How much gland to remove?

[macman213]

I'm set to go in for revision surgery on Friday (the first time it was JUST lipo, which didn't make 1% of a difference since I'm a thin guy and just made the puffy nipples more prominent). I switched surgeons to a more experienced surgeon and he mentioned that he removes ALL of the gland and then essentially tacks down the nipple with a suture (to prevent cratering). Has anyone heard of this method? Its the one concern I still have left, because it seems on this board, a bit of gland is left over usually.

Thanks in advance!

Later this week, after surgery, I'll post a more detailed account of everything, because I have learned ALOT throughout this process.

[Dr. Elliot Jacobs]

I have not heard of this method.  If indeed all the gland is removed, then a crater becomes likely.  And then to tack down the undersurface of the areola would, if I understand this correctly, create a crater.

When I am faced with a similar situation, I remove as much of the gland as possible.  If there is any hint of a crater, I will perform fat flaps immediately to fill in any depression.  The nipple should then lie flat on the chest and flush with the surrounding tissues -- then there is no need for a suture to "tack it down."

I would suggest you ask to see some photos of this surgeon's crater revision work in order to witness the success of his method.

Dr Jacobs

[MammaryMan]

I have consulted with two physicians who said that they would not remove all the tissue - for contouring purposes.
However, I am on a drug (Casodex) for prostate cancer that makes, in my case, the gland tissue grow, so
I want it all out regardless of a non-sculptured look. Maybe your doc is one I want to talk to.

[Dr. Elliot Jacobs]

Understand your concern about removing as much breast tissue as possible.  However, be aware that breast tissue -- in small numbers of cells -- is scattered across your chest.  No gyne procedure can remove every last cell of breast tissue (gland).  If anyone tried to do so, your chest would be mutilated.

Your situation is a conundrum -- no easy answers.

Dr Jacobs

[macman213]

When I went for my consultation, I sat through almost an hour of before/afters... all of which looked good. I was just confused at the suggestion that it was all removed... so I had followed up via email a few days later and was told

2.  a.  In this procedure, you are removing glandular tissue which is just hyperactive tissue that had been stimulated to overgrow via genetics/hormones.  During the procedure we remove all the glandular tissue.  There is tissue beneath the nipple that is still in place, but it is not glandular tissue.  What is left over is subcutaneous tissue which is what everyone has beneath the skin. 
b. What you do is tack down this tissue using suture to prevent indention of the nipple because you don't want a divot or indentation (concavity) below the nipple.  We want it to look natural and full. 

Does this help clarify?

[Dr. Elliot Jacobs]

Sorry -- it is confusing to me as well.

Dr Jacobs

[fguss01]

Understand your concern about removing as much breast tissue as possible.  However, be aware that breast tissue -- in small numbers of cells -- is scattered across your chest.  No gyne procedure can remove every last cell of breast tissue (gland).  If anyone tried to do so, your chest would be mutilated.

Your situation is a conundrum -- no easy answers.

Dr Jacobs

Not hijacking this thread as I think this will be interest to the OP - if just a few cells are left can they grow back into significant gyne?

[Dr. Elliot Jacobs]

You raise an interesting question -- the answer is that no one really knows.  However, if one applies common sense, one would think that if 90% of the breast cells were removed, then the chances of major recurrence would be 90% reduced.

That is the thinking when women (think of Angelina Jolie) have a prophylactic mastectomy to remove most, but not all (that would be impossible) of their breast tissue.  And long term studies have seemed to back this up.  Women who have had prophylactic mastectomies do seem have a lowered risk of breast cancer -- even if they have the genetic predisposition for breast cancer.

Would it be the same reduction for men as regards recurrence of gyne (ie not breast cancer)?  No one knows.

Dr Jacobs

[fguss01]

Thanks for the honest answer - this seems to be something of a puzzle.

No-one seems to know how long the florid phase of gyne lasts and what signals the tissue to stop developing. Equally if surgery is attempted there seems to be no clarity as to whether the remaining glandular tissue will just develop a little more or grow to replace the tissue that has been excised.

So, it feels like a bit of a gamble really if surgery is to be attempted during the florid phase - I am 2 years in with tender growing gyne and will probably seek surgery later this year despite the fact that it is still growing.

All hormones are normal range and I am under the care of an endo so checked all the obvious things...

What did interest me in your post is that you appear to have a technique for removing most of the gland in cases where the tissue is potentially still growing which pre-supposes that you must operate on patients in the florid phase?

thanks again for the responses,
Best regards

[Dr. Elliot Jacobs]

I usually do not operate on someone who has active growth going on.  On the other hand, sometimes a patient complains of tenderness -- which sometimes is associated with growth and sometimes not.  In these cases, I will operate on them but with a caveat that re-growth is possible (so far that has not occurred) and that there may still be tenderness after surgery (so far there has been minimal to no tenderness).

Dr Jacobs