Who has had Surgery on the NHS?

[radio-boy]

It seems that most people on here have gone private, which is really what terrifies me.

I have been refered on the NHS, but to be honest, im not 100% sure i want the surgery. Well i am 100% sure i want it, just not on the NHS.

The thing is, im nowhere near affording to go private. Having not long finished my university course, my debts are already rediculous without taking another loan.

All i really want is some reasurrance that the NHS is capable of doing this op, convincingly, without any cosmetic mess ups. All the warnings of sunken chests, scars etc arent exactly inspiring confidence.

Bottom line is, im terrified.

[phantom]

Hello radio-boy

I assure you, there are all kinds of reasons why some of us went private - and it is not essentially to do with the ability of an NHS Surgeon.

I decided to go for surgery two years ago, but not until I had proved to myself that I could loose appropriate weight (to prove it was not a weight issue).  I could have gone down the NHS route, but knew that once I was on the waiting list, I'd have little incentive to loose weight.

Fortunately, my student days are a few years behind me how (ten in fact) and have pulled through my debts.  I spent the last two years saving £4,000 for surgery.  Going private meant that I'd have no problem shopping around for a surgeon, making a decision and going for it at a time that was convenient for me.  It also meant that I'd have stronger grounds to go back if I had any concerns or complaints about the work that had been carried out.

There are very few guys that have had surgery that are absolutely delighted with their results.  Rather, we generally express how near to being our ideal we are.  I am 3 weeks post-op and peg my improvement at 70%, which is ok.  I don't recall any NHS patient on here being devastated or reporting a botch job.  NHS surgeons are as qualified as  non NHS.

The difference is, you find that on the whole, NHS surgeons usually have a much higher caseload of female patients for reconstructive surgery, such as mastectomies, reductions and augmentations.  All of which are very different procedures to male chest reduction/sculpture.  They might do between 3-6 MCRs a year compared to a private surgeon such as mine (Mr Levick) that does nearer 80 such procedures/year.  Mr L probably does more of this kind of surgery than any other in the UK, which is probably his biggest selling feature.

You have a choice.  You can wait and save (or take a loan) for private, or in the meantime progress through with the NHS.  Go and see the surgeon when your appointment comes up and tell them about your fears.  Ask them what they think is a realistic expectation for them and you.  Ask them how and what they will remove from you.  Will they focus on just fat, or fat and gland.  If they say they won't be excising gland, ask them why when you know of other surgeons (like Mr L) remove as much as they can.  Ask them where you stand if after surgery there is still a significant problem.

Believe me, despite using Mr Levick, I was terrified just before the operation.  But I kept reminding myself that whatever the result, it was highly unlikely to make me look worse - in the least I'd be able to wear clothes without feeling self-conscious.  Everyone is frightened because it's an unknown path.  You choose whether to take the risk or not.  But by far, most guys, whatever the result tend to be happier than before the surgery.  The more you can learn about your surgeon and the more questions you ask him or her, the more confident you will be in knowing if they are the one for you or not.  If money was an issue for me, I know I'd use the NHS.

Don't be afraid to ask all the above.  A good surgeon will understand and want to put your mind at rest.  Even after that consultation, you don't have to go through with the surgery if you are not happy.  Go back to your GP and explain how the consultation goes.  If you are not happy, you GP may be able to refer you to another surgeon.

I think if I had had the chance around your age, I would probably have gone via the NHS.  But I'd imagine my GP would have laughed me out of his surgery back then.  It's only in the last five years or so this issue and how much it affects us is comming out which is why it has been a little easier to get referrals via the GP.  But back then, I didn't even know my t*ttie problem even had a posh medical name, let alone getting treatment for it!

Hope that helps.

[radio-boy]

It does help, thanks.

I already have a big list of things i want to ask, including an appointment with an Endo.

Another thing is that the last time i saw a surgeon, he said i would be in hospital for 5 days....

My appointment is the 7th of march, which isnt too far away for the NHS i guess, but i know surgery will be much further away.

[Hypo-is-here]

I have had surgery on the NHS.

I do not have a sunken chest or any awful scarring.

You can get a good surgeon and operation on the NHS.

However this route is not without complications :-/

Many people face intransigent gps who do not wish to refer their patients to endocrinologists and breast surgeons.

Many men face NHS trusts who do not wish to pay for such operations.  This can mean everything from having to strongly argue your case and need for an operation to having to face psychological assessments.

Sometimes even then they are simply a ruse, an excuse as to how they can get rid of the patient without having to pay for surgery.  

I myself was sent for such an assessment and was told I had no psychological justification for surgery.  This was despite the fact that I was refusing free holidays to hot countries due to the problem, avoiding most social gatherings and becoming a virtual recluse.

My eventual surgeon at a different NHS trust told me that such assessments were ridiculous, that I blatantly had gynecomastia and that I shouldn’t have had to endure such a situation- that it was about cutting costs and nothing more).

If you don't get an awful gp old fashioned gp and you get a referral and you don't face an unwilling trust then you still face other problems.

Waiting times are inherently longer on the NHS.  Even when a procedure is booked, the strains placed on the NHS mean that it can be cancelled due to emergencies and put back a number of months.

Surgeons on the NHS typically deal with female breast cancer and masectomies, these are very different issues which do not really prepare or qualify them for this type of surgery.  There are also general surgeons who do this work, some of who know very little about what they are doing :-/

Now no one is going to want surgery from a surgeon who has little to no experience in this area, so this is a massive problem.  Especially when you think that private plastic surgeons like Levick are very experienced with such procedures and have a great deal of in-depth knowledge when it comes to obtaining good results.

So even if you are granted the operation on the NHS you still have to carefully vet your potential surgeon (something you can only do by gaining a lot of information and knowledge about gynecomastia and the issues surrounding these surgical procedures).

Having overcome many, many hurdles you may get this far and then maybe even then have to say;

"you know what I do not feel comfortable having surgery with you as I do not feel you are experienced enough in this given field of surgery, can you refer me to a fellow surgeon with greater experience in gynecomastia procedures".

And doing that can sometimes mean you are told a blunt no and that can mean starting the whole process again with your gp and gaining a referral to a differing NHS trust.

If you are not put off by all those potential problems  

I have experienced all of the above.

Then you might want to go ahead and go the NHS route.

Of course you could be lucky and experience none of the above, but my guess is you will experience at least some of these problems and maybe other ones also.

I finally reached the promised land of speaking with a competent NHS breast surgeon who had experience with these procedures who gained my confidence/trust after passing my intensive hardboiled questioning.

The fact that my surgeon was very friendly, open to discussion, transparent and honest in all areas of questioning and had experience with these procedures meant that I was finally able to say lets run with this.

My procedure was on the 13 of December just gone.

I have a good result by my standards although I must say that these things are very subjective and it is possible someone else would be more body conscious than myself.

If I had my time again and I and I had the money I would 100% go private as the psychological hardship of having to argue and fight tooth and nail was very troublesome and I think the whole experience and result going with the correct private surgeon ensures a greater likelihood of a positive result.

That said I am happy, very happy with my new chest and VERY thankful it is all over.

If you really don’t have the funds you can reach the promised land via the NHS as well, but it can be a very tough journey.

I hope this information helps.

[radio-boy]

Wow, top, top post there mate.

Well my GP was very good. He is an old guy, but has refered me straight away with the minimum of fuss. I already have a reasonable list of questions, these are:

Where will you make the incision?

How big an incision?

Scarring?

Can i see an Endo first?

Will you be removing gland and or fat?

I have read in many places that on the NHS, the operation done on men is performed by plastic surgeons, is this true?

Results expectations?

I dont think i will ask about previous experience, as i dont want to undermine the surgeon. This is all assuming that he agrees that i have a problem and will operate!

How long were you in hospital for hypo?

[radio-boy]

Also, can i ask where your surgery was done? its ok if you dont want to answer that.

[Hypo-is-here]

You don't want to give the surgeon too much of an idea as to the answers you are looking for in the questions you ask.

Therefore it is probably better to let them state how they would perform the surgery first.

You should ask what the name of the type of incisions/procedures that they are contemplating in your case.

I played it that way and my surgeon started talking about glandular excision via the areola.  As soon as she stated this I knew that this was in keeping with one of the major techniques used for removing glandular tissue.

It let me know that at least in theory she knew what she was talking about.  had she have spoken about anchor scars I would have known that her knowledge was outdated, if she had spoken about liposuction only I would have known that this often leaves behind glandular mass and her knowledge was questionable.

By the way the other accepted modern method of glandular excision is via the armpit, although I think this is more specialized and more difficult to obtain a good result, so I would say this technique is perhaps best left to those in private practice who undertake many of these procedures.

On the NHS I would be looking to hear the words glandular excision via the areola or a physical explanation of such.

With the knowledge I have aquired I also said that given I had fat around the armpits that could not be targeted via nomal weight loss (you cannot localize fat lose) that I would also benefit from liposuction as well.

I persuaded my surgeon that this was a course of action that I thought was not only worth while but very important in order to achieve a good result.

Because my surgeon was very open minded and not at all egotistical or dogmatic she agreed.  At this point I knew I had in place a standard procedure that many top surgeons perform and I knew I had a surgeon who I trusted in terms of her attitude.

When she went on and stated that she had performed over 80 gynecomastia operations I knew that whilst I might not be stood in front of a private surgeon who deals with these operations day in day out, that I was stood in front of an experienced, able surgeon with a fantastic attitude.  I made enquires around the hospital and the information that kept coming back was that she was very good at her job.

My surgeon has since told me that I was correct to ask for the liposuction and said that it has indeed given me a better result.

I was right, but I would/could not have been so if my surgeon didn't have such a superb attitude and have been able to react in a positive manner to my claims.


Remember if you have fat as well as gland then you need liposuction as well as glandular removal.

Liposuction often does not remove glandular tissue, so I would say presume that there is gland there no matter what anyone says and insist on glandular exicison with or without liposuction.

I say this because you only want to go through one procedure.  And the fact according to even the top private surgeons- they do not know the exact nature of the mass until they have it in their hands- it is educated guesswork based upon the contour of your chest and not a lot more than that given;

fat can be firm even though it is usually soft and gland is usually firm but can also be soft.

This is just from today, I have seen many such postings that result from men unhappy with having liposuction alone

here's my case. igot lipo done last yr and to be honest, not very happy with the way i look . i still have one side a little protruded but when its cold, its kinda ok.

i think i might go for a revision. im sad and depressed and cant concentrate on anything..

In terms of questioning- Do not be afriad of offending the surgeon!!!

If they are so precious that they are offended by your questions then they are egotistical and not tansparant enough and you can't really trust what they have to say to much- something that doesn't instil confidence.

This is your body you will be talking about and you have a right to ask pertinent questions.

Make sure you ask how much experience they have with such procedures and even ask if they are willing to show any before and after photographs.  This IS something that NHS surgeons sometimes have.

I was asked if I would have photos taken that my surgeon could use and one of the options when signing for them was;

Can they be used to show other patients?

Of course I ticked that box when signing for them so that my photos could help future fellow sufferers.

Remember, it is better to go all the way back to the gp level and get a referral to another NHS trust than opt to go with a surgeon that you do not have confidence/trust in.

Last of all- ask your gp for a referal to an endocrinologist now so that the hormones are checked prior to having surgery.

I had surgery in Liverpool

P.S

This post has meandered a bit but I hope there is enough information in it to help.

[cozzo]

I made my initial enquiry about my gyno last June and was referred to see a breast surgeon, I finally saw the breast surgeon in October, where I had to undertake some blood tests and have an ultrasound on my chest. I was told that, its mainly fat and there is some breast tissue on the LHS. Then I was told that I would be referred to a Plastic surgeon for a consultation..I seriously thought that I was lost in the system, because I hadnt heard anything by Jan of this year. Eventually a letter comes in the post, saying I have an appointment for the 28th of Feb..To be honest if its mainly fat then I would prefer the lipo option..

I just wanted to know is how long (on average) is the process from being referrred to actually having the surgery?

[Hypo-is-here]

But cozzo there is absolutely NO possible way that ANYONE can say whether or not the gynecomastia is fat or glandular until they have it in there hands-

NO SURGEON CAN TRULY TELL!!!

This is according to the top plastic surgeon Dr Bermant.

And if you get lipo only and there is gland there you will require a second procedure.

Do not believe the NHS if they do an ultrasound either as this only picks up the dense form of glandular gynecomastia and not the form where fat is interspersed with glandular tissue.

I was told my gynecomastia was only fat.  

However my gynecomastia significantly got worse at 28 years old due to testosterone replacement therapy mismanagement where my estradiol level went through the roof.

It got really bad within a three week period due to this issue and the only way that estradiol can cause gynecomastia is via an increase in glandular mass- not fat.

Furthermore my surgeon told me my case was glandular-diffuse glandular gynecomastia.

If you or in fact anyone accepts a surgical procedure that does not involve excision there is a far greater chance of a poor result!!!

At least that is what I have seen on these boards for over two years and again Dr Bermant also says there is no way of knowing what the gynecomastia is prior to surgery and liposuction will NOT remove gland.

Get excision no matter what!

Cozzo once you get your appointment and they agree on performing the procedure they have to give you a date and they must perform the procedure within a given time frame.  If you phone the hospital involved and ask to speak to PALs (Patient Advice and Liason service) and they will give you the time frame involved.

It is good to know what this is as surgery can be postponed if an emergency case comes in.

[cozzo]

Thanks..Hopefully things will be clearer after the consultation with the Plastic Surgeon..I will keep you updated.

[phantom]

radio-boy

You may find this current thread useful:

http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=8;action=display;num=1138021489

[Hypo-is-here]

Well that and my case shows that that good results can be obtained on the NHS, even if our respective experiences in order to reach the operating table were very different.  

He was a lot more fortunate than myself and others in terms of the journey he had to make in order to get the operation.  But hey it is the NHS and will differ trust to trust never mind region to region.  

Hopefully more guys will have his experience and less and less have mine.

A lot of guys have had a similar experience to mine unfortunately, I know having read the stories over the last couple of years.

But hey his experience balances might out in that regard....if you haven't got the funds then you might get exactly what you need via the NHS and at least you are prepared when it comes to the possible problems along the way.

As for the length of stay he had in hospital.  It will most likely be due to the extent of the gynecomastia he had.  He stated he had sgnificant case and a lot of the guys that do, me included had fairly long stays in hospital.

My operation was 3 hours long and I was in for 5 days.

I think the drains and bleeding is at least part of the problem in significant cases, I had four drains in and they weren't able to take out the final drain until my last day in hospital so obviously I couldn't have got out any earlier.

I also had to stay in the night prior to the operation and I think this maybe a case of ensuring that you have the bed (bed management) and ensuring you are actually there- possibly a peculiararity of the NHS or at least some hospitals.

Let us know how things progress guys.

[radio-boy]

This is all good to hear. I guess i just hope that the breast surgeon is very different to the general surgeon i had last time  

Im still a tad worried that im not with a plastic surgeon. Maybe i should mention it to the breast surgeon.

[Hypo-is-here]

That's understandable.

Above all ensure that you only say Yes to the operation if you have trust in the surgeon.

As bad as it may seem it is better going all the way back to the start and getting a re-referal via another trust than going ahead with something this important without that trust.