Hello

[jimmyp25]

Hey guys, I'm new here, and I'd really appreciate some advice.  I just got done typing 3/4 page post all about my history and such, and my stupid browser timed out while I was posting so I lost the whole post, how frustrating! haha  Anyway this will be a cliffs notes version.

I've been working out for 10+ years, I do my best to stay healthy and lean.

My chest used to be high and tight", but over the past 16 months, it has started feeling real bottom heavy.

3 Months ago, I was at my wits end, I went to a srgeon who performed tumescent lipo, and removed a total of 170cc of fat from both pecs(very little).  Before starting, he told me I didnt have much fat, but he would do his best.  After 3 months of recovery, the soreness is almost totally gone, but my pecs look ZERO % better!  They are still bottom heavy, and bulge out in a T-shirt.

Last week I went to a plastic surgeon out here, who was confident he could flatten out my chest.  He told me he wanted to use general, as opposed to local, that my previous doctor used, and this would allow him to be more "aggerssive and thorough"  on any fat near the lower pec area.  He also thinks I have a small amount of gland that could be removed.  I got a good vibe from the doctor, but one can never be sure someone has your best interest at hand, when $ is involved. 

At this point, I'm really confused on what my best course of action is.  I'm terrified of spending 5k on a procedure, and going through recovery, unless there's some certainty that I can get decent improvement. 

When I palpate behind my nipples, there is no 'marble like' hard mass, but there is some fibrous tissue back there..maybe the size of a quarter.

I would really appreciate some opinions from board members, or any of the M.D.'s who frequent the site.  Thanks a bunch guys.

Let me know if I need better pics

- Jim






 

[Dr. Elliot Jacobs]

You are in great shape and honestly your chest looks terrific.  However, I have had many patients such as yourself who want absolute definition of the entire chest.  Often, there is both fat and gland present, though in your case, the fat component would probably be small.

My guess is that if additional surgery is done, it would require both lipo and direct excision of tissue.

If you have confidence in your second surgeon, then seriously consider doing it.

Dr Jacobs

[morpheus11]

I'm not an expert, nor am I qualified, but the gland looks present.  You can tell because the nipple region isn't collapsed, it's puffy.

I would look for a surgeon who is familiar with this type of surgery. 

Good luck.  Aside from that, you're in great shape, so congrats on that.

[jimmyp25]

Thank you both Dr Jacobs, and Morpheus for the thoughtful replies. 

As you said Dr, my chest is in decent shape, but I feel like I have what looks like a disproportionately large bulge on the bottom side.  Being lean everywhere else, almost accentuates the bulge there. 

When speaking with the Dr last week, I also inquired if it would be beneficial to do any type of tissue tightening to help INSURE the desired effect is achieved.  I asked about cutting a small crescent around the areola, as I've read many surgeons do.  He was open to the possibility, but didn't want to change the nipples relative location, if not needed.  Any thoughts on if something like this would be applicable to help 'tighten/flatten' the chest in my case?

Also this Dr. prefers to make the incision through the areola(not around).  He said this helps to tighten the areola, and the scar will be hardly noticable.  Through this small incision, he said he's able to tease out gland tissue in pieces.  I noticed in his post-op pics, the gland tissue is out in many chunks, as opposed to one big lump like other Dr's I've read about.  Is there any reason why this would be inherently less effective?

Lastly, I posed the question if it was possible if my chest 'felt' worse than before because I have a small amount of scar tissue from the first procedure.  The Dr. said it was possible, and If so, he would tease/cut it out while he was in there.  Does this sound credible, and do you ever do anything like this Dr Jacobs?

Thanks again, and sorry for my lengthy/specific questions.  I'm in the final hour of decision making time, and I feel fortunate to have found this site, to get some outside perspectives.

Thanks, - Jim

[DrBermant]

Hey guys, I'm new here, and I'd really appreciate some advice.  I just got done typing 3/4 page post all about my history and such, and my stupid browser timed out while I was posting so I lost the whole post, how frustrating! haha  Anyway this will be a cliffs notes version.

I've been working out for 10+ years, I do my best to stay healthy and lean.

My chest used to be high and tight", but over the past 16 months, it has started feeling real bottom heavy.

3 Months ago, I was at my wits end, I went to a srgeon who performed tumescent lipo, and removed a total of 170cc of fat from both pecs(very little).  Before starting, he told me I didnt have much fat, but he would do his best.  After 3 months of recovery, the soreness is almost totally gone, but my pecs look ZERO % better!  They are still bottom heavy, and bulge out in a T-shirt.

Last week I went to a plastic surgeon out here, who was confident he could flatten out my chest.  He told me he wanted to use general, as opposed to local, that my previous doctor used, and this would allow him to be more "aggerssive and thorough"  on any fat near the lower pec area.  He also thinks I have a small amount of gland that could be removed.  I got a good vibe from the doctor, but one can never be sure someone has your best interest at hand, when $ is involved. 

At this point, I'm really confused on what my best course of action is.  I'm terrified of spending 5k on a procedure, and going through recovery, unless there's some certainty that I can get decent improvement. 

When I palpate behind my nipples, there is no 'marble like' hard mass, but there is some fibrous tissue back there..maybe the size of a quarter.

I would really appreciate some opinions from board members, or any of the M.D.'s who frequent the site.  Thanks a bunch guys.

Let me know if I need better pics

- Jim

I do not see any contour issues on the pictures you posted. However, subtle shape issues need additional views and techniques that my Standard Revision Gynecomastia Pictures help bring out. The flexing muscles tightens the skin against the skin pushing gland out if there is enough to distort. If there is a lower pole fat excess, the flexing views and arms up overhead tend to demonstrate the difference between fat vs muscle too. Videos are even more critical of issues of the male chest.

In addition, do the pictures actually look like what you are seeing at home? Check the resource and see the instructions. For instance the holding of the camera in one hand destroys ability to check for symmetry. Still pictures just do not tell the entire story. Check out the recently added resources I added demonstrating such issues especially when too much fat is removed leaving the skin attached to the muscle. OK when looking at the sill photo, but flexing, moving the arms, the results devastated that individual, listen to his description of the deformity to understand the emotion of the issue.

This is the problem of adequate documentation and becomes an issue when too much tissue is removed. You just cannot tell if there is a problem on the images you provided.

Hope this helps,

Michael Bermant, M.D.

[jimmyp25]

Dr. Bermant, thank you very much for your reply sir.  I will do my best to take a video here, and see If that can yield more evidence for you or Dr. Jacobs to make a call with more certainty.  I would also be grateful to hear any thoughts on my secondary questions regarding optimal techinque to be used.  Ok, gonna go take a video, and see if I can get it uploaded here.

Thanks, - Jim

[DrBermant]

Dr. Bermant, thank you very much for your reply sir.  I will do my best to take a video here, and see If that can yield more evidence for you or Dr. Jacobs to make a call with more certainty.  I would also be grateful to hear any thoughts on my secondary questions regarding optimal techinque to be used.  Ok, gonna go take a video, and see if I can get it uploaded here.

Thanks, - Jim

What I answer here on a forum will be in generalities. I am glad to help a patient explore specific recommendations during a consultation or our Preliminary Remote Discussion. Any doctor giving specific advice on a forum can be establishing a doctor patient relationship. The advice is also not of much value without all of the other details we go into during this evaluation. So, putting up the documentation is a great idea to have a general discussion, but there is a limit to the value for any one specific situation. If you are interested in learning more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

I have an extensive introduction to the techniques I use for Revision Gynecomastia Surgery on my site.

Hope this helps,

Michael Bermant, M.D.

[jimmyp25]

Absolutely Dr Bermant,  I wasn't trying to get too in detail   ..I've just spent a few thousand on procedure, and consults...and I wanna know If I have legitamate reason for my distress, before I look to invest more in getting this problem solved.  To be honest, if you or Dr. Jacobs were closer, I'd much rather come to you for the procedure, as I can tell you're both experts on this subject.   Regarding your recently added resources concerning skin to muscle attachment, I can't seem to find it..is it on your site?
I'm gonna go take that video, and I fully understand the specificty of your recommendations can only go so far.
- Jim

[DrBermant]

Absolutely Dr Bermant,  I wasn't trying to get too in detail   ..I've just spent a few thousand on procedure, and consults...and I wanna know If I have legitamate reason for my distress, before I look to invest more in getting this problem solved.  To be honest, if you or Dr. Jacobs were closer, I'd much rather come to you for the procedure, as I can tell you're both experts on this subject.   Regarding your recently added resources concerning skin to muscle attachment, I can't seem to find it..is it on your site?
I'm gonna go take that video, and I fully understand the specificty of your recommendations can only go so far.
- Jim

Yes, that is where I have the resources that I have published. This site's new rules do not permit linking.

Hope this helps,

Michael Bermant, M.D.

[jimmyp25]

As you cited Doc, the site isn't allowing a direct link to video.  Does anyone else know is there a way to do a direct upload to the site?  Thanks guys.

[Dr. Elliot Jacobs]

To answer your questions directly and to the point:

When speaking with the Dr last week, I also inquired if it would be beneficial to do any type of tissue tightening to help INSURE the desired effect is achieved.  I asked about cutting a small crescent around the areola, as I've read many surgeons do.  He was open to the possibility, but didn't want to change the nipples relative location, if not needed.  Any thoughts on if something like this would be applicable to help 'tighten/flatten' the chest in my case?

At your age and looking at your photos, there is no doubt that your skin will tighten up by itself without any special treatment.  In fact, if a crescentic excision was made, it might distort the areola -- don 't do it.

Also this Dr. prefers to make the incision through the areola(not around).  He said this helps to tighten the areola, and the scar will be hardly noticable.  Through this small incision, he said he's able to tease out gland tissue in pieces.  I noticed in his post-op pics, the gland tissue is out in many chunks, as opposed to one big lump like other Dr's I've read about.  Is there any reason why this would be inherently less effective?

Some surgeons have advocated an incision horizontally across the areola and directly across the nipple itself (thereby "halving" it during surgery).  Although this usually results in a satisfactory scar, it is, in most circumstances, no better than the standard peri-areolar incision (assuming the peri-areolar incision is sutured closed with care and precision).  One can excise solid gland through either incision, however.

Lastly, I posed the question if it was possible if my chest 'felt' worse than before because I have a small amount of scar tissue from the first procedure.  The Dr. said it was possible, and If so, he would tease/cut it out while he was in there.  Does this sound credible, and do you ever do anything like this Dr Jacobs?

Since you have had prior surgery, you absolutely do have some scar tissue present -- and that may impart a "less than normal" feel to your chest. Usually this feeling will disappear very slowly over time so that eventually your should feel no difference in your chest.  On the other hand, it is a fool's errand by a surgeon to try to cut out scar tissue (except if it is in a lump under the areola) because, guess what, you will heal with more scar tissue.

Hope all goes well!!

Dr Jacobs