Scheduled for Surgery, but Skeptical

[DF]

Hey everyone, I'm new to the site, so I'll give you some background of my situation.

A few weeks ago, I noticed that my right nipple was tender on the top right side and there seemed to be some slight swelling (but to be honest, I had been rubbing on it for quite a while before I had a chance to actually look at it, so this might have made the swelling look worse).  I made an appt. with my family doctor and he looked at it and said it might be a mild case of gynecomastia.  He sent me to a general surgeon because he felt that they would know specifically what to look for.  I saw the surgeon last week and he felt me up and said he could feel a "knot" in my right breast and maybe a smaller one in my left breast.  He took my hand and said, "See, here it is.", but I didn't feel anything.  It just felt like skin and fat.  Nothing hard or with a shape.  Without even saying that I needed surgery, he sat down on his stool and said, "I'm going to cut under both of your nipples and remove the gynecomastia and send it out for pathology."  I was in shock to hear this, so I was at a loss for a lot of questions.  I asked him if I would be able to drive home after the procedure and while writing something in my file he said, "No, someone will have to drive you home.  Any questions?"  Then I asked when I could go back to work.  He said, "You could probably go back the next day, but you might want to take the next day off to recover.  Any questions?"  He was very short with me and ended each comment with "Any questions?", not "Any more questions?" or something like that.  I was quite numb after hearing this news, so I went ahead and scheduled the surgery. 

The next day, I started doing some research on gynecomastia and discovered that it is a benign condition that could be caused by certain medications, testicular cancer, etc.  I also looked at the pictures and could not find any that really looked like me.  I started to question the surgeon's diagnosis and was irritated with his lack of bedside manner.  I have not cancelled the surgery, but I have scheduled an appt. for a second opinion with a different surgeon.  But until then, I have a few questions that you possible could answer:

1.  Why did he not request any diagnostic testing - x-ray, ultrasound, mammogram, etc.

2.  Should I see a endocrinologist before the surgery?

3.  Why was he so eager to do surgery?  Why would that be his first option?

4.  Is surgery really necessary?  I do not feel what he is talking about.  I have gained a considerable amount of weight over the past five years (30+ lbs) and I know my boobs have some flab on them.  Could it just be a matter of weight gain?

5.  If I decide to not have the surgery, what will happen?  Will I end up looking like Dolly Parton?

I know my post is long, but I am scared to death and I have so many questions.  Thanks for the support.

DF

[DF]

By the way, I'm 34 years old, 5'9", 165 lbs and in average shape.

[DF]

Thanks.  I'll try to post some pictures tonight.

The gyne does not bother me.  I'm married with a kid, so I'm not trying to impress anybody.  What worries me is having an unnecessary surgical procedure that may or may not be covered by insurance.  I just think this surgeon I saw last week was way too quick to determine that surgery was the way to go. 

[TiredofIt]

If it doesn't bother you, why even consider surgery? (Especially before you try losing weight to see how it affects you.) It's expensive and completely elective. Remember, it's your body and you make the decisions. If you don't want it, don't get it!

[DF]

The only reason I would consider getting the surgery is to rule out any other conditions.  This surgeon is a general surgeon, not a PS.  I just don't know why he can't use another diagnostic tool to rule out anything worse. 

[TiredofIt]

Based on everything you've posted so far, I can't imagine why in the world surgery would be considered the next logical step. Did your first doctor understand that you're concerned for health reasons and not for cosmetic reasons?

[DF]

My first doctor didn't give me the chance to really speak.  He didn't seem too concerned with answering my questions and concerns.  I will make sure to ask all of my questions when I get my second opinion on Friday.  Hopefully they will be able to tell me if surgery if absolutely necessary to rule out anything else. 

[TiredofIt]

Sorry if it seemed like I wasn't understanding you completely; the situation just really confuses me. Do the doctor and surgeon happen to share the same last name?

Best of luck to you.

[gynogone]

So this just sprang up?  The slight gyno?  Any new drugs you are on?  Propecia can cause gyno, just like that.

Just call and cancel the surgery.  Sounds like you are being strong armed by some super ego doctor.  Just cancel it.  You don't want a general surgeon anyway, you'd need a specialist.  This guy just sounds like a jerk.

It's not trivial surgery.  I'm in a vest 3 weeks and 3 days later.  I can't work out and even a brisk walk chafes my chest.  If I had had a really mild case I would never have gotten the surgery.

IF it doesn't bother you except for health reasons go back and get a referral for an endocrinologist.  They'll at least measure some hormones.  Or maybe the general practioner can trouble shoot what could be wrong.

And NO it it most likely NOT covered by insurance.  That's about 4K out of your pocket.

And as for tests, ultrasounds, mammograms, they're probably useless.  Endocrine tests would maybe be useful.  Have you had a huge amount of growth of glandular mass in a short time?  Or is it gradual?  You say you can't even feel it...doesn't sound too bad.  Breast cancer is very rare in men...I don't know.  You may be right, maybe it's just old age catching up to you.  Old men frequently have some gyno...they were once young and didn't have any.  So it had to start sometime.

[Time_to_fix_it]

I have read your post carefully and several things disturb me.  The main one being that you appear to have only recently developed gynecomastia at the age of 34.  I take your point that you have put on weight and this could easily explain why you have developed extra flab around your chest.  However you have developed tenderness around the nipple and the doctor has found a lump.  In my layman’s opinion, this should be thoroughly investigated.  I base that opinion on my own experience which is similar to your own.  I was about 46 when one of my nipples became very tender.  Like you I thought I had knocked it and expected the tenderness to go away.  It didn’t, it got worse.  I consulted my GP who found a lump and I was sent for investigations.  When a man in middle age develops a lump around his nipple it can mean a number of things and they all need to be checked out.  I had all of the tests you list and my local breast surgeon told me it was not a cancer but a benign condition called gynecomastia.  Ok I thought it won’t kill me, but what caused it and is it going to get worse?  The same sort of questions that you are asking.

Simply put Gynecomastia at ANY age is caused by an imbalance in the androgen to oestrogen levels in the body.  That imbalance is very common around puberty and also in older age men (65+).  I won’t go into the technical reasons for this, but suffice to say pubescent imbalances nearly always correct themselves, and "older age" ones tend not to get out of hand.  However hormonal imbalances that happen between puberty and older age should ALWAYS be investigated by an Endocrinologist.  I could quote the medical papers that recommend this but it would simply make this post longer than is necessary.

There are large number of reasons why a mans hormones can become unbalanced, many of them are simple side effects of drugs (prescription or otherwise), and many of them are more complex conditions or diseases.  I believe you need to find out what state your hormones are in, and to do that you need to see an Endocrinologist (preferably one who specialises in the male reproductive system).  If your hormones are ok (and I’m being simplistic here by using the word ok), then you can consider ways of getting rid of your gynecomastia .. if that is what you want to do.  For someone who has only recently developed the condition (within the first year or so) there are other options than surgery.  But let’s not rush down that road until you get yourself checked out properly.

One note of caution .. but it is important.  If the cause of a mans gynecomastia isn’t properly investigated then surgery would in my opinion be foolish.  If there is an underlying condition causing a hormonal imbalance that isn't corrected first, then the gland could simply re-grow after surgery.

To answer your questions in order:

1.   I don’t know why the tests you list were not done. I think some of them should have been carried out.
2.   Yes you should see an Endocrinologist before surgery and as soon as possible.
3.   I don’t know why he is so eager to do the surgery.  He is a surgeon and they sometimes think that surgery is always the way to go.  I am surprised he doesn’t seem interested in why you have developed this condition at your age.
4.   Is surgery necessary?  Well that’s down to you of course and will be YOUR decision to make when you are armed with all the facts.  I don’t doubt for one minute that he can feel something like a lump when maybe you can’t.  His knowledge of anatomy and tissues etc will tell him when there is something there that shouldn’t be.  What I do doubt is his rush to surgery without knowing why this lump has appeared so recently in a man of your age.
5.   One step at a time.  Make that decision when you have the facts about what your body is doing and have spoken to an Endocrinologist

Mine is the opinion of a non medical person but I did develop gynecomastia in middle age and alarm bells started ringing in the doctors and Endocrinologists that I saw.

Feel free to ask questions.  There are some very knowledgeable people on here that can help you.  If you have problems finding an appropriately specialising Endo, then Hypo Is Here can probably help you with that and a whole lot more.  Lastly, don't worry, you are among fellow sufferers with a lot of experience.  Keep us posted as to how things go

[DF]

Thanks for your feedback.  As far as new drugs, I haven't really started anything recently.  Here are the drugs I take and the how long I have been using them:

Lisinopril/HCTZ combo pill for blood pressure - 18 months
Zoloft - 8 years
Loratidine (Claritin) - 9 years
Ranitidine (Zantac) - 2 years

I also take the following vitamins and supplements:

Vitamin C
Fish Oil
Garlic
Echinacea

Other than being scared, I feel fine.

DF

[DF]

Hey guys,

I justed wanted to update you on my story.  I am leaning towards cancelling this surgery and having some tests done before I make any decision.  I am just not very confident with the way the surgeon rushed into his decision to cut.  He offered no testing or other options.  I have a second opinion on Friday, so maybe this surgeon will offer a lot more advice.

[braveboy]

smart call,and if you do go for surgey at some point it will probaly be better handled by a plactic surgeon who performs these surgery often,also they should probaly do some lipo as well which a general surgeon will not.

[DF]

Thanks for everyone's help.  I have had so many questions since I was told that I needed surgery.  I was so shocked at first, I couldn't even think of any questions.  Now that I have done some research and received your support, I feel much better about making a decision for treatment. 

Check out my pictures and tell me what you think.

 http://www.gynecomastia.org/smf/index.php/topic,8840.0.html