Surgery Blog with Pictures, Video, and Tips (Minneapolis)

[jls187]

Hello everyone.  This is my first time posting here.  I will use a timeline format. 

10/14/08 is today.

I'm 25 years old and 5"11 164lbs.  I've had gynecomatia since puberty.  It bothered me a lot in middle school and high school.  I learned to accept it after college, and I'm not self-conscious around my girlfriend of 2 years.  Like many of you, I am selective when I shop for clothing and buy shirts that 'hide' my condition.     

I'm STILL embarrassed around my family when swimming (my parents have a pool).  In addition I've become a health nut.  I have a healthy diet and get plenty of aerobic exercise.  I recently dropped 12lbs.  Problem is, as much as I get in shape, I can't look or feel in shape because of my gynomastia.  This is the main reason for my surgery.     

I learned of the surgery option 8 months ago and fought the insurance company to cover it.  They are covering 80% and I'm covering 20%.  Cost of the surgery will be between 5-7k.         

*Pre-surgery check up scheduled for 10/31/08
       Park Niccolet Clinic in Minneapolis

*Surgery scheduled for 11/11/08 (Lipo with Excision)
       Methodist Hospital Plastic Surgery in Minneapolis

1)  I will post many pictures and youtube videos throughout the recovery process. 

2)  I'm going to post tips that you should ask your doctor about before trying.  I'm not an expert.   

I attached pictures taken 10/10/08 before the surgery.  I will continue to post pre-surgery pictures and videos as well.

**UPDATE 10/15/08**
I added a -VIDEO- from my youtube account.  Check out the video of my pre-surgery condition.  This was taken 3 weeks before surgery.

http://www.youtube.com/watch?v=a7HH3FnJ_AA

**UPDATE 10/31/08**
I had a meeting with my doctor today to determine if I'm fit for the operation.  I am.  He explained how the real risk was the anesthesia and not the actual operation.  He knows of the doctor I'm using and supports my choice.  I told him that I took 'before' pictures and am looking forward to comparing them with the results. 

I have to say that I'm anxious about all of this.  Part of me can't believe that this kind of surgery is available.  The other part of me can't believe that I'm actually going through with it.  Honestly, this would have been more life changing in middle/high school when I was developing.  Now I'm comfortable with myself and my relationships.  This surgery almost feels like I'm getting even with my gyno and the pain it put me through during those middle/high school years. 

But let's do it.  I want to stop worrying about my clothing choices.  I want to stop worrying about swimming.  I want to stop worrying that my next game of pickup basketball will be shirts vs. skins. 

Sorry I'm rambling.  Surgery is in less than 2 weeks.  Stay tuned...

[Atomic6]

What was your argument to the insurance company?

[jls187]

Q: What was your argument to the insurance company?

That's an excellent question, thank you.  First I'll post what is and is not covered then talk about how I handled it.  I have HealthPartners insurance. 
_______
COVERED BY INSURANCE
Adolescent Coverage:
Unilateral or bilateral Grade III or Grade IV gynecomastia present AND:
A. persists more than two years after pathological causes are ruled out OR
B. persists after 6 months of unsuccessful medical treatment for pathological gynecomastia; OR
2. Pain due to distention and tightness from the hypertrophied breast.
Adult Coverage;
1. Breast biopsy is indicated when malignancy is suspected; OR
2. Unilateral or bilateral Grade III or IV gynecomastia present AND:
A. persists more than 6 months after pathological causes ruled out OR
B. persists after 6 months of unsuccessful medical treatment for pathological gynecomastia; AND
3. Pain due to distention and tightness from the hypertrophied breast.
Documentation needs to include 1) the type and grade of gynecomastia; 2) length of time present; 3) causes tested
for and ruled out; 4) treatments tried and 5) results of treatment.

NOT COVERED BY INSURANCE:
1. Breast enlargement that occurs as a result of a developmental condition expected to resolve with time (i.e.
adolescence).
2. Removal of excess adipose (fat) tissue (pseudogynecomastia).
3. Surgery for cosmetic reasons (grade II gynecomastia).
_______

When I asked about gynecomastia coverage the first time, my doctor submitted his notes that basically said, "This patient has gynecomastia."  My doctor was not specific enough because he did not classify the condition as Grade I-IV.  My insurance company wanted us to be a bit more specific.  In the end, I was classified as a Grade III or IV with some discomfort because of the condition.     

Here is the breakdown for gynecomastia grades:
_______
Grade II: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct
from the chest.
Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are distinct
from the chest with skin redundancy present
Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast
_______

I hope this helps!  Keep those questions coming!
 

[GRADY]

Who is your doctor?

[jls187]

The surgeon is Dr. D.e.a.n.g.e.l.i.s.  He is not a gynecomastia specialist, but is a credited plastic surgeon that works out of a hospital.  I didn't want to get this done at a private practice.  Being in an actual hospital makes me feel more comfortable.

I trust him after meeting with him twice.  The way he explained the procedure matched up with the 'right' way to do it.  He explained the liposuction and excision technique with drains.  He has many years of experience and does about 6-10 of these procedures each year.  I did not get before/after pictures of other patients, but spoke to one of his nurses about past patient results. 

[jls187]

***Update 11/05/08***

Here are my notes and tips compiled from all over the internet and these boards.  I don't want credit because many of you have given ME these tips.  I just compiled the tips I found useful.  I'll update this section as I find more tips.

Please consult your doctor before trying ANY of these tips as I am personally NOT a doctor. 

Confidence Boosters:

·   Remember to keep your chin up, you may be very uncomfortable and regret having had your surgery but in a few weeks it will be at the top of your "Best Things I Have Done For Myself" list!   

Tissue Massage

·   Do you recommend tissue massage to help with scar tissue?
a.   How long after the surgery should I wait?
b.   Can I use an electric massager?

Board Answers from Various Members
c.   You should massage these areas deeply about three times a day for about six weeks. Sometimes, patients whose skin was not firm and elastic will experience dimpling or wrinkling of the skin. These can be eliminated or minimized by massaging and early exercise.
d.   All contoured areas stay numb for four to eight weeks. Massage will help to desensitize your chest skin and nipple in order to avoid hypersensitivity or skin irritation.
e.   The most important way that a person can contribute to having a great result is by being meticulous about conducting massage.
f.   I have read a lot about scar tissue and in a couple weeks will be hitting up the steam room/sauna at the gym along with massaging the area to prevent this from being an issue.
g.   4 Weeks, I start massage to help with the swelling.
h.   Scar tissue will stick around for a few months.  You should start massaging it when your doctor allows.

Physical Exercise

·   Patients can hasten their recovery by moving as much as they can, to increase their circulation. Many will find this difficult, but should push themselves to take at least small steps. The walking will reduce your risk of blood clots. It is helpful to elevate the areas where you had liposuction, by placing pillows under those areas.
·   I would not recommend just laying around the whole week.  No excuse not to take an easy going walk around the neighborhood after a couple days of the surgery.  Any form of exercise promotes colon health along with all other health.
·   Don't try to pick something up from the ground for at least 3-4 days.
·   Your chest may feel tender, stiff and/or sore for a few days and will more than likely not want to move too much.   But, listen to your surgeon's instructions as for when you should move around for a few minutes, even if it is around your house.  Sitting around all day increases your risks of blood clots which is very dangerous, so if you have had liposuction with your gynecomastia procedure you may be asked to move about a bit.  If you have stitches they are removed within the first 5 - 10 days.  Be sure to take your required medications and follow the precise instructions provided to you by your surgeon.

Compression Garments

·   Compression Vest Garments should be worn 24 hours a day for three weeks, and then during the daytime for the next three weeks. This will help to reduce swelling, and to help shrink the skin.
·   2 weeks 24/7, followed by another 2 weeks night OR day.
·   My surgeon said 4 weeks 24/7 followed by 4 weeks day's only.  I would definitely consult your own surgeon and ask him specifically about his regimen if you're concerned.
·   Depends on how bad.  For slight gyne they recommend 6 weeks at least.
·   Under armor shirt after week 6.
·   3 Weeks, I get to remove the binder and switch to a "secondary garment", tight Under Armor.

Surgery Questions

·   Are you going to take out the gland?

Healing Lotions and Supplements

·   Ice your chest post-surgery? How much?
·   Coconut oil rub into the skin around will help heal and minimize scaring?
·   Vitamin E rub?
·   The two week mark is really insignificant.  Only thing that happens today is a switch from my daily routing of putting on neosporin to putting on Vitamin E. 
·   Vitamin C capsules or tablets, or medications such as Vicon-C to be taken a few weeks prior to surgery. This is thought to promote good healing and ward off colds. Although Vitamin C promotes healing and helps with bruising it is possible that excessive Vitamin C consumption can cause over-production of collagen (excess scar tissue formation) so adhere to your own surgeon's instructions.
·   Also, discuss with your doctor the use of arnica montana or Bromelain, a pineapple extract, for added anti-bruising and anti-swelling properties. Even drinking pineapple juice for 3 days pre-operatively is reported to help, however juice contains a lot of sugar so please abide by your surgeon's instructions.
·   Drink a lot of fluids like water and fruit juice, don't eat salt at all, eat fruits, low fat foods, don't take vitamin e, don't smoke, and don't take off the compression vest for 2 days or so, and when your do, get your quick look, take a lukewarm shower while leaving the tape on your incision areas, put garment back on and rest.

No-Nos

·   Drinking caffeine may seem like a good idea for a diuretic effect but if your body is balanced naturally and you are drinking enough water your body will expel the excess.
·   Echinacea may have a severe impact on the liver when general anesthesia is used.  Please advise your surgeon of all medications and supplements and alert him to the possible effects of herbal supplements and remedies, he may not be aware of the contraindications.

Night Before

·   Shower the night before and the morning of the surgery with the special soap.  No regular soap or deodorant and no shaving.
·   Take an antibiotic with dinner to get a jump start on killing any bacteria that might cause a post-op infection.

Day Of

·   DON’T eat or drink anything before surgery
·   Shower the night before and the morning of the surgery with the special soap.  No regular soap or deodorant and no shaving.
·   Bring a bucket or can, with a lid (like an empty and clean coffee can) and some cool, bottled water to sip and rid you of the nasty taste you get after vomiting. Besides cool water really helps keep the nausea at bay.
·   Bring a few packs of crackers to help with the nausea. Ritz crackers always seem like the best although plain saltines are fine. Low Sodium is recommended. Increased sodium levels can cause more water retention, hence more swelling.
·   Bring Nike Shorts to wear for surgery.

Week 1

·   Take your temperature regularly, a raised temperature could mean an infection so please alert your doctor to fevers over 101F.

[jls187]

***UPDATE 11.10.08***

Alright, boys.  Surgery tomorrow.  Here's the schedule!

6:30 AM
Show up to Park Nicollet Hospital in St. Louis Park, Minnesota.
Pre-surgery check:
Get changed.  IV started with medications.  Antibiotic rub to fight bacteria.  Meet with the Doctor.  Blood pressure taken.  Temperature taken.  Meet with anesthesiologist.  Get put out!

7:30 AM
Surgery.  Scheduled for 2.5 hours.  Room reserved for 3 hours. 

I'll post more later this week.  Looking forward to being in the 'after' column.  Wish me luck.

[anwar]

i wish you best of luck buddy.

[jls187]

Thanks dude.  I had surgery on 11/11/08.  It's now 11/13/08.  I don't want to type forever because I'm in discomfort, but I can tell you that I am excited to see the results.  I have not taken the compression garment off at all yet.  I can look down it to see, and it looks ok so far.  I understand that brusing and numbness are normal.  I hope to post pics this weekend.  I am not taking pain meds.  I'll know more tomorrow afternoon.

[jls187]

**UPDATE 11.17.08**
Ok time for the first real update after the surgery...

I had the surgery 6 days ago on 11/11/08. 

Week 1 Recovery Summary

Day 1 - Day 3:  Chest felt very numb and nipples looked like pink flat discs.  Was a bit worried that they didn't look like nipples.

Day 4 - Day 5:  Chest is getting a little less numb and nipples are starting to look a little better. 

Day 6:  Got my drainage tubes removed.  Nipples continue to heal.  Maybe chest is filling in a little.

I have only 3 concerns at this point.  I understand it will take time.
1)  I want my nipples to look normal.
2)  I want to get feeling in my chest back completely.
3)  I want my chest to 'fill in' a little more.  Almost too flat right now.

I have not taken ANY pain meds.  Really no pain because my chest is numb.  Getting the drainage tubes out was a real relief.  I had them in for 6 days - they were the most bothersome part of the experience so far.  BUT I'd rather have them than have to manually drain with a needle every couple days. 

My next update will contain a video and more thoughts and pictures.

Check the pics.  Let me know what you think!

[jfk8]

Especially the side shot shows how dramatic your improvement is. You must be happy! Awesome....

[john7heaven]

Great report - the end result is amazing, huh?
(My chest is bigger than yours, so I doubt mine would look as good as yours).

Regarding the worry over your nipples - logic would say if you get a postage stamp and 'flex' it in the middle it points into a V shape.

From your photos - your nipples were like this before due to the Gynecomastia, but now - they are flat!   

I'm sure they will improve and the body will heal - meaning your nipples will fill out some and become less indented.

Did the Surgeon do a nipple incision? If so, this must be the reason as well.

Good luck, i'm really happy for you and you were brave to have the procedure done, it's made a great improvement.

 

[jls187]

**UPDATE 12.01.08**
Week 2 Recovery Pictures

I'm getting some feeling back.  Some nipple sensation in the left nipple, none in right so far. 

[jls187]

***UPDATE 12.02.08***

WEEK 3 RECOVERY PICS AND VIDEO

Still not much feeling in the right side.  Some in left side.  Left nipple is starting to look a bit better.  Right looks great.  I've started putting neosporin on the incisions.

See video here:
http://www.youtube.com/watch?v=5zmxR-bk6l4

[iki4life]

wow, your gyne looks completely gone...i hope mine turns out well too...my pics will be up on monday or tuesday....seeya