No Excision

[Island Guy]

Hi all. I'm new here, so hope I'm posting this in the correct section. I'm 54 years old, 200 lbs 6'1". Had gyne for about 30-35 yrs. During that time I've been thin (175 lbs) and heavy (225 lbs) and now am in the middle (200lbs) Gyne has been the about the same throughout all those weights. Went for a consultation and he said from the feel that they're a  combination of  gland and fat  and would need a combo of excision and lipo. From what I read here, determining gland vs fat by feel or any other method is impossible so I'm not sure how reliable that diagnosis is. I have a price of $4400 for the combo procedure.  I have no problem with the lipo but  but have decided that I will not go through the excision process. So I'm still considering the lipo part of it without the excision. My questions;

What are the chances that I could end up looking worse than I do now with just lipo?
What are the chances that I will see some improvement with just lipo?

If I pay $4000 to do just the lipo and have little or no results ,I'm fine with that. My only concern is possibly looking worse.

This is a great forum for information on this topic and would be very interested in all your comments.

http://img682.imageshack.us/g/p1030422c.jpg/
http://img243.imageshack.us/i/p1030423q.jpg/  

[wantridofgyno17]

Ofcourse you can determine whether there's tissue by feel, you can FEEL the tissue.. If you're trusting him to do your surgery, I'd trust what he tells you he needs to do. If you don't trust him, find a surgeon you do trust.

Judging by your pictures, I'd say there's almost certainly tissue there, that doesn't look like just a fatty chest. Get it done properly or not at all, why throw $4000 the toilet for nothing? If you're that keen to spend $4000, feel free to send me it.

[DeeDubStyle619]

$4400 is not too bad. Why dont you want to go through with excision? Especially if its $4000 for just lipo. From my understanding, if he were to perform lipo only, you could be left with a case of puffy nipples, depending on how much gland is there. I think lipo alone will make you look better, but for optimal results, excision would be necessary.

[Paa_Paw]

It would be rare for the breast enlargement to be due to fat only. The more common thing is for glandular tissue to be threaded through the fat. Lipo is not effective at removing anything other that fat, excision is needed for the fibrous glandular tissue.

If you are wise, you will leave the option open for the surgeon. Insisting on Lipo only would be comparable having a Michelangelo do his sculpting while wearing handcuffs. Don't set limits or conditions prior to surgery if you really want the surgeons best work. If you are not inspired to place that much faith in the surgeon, find a surgeon you do trust.

[Viking75]

I would be realy surprised íf you get away with lipo alone. your chest looks alot like mine besides I can se that your right one hangs down more then the other. Dont limit your self to the lipo alone you will sertanly regret it.

[Dr. Cruise]

Looking at your pictures it is clear that you are in good shape. You are not significantly overweight, this leads me to believe your gyne is not caused by a predominance of fatty tissues. It has somewhat of a round contour which is indicative of breast tissues. As you pointed out it's impossible to say for sure. Liposuction alone in patients with significant amount of breast tissue will make the volume decrease, but will most likely become more like a puffy nipple. By definition of puffy nipple it's almost all breast tissue with very little fat.

My strong recommendation would be to have the glandular excision in addition the liposuction.

Here is animation showing the gynecomastia surgery

[Island Guy]

Wow thanks for all the replies already!

 Just for the record, I've researched this subject heavily and know that excision/lipo combo will produce the best results but I will not do the excision. It's either lipo only or nothing at all.

There seems to be some conflict on whether or not gland can be differentiated from fat by feel. Several of the doctors here say they can't tell even with all their experience, several other people say you can feel the difference. If there was a way to tell beforehand, I would know for sure what to do.

As I said, I'm fine with less than optimum results by using just lipo, I just don't want to look worse. The general consensus so far seems to indicate I'd end up with puffy nipples instead of the breasts I have now by using just lipo. If that's true, I guess the question I then have to ask is will puffy nipples look better then what I have now.

[DeeDubStyle619]

Is there a particular reason you wont do excision?

[Island Guy]

Is there a particular reason you wont do excision?

Scaring, healing, recuperation time, complications. Mostly scaring. Look at the scar on the center of my chest. That was from a cyst removal about 5 months ago. The surgery was performed by a well regarded plastic surgeon in the area instead of a general surgeon so that scaring would be minimal.The scar is now what they call hypertrophic and will need some injections and cremes to try and get it to look somewhat normal, but I'm told it may never look right. Obviously my skin doesn't heal well. If I were to have those kinds of scars on my nipples after excision, I'd look like a freak.

[wantridofgyno17]

Is there a particular reason you wont do excision?

Scaring, healing, recuperation time, complications. Mostly scaring. Look at the scar on the center of my chest. That was from a cyst removal about 5 months ago. The surgery was performed by a well regarded plastic surgeon in the area instead of a general surgeon so that scaring would be minimal.The scar is now what they call hypertrophic and will need some injections and cremes to try and get it to look somewhat normal, but I'm told it may never look right. Obviously my skin doesn't heal well. If I were to have those kinds of scars on my nipples after excision, I'd look like a freak.

Scars are rarely very bad after the op if it's carried out by a good surgeon, as long as you massage the area and have a good diet post-op, the scars should heal fine. Also, due to the fact that the usually make the incision for excision around the edge of the areloa, this disguises the scar, it's not like it's made in the middle of a area of skin - which is more likely to be obvious.

I think you should discuss this with your surgeon and see what he says, but imo I'd rather risk having a little visible scarring and a good looking chest, then having just lypo performed which will likely leave you with a chest which still looks awful.

[Dr. Elliot Jacobs]

If I were doing your surgery, I would be shocked if you didn't require excision as well as the lipo. 

There is no need to fear a scar from excision -- they do tend to heal very well, especially in the hands of a competent plastic surgeon.  Your fear of a poor scar based on the scar in the center of your chest is truly unfounded -- scars in the center of the chest predictably heal poorly -- with a plastic surgeon or not.  It is a very bad place to have a scar.  On the other hand, scars at the edge of the areola predictably heal extremely well.  In essence, scars predictably heal differently on different parts of the body.

I have had some patients who insisted on lipo only.  That will limit what your surgeon can do. That's like telling a soldier to go and fight a war with one arm tied behind his back -- not fair. 

If you want the best result possible, then you should have surgery with the most experienced surgeon you can find -- and allow him to do whatever is necessary to get the job done.  Otherwise, don't have the surgery and live with it.  I have had too many patients who had lipo alone and then regretted it.  They then needed revision surgery (including more lipo and excision) to get the job done right.

Dr Jacobs

[Island Guy]

Thank you for your reply Dr Jacobs. That gives me some relief regarding the scaring. Circumstances bring me into your area every now and then. If that happens anytime soon I will call you for a consultation for sure. In your opinion, using just lipo, would I look worse or is there a good probability of me looking even slightly better?

 

[Dr. Elliot Jacobs]

Doubt if you would look worse (unless the doc screwed up the lipo -- which is possible -- I have seen that).  But you may not look substantially better -- and you would have spent some previous dollars seeking improvement -- which would have been wasted.

Dr Jacobs