Surgeon selection & General Questions

[zolen]

Background
I'm 25, 5'7", c.150lbs with c.10-15% body fat, fit, Asian. I've had gyneo for 8-10 years already and looking to find advice on the surgery and an appropriate surgeon.

My Story
I've struggling with gynecomastia just as I started going through puberty at the age of 13. It all started as small somewhat malleable lump beneath my left nipple and shortly after my right. The lump slowly got harder and larger. I was told by my doctor that it would go away eventually and it was normal. I was told that exercise would help, but during my teenage years, I was not the lightest kid in town and the moobs didn't motivate me to hit the gym or exercise outside. Not until I was 21 that I got fed up with my weight and appearance that I decided to lose weight and see if my moobs would go away. Deep down having read a few journal articles, I knew it was gynecomastia but I was secretly hoping it would be psuedogynecomastia. When I hit the low teens in body fat, I finally admitted to myself that I had gyneo. I went to my university's med school library hoping to find alternatives to invasive surgery but most options didn't seem viable anymore - inhibitors and exercise would have only worked during my earlier years.

Questions

Out of town patients: I'm currently based in Hong Kong and looking for options to where I would have my surgery. There seems to be less anecdotes on successful surgeries in the region and less specialized surgeons with informative websites. Given the situation, I am looking to go back to the US to get the surgery. However, because of work, it is unlikely that I can return back for more than 2 weeks. What are the typical post-op procedures for out of town or international patients? What is the shortest recommended time before the patient travels on a long-haul? Is it necessary that the patients has a face to face follow-up?

Cratering: What causes cratering? I understand that most surgeons are diligent and take much precaution to prevent this, but are there patients who are more prone to this? Do patients see complications after they put on weight in the future?

Scarring: I believe that most patients talk about scarring on the surface where the incision was made - what about internal scarring? How is the that addressed?

Technique: I understand that every surgeon has their own technique based on their experience, but I haven't found any articles that does a discussion or a comparison on the various techniques. Is there a resource that I can be directed to? My concern is that if I am only left wit the option to have the surgery internationally, I hope to be able to understand what my surgeon will be doing. While the end result is what I'm aiming for, I want to make sure that I will be working a surgeon that not only has the necessary experience but will proceeding with the technique with the best likely outcome.

[DrPensler]

Basically the questions you ask are reasonable.
1) Out of town patients:
Each physician who treats a significant volume of out of town patients will have a set protocol for how they handle patients.Contact each potential physician by email and they will be happy to respond.The one caveat I can give you is a portion of the treatment protocol  is dependent on your specific anatomy.
2) Over resection and failure to treat the adjacent area are potential causes for cratering.
3) Every patient develops scar. Excessive scar formation can be a problem in most cases it resolves with time and some help with massage and /or exercise.
4)As you said if I may paraphrase,we do what works for us.Ask your surgeon about this,there is no absolutely right way to do every minute step,there are overriding principles that must be followed.

[Litlriki]

If you have family or friends in the US, it would make sense to start your investigation to see if there are surgeons in that area who focus on gynecomastia, and start your inquiries there.  As you narrow down your search, you can better address your questions and get answers that are more specific to your case.  A two week trip to have your surgery should allow more than adequate time for some recovery time and early post-operative follow up before you return to Hong Kong.  Presuming no post-operative issues, you can follow up remotely with e-mail, photos, Skype, etc. and in-person follow up if you return to the area where your surgery is performed. 

Good luck,

Rick Silverman