomastia and concurred with by Ishmail and Barth’s 2002 white paper the Endocrinology of Gynecomastia)  

I have only raised this as I have been fighting for the rights of men with hypogonadism and gynecomastia for the last 2 years and thought it was very important to explain the above.


P.S

Endocrinologist ARE experts in gynecomastia.  

No one else is!!!

Plastic Surgeons and consultant breast surgeons are ONLY experts in gynecomastia removal.

Neither a gp or a surgeon are experts in gynecomastia!!

This is why it is important for all gynecomastia sufferers to be referred to an endocrinologist prior to seeing a surgeon!!!

[radio-boy]

So you reccomend that i ask my GP to refer me to an Endo?

How do you think i should mention it to him without me sounding like im telling him how to do his job  

[Hypo-is-here]

So you reccomend that i ask my GP to refer me to an Endo?

How do you think i should mention it to him without me sounding like im telling him how to do his job  

A very good question and an inherent problem in making such a request.

You could say that you have had your consultation with a plastic surgeon regarding the fact that you have developed gynecomastia and that you want to see an endocrinologist to rule out any hormonal cause.

Any gp worth their salt should accept this and make the said referral.

In making the request, word it more as a stern statement rather than a question, being firm but reasonable.

If you have any difficulty let me know.

Again just to reiterate most of phantoms post was brilliant.

Pathology for the majority of gynecomastia sufferers is about rulling underlying causative conditions and is just routine.  Of ocurse the only way of knowing if you are in the majority or the sizeable minority is to have the tests.

It is better to be safe than sorry which is why I have detailed the points I have and why those professionals bodies/top endocrine sources concur with statements.

[radio-boy]

Couple of problems, i have been refered to a breast surgeon, not a plastic surgeon, so any consultation there will be based on the surgery itself, and not the underlying gyno  

[Hypo-is-here]

It doesn't matter whether you have been referred to a consultant breast surgeon a general surgeon or a plastic surgeon.

At the end of the day they are ALL surgeons and NONE are experts in gynecomastia.  They are ONLY experts in the removal of gynecomastia.

You need to obtain a separate consultation prior to any surgical procedure and you can obtain such an appointment in the manner I have stated.

Like I said if you do that and encounter any difficulties let me know.