Surgery preparation w/pics included!

[Ibanez99]

Hello guys,
For those of you who are already not familiar with me, here's the link to my story -

http://www.gynecomastia.org/smf/index.php?topic=20480.0

Well I talked it out with my parents and they were very supportive and agreed to get the surgery done (Thanks to Dr.Rick Silverman and Dr.Bermant for motivating me to go ahead)
I went to a surgeon last week and he examined my chest and said he would perform a lipo + excision(if needed) as he said mine is a case of fat+gland. But what he said was he would remove the glands only if it is needed and he would decide that at the time of surgery. What does that mean? Isn't he supposed to remove the glands first anyway? Confused about this :S . He said there is a little amount of gland in every male chest, it's just that the amount in which it is present is too much makes it look bad. Doctors please help me with this? Should I insisit on the glands being removed or not. I personally want to get rid of everything that contributes to this.
I got my blood,urine,pre anesthetic tests done and everything is perfect.
He's scheduled 01.06.2010  for the op.  I'm happy about this. However since I was confused about what he said regarding removing the glands so I'm going to another surgeon today for consultation to see what he has to say about it just to clear things on my mind.

I've been working out at the gym doing bench presses etc so  the upper chest has some amount of muscle as well.

I'm posting my pre-op pics here, please have a look
front view 1- http://i1021.photobucket.com/albums/af336/ssssdddd/Photo0025.jpg
Side view: http://i1021.photobucket.com/albums/af336/ssssdddd/Photo0026.jpg
Front view 2- http://i1021.photobucket.com/albums/af336/ssssdddd/Photo0027.jpg

thanks for reading,
Sid

[Dr. Elliot Jacobs]

Sid   Every surgeon approaches gynecomastia surgery differently.  I usually do "aggressive" lipo first because in many cases that is all that is needed.  I then evaluate during surgery and if  gland needs to be excised, then I do so without hesitation.  This graduated decision making process during surgery is common to all operations and all surgeons.  Some surgeons call this a dynamic technique, but it is all the same. This surgical approach is, I believe, similar to the one that your surgeon has proposed.

Other surgeons approach gyne surgery by performing gland excision every time and then using lipo to smooth out the edges (surgeons call this "feathering").

Either method will work -- what counts is the final result, which should be a smooth contour and which should be consistent with your surrounding tissues.

One thing you should be aware of:  gyne is a condition of excess tissue (usually breast and fat together).  The presence of breast tissue is normal in all males.  One need not approach the operation in fear that "some breast tissue might be left behind."

Hope this allays some of your fears. 

One more thing -- make sure you check out your surgeon carefully and be sure that he has significant experience in gyne surgery -- there is truly a difference.

Best of luck to you!

Dr Jacobs

[Ibanez99]

Thank you for reading and replying Dr. Jacobs.  My surgeon said that after op there will be a drain pipe attached to my chest for a day or so. Is this normal? I mean surgery without drain pipe aid is better than the one with it? Or is there no such difference.  Please enlighten me on this.

Thanks again
Sid

[Dr. Elliot Jacobs]

Drains may be thought of a "safety valve."  Each surgeon uses them according to his training and according to the actual conditions at the time of your surgery.  Drains can and will reduce any fluid or blood which might accumulate after surgery.  In addition, one might have to remain on antibiotics while the drain is in place.  Some doctors leave them in just overnight -- and others for a week.  Again, it varies with their training and the actual situation.  One must remember that drains are a two way street -- they can remove fluid from inside -- but they can also allow germs to enter your body.  Therefore, the use of drains must be carefully monitored by your surgeon.

In my practice, with the techniques that I use, drains are used only extremely rarely -- perhaps once or twice a year.  The surgical techniques that I use, the very careful stoppage of any bleeding during surgery and the compression garments applied after surgery all combine to make the use of drains very rare in my practice.

However, there is no right or wrong with drains.  Again, what counts is the final result.

Dr Jacobs

[Ibanez99]

Thanks again Dr. Jacobs

He did mention the compression garment. But the second surgeon I consulted with mentioned no drain pipes ,he said only a compression vest will be there.
 I'm rather confused which surgeon to go for. Tomorrow I have my second consultation with my surgeon. Can you help me with what questions should I be asking him ? Things I have jotted down-
1. Will there be any crater deformation?(A dent )
2. Will I get a completely flat chest or there would still be some flab left
3. When can I resume gym after surgery

Am I missing out anything?
One more confusion I have is regarding this- When I asked my surgeon if there are chances of the condition reoccuring after surgery or fat deposits taking place in the chest again after operation? he said something like he can't assure me if it will reoccur or not but it usually doesn't and also said if I start eating butter,oil etc then fat deposits might take place again.

However when I asked the same question to  the second surgeon he said it can never reoccur after surgery once the glands are removed because during liposuction the fat cells are suctioned out and fat cells are fixed in number in an adult, they just swell up when we eat fatty food so once they're removed there is no way my chest is gonna be the same again.

I'm rather confused what to do.  Both of them are highly qualified and experienced in my opinion.

Please throw some light on this
Sid

[90293]

It might help if you shed some light on who the PS's are and what area you are looking in. I did a lot of research before I proceeded with my surgery. I spent a year reading and learning as much as possible. I saw over 5 different PS's. I finally settled on a PS who I felt comfortable with. And yes, the less experienced surgeons wanted to use drains, but my PS was very skilled and did not use drains. Your pictures are a little blurry, but it doesnt appear that you have a bad case of gyno.

I'd suggest you write down a list of questions you want to ask every PS and also look at pictures of the procedures that they have done.

I am only about 4 days post-op, but I am happy with my choice...zero bruising, very little swelling, and the PS was very responsive; answering all of my questions and calling me after my surgery.

You really only want to do this once, so find the person who is the most qualified and who you are most comfortable with.

[Dr. Elliot Jacobs]

1. Will there be any crater deformation?(A dent )
2. Will I get a completely flat chest or there would still be some flab left
3. When can I resume gym after surgery

A crater deformity is due to overzealous removal of tissue.  There should not be a crater deformity when the operation is completed.

Usually, the skin will tighten.  I cannot predict if you will have any laxity -- particularly from photos alone.  One has to be able to examine you in person.

Usually, one can resume exercise within about one month -- but each surgeon's recommendations may differ.

Hope this helps.

Dr Jacobs

[Ibanez99]

Thank you Dr.Jacbos for that useful info. I had my second consultation today and he said he can't tell me if I need a gland excision or not until I'm at the op table. So I wouldn't know until I wake up whether the gland has been excised or not. This is really bothering me..He said it would be his judgment whether to excise it or not. I was told the swelling after liposuction would go away in 2-3months so if I still am not satisfied with the result and want a gland excision it would be after 2-3months of lipo. However I don't have to pay anything for this surgery as it is through defense hospital and my father is an ex-defense officer so it's free for me.
However the second surgeon I went to who's a private PS (I have to pay for this but my parents don't mind paying if its the best for me) he said I won't be needing a revision surgery and he would be performing lipo+excision in the first go and that 80% of the cases do need an excision.
I'm just confused which one to go ahead with.

Sid

[Dr. Elliot Jacobs]

Both surgeons seem to have the right idea, but my gut feeling is (sight unseen) that I would go with the second surgeon.  However, this is absolutely your call.

Dr Jacobs

[Ibanez99]

Thanks again Dr.Jacobs. I too feel the same. I really really hope there is no need for a revision surgery with him even though he assured me it won't be needed. Cause I don't want my parents to pay for 2nd surgery! that would be alot when I can even get it done free of cost. But I felt more comfortable with the second surgeon as well. He was very casual as if it's a cakewalk for him.

Sid

[Ibanez99]

Good morning

I just had my final consultation with my first PS .I would like to type it out all that I can remember:
I: Sorry to ask you again but would you be performing lipo or excision as well?
Doc: I would be performing excision if I feel it's needed after doing lipo at the same time.
I: What about crater deformity?
Doc: To avoid that I won't be removing the gland in excess which you're forcing me to do as it causes dents and deformity of the chest. I want to give you a normal contour and not something that looks dented.
I:What if my chest is not totally flat after surgery?
Doc: There is nothing as "flat" that you can define. As I've told you some amount of gland is present in every chest and that is normal.
I: Then what expectations can I have post op?
Doc: Here are a few things you can expect-
   1. Remarkable improvement in the chest contour
   2. A chest that doesn't look as if it's been operated ,something normal.

I: What are the issues that can take place with the scar tissue?
Doc: Yes, there is scar formation in any kind of surgery and it's normal.
I: when can I expect it to go away?
Doc:  Well, normally it goes away in 3-4months, sometimes 6 or maybe upto  a  year but that rarely happens and I would also like to tell you that in some rare cases it stays forever. (ok this scared me! but I guess he was just being too frank with me and I like that )

I: How long will I have to put on the compression vest?
Doc: It varies in every case but for you I would recommend wearing it for at least 10-12 weeks or I might change that seeing your results after surgery but I recommend at least 10 weeks for better results.( My second PS had told me to wear it for 2 weeks)
I: Would a drain pipe be used post op?
Doc: It may or may not be used. We can't tell you yet. We'll decide that later whether you need one or not.

I: What are the chances of fat deposits taking place in the chest again after surgery?
Doc: This doesn't happen usually unless you gain a phenomenal amount of weight then fat will deposit in the chest as well like it would in every human being.
I: I heard that the number of fat cells are constant in an adult and once taken out (lipo) they can't form again?
Doc:  Regeneration of fat cells can take place there is no such rule that they can never regenerate but it's rare though. You're 21 ,at this age the hormones are still playing.

I: I obviously don't plan on gaining that much weight but I thought surgery was a permanent solution..
Doc: You seem to have some mental block more than gyne.(in a funny way he said that). There's been no need of revision surgery till now except for one case and I do this surgery every week or so. You sound like you would never be happy even after surgery and then you would need a psychiatrist for counselling.
(we both laughed here)
I:  No, that's not the case...I just want a totally flat chest and there should be just one layer of fat between the muscle and skin so it doesn't sink in.
Doc:  That's what we try to do but you're sounding like you're giving me a very narrow margin to work on and too many restrictions. I wouldn't be comfortable operating you in such a narrow margin. All my patients are usually satisfied and there is maybe one or two cases where I felt I could do some more so they had a revision surgery but that's extremely rare. This is a kind of surgery where the doctor and patient should be in mutual agreement and I want you to be very comfortable with me before I operate you cause you seem to have this fixed idea in your mind of having an abnormally flat chest and I want you to think some more and we can have another consultation next week so we can fix a date for surgery.
 I: I'm fine with the surgery but just needed to clear these doubts and I want the gland removed if it's needed..
Doc: (laughing a bit) I will surely do that if it's required 90% of the cases need an excision so don't worry about it.

Well that was it I guess I thanked him and left. He was pretty convincing to me this time. Maybe I;am over reacting and being obsessive compulsive about having an abnormally flat chest? In any case I don't want any deformities.(I made that clear to him)

  the doubt I have here is that when I had counselling with my second surgeon he had told me that fat cells are constant in an adult and will never come back once they're removed but this PS told me that they CAN regenerate in some cases and there's no such rule.  What's right?? Doctors please throw some light on this

Overall I was pretty convinced this time with my first PS. My dad said money is not an issue and he would be ready to pay even for revision surgery (that is in the case of my 2nd PS as I have to pay for that and my first PS i dont have to pay anything.). As my second PS said I would have a totally flat chest, however I believe he meant it would be much better and normal which is what my first PS told me. He is just a bit more frank I guess (which is nice in  a way so there's no confusion or misunderstanding)

Doctors please comment on this .I really need to decide which PS to go for.
thanks again for reading,

Sid

[Dr. Elliot Jacobs]

I read your description and both doctors appear have to have the proper perspective towards your surgery. 

It eventually comes down to you making the choice -- not a doctor on this forum.

Dr Jacobs

[Ibanez99]

Thank you Dr.Jacobs .Really appreciate your concern.
I'm still confused about the regeneration of fat cells? could you please tell me about it. Do they regenerate even after surgery or they don't.
Thanks again
Sid