Cutting all the gland out?

[Bonfunkjc]

So I've had my gynecomastia confirmed by 2 specialists, and I'm now looking to go ahead with surgery. The set up all seems fine, but one thing bothers me:

The clinic states that they remove ALL the breast gland, in their words 'making sure it doesn't grow back'. This seems a bit drastic to me, particularly as I've heard about and seen the dangers of 'cratering', where the chest falls in somewhat.

Does anyone know if their technique, which removes all the gland, is a standard procedure? All advice much appreciated.

[Dr. Elliot Jacobs]

Most of the gland is concentrated under the areolas -- but it does spread out over the remainder of your chest.

Gyne is not cancer.  You do not have to remove every cell of breast tissue in order to achieve a good result.  The operation should be considered more of a contouring operation in which a lot (but not all) of the breast tissue is removed.  Remember, for most men whose gyne started in puberty, the chance of recurrence after gyne surgery is minimal (unless there are some underlying factors such as hormonal problems, side effects of drugs, anabolic steroid intake, etc).

Yes, if surgery is only directed to the tissue under the areolas, then a crater deformity is possible.  You should go over all of this with your surgeons ahead of time.  And, if possible, consider a second opinion with an experienced gyne surgeon as well.

Good luck!

Dr Jacobs

[MammaryMan]

In my prostate cancer support group, most (but not all) men have some degree of gynecomastia if they have been on Avodart and Casodex for any length of time. This includes me, and my gynecomastia is a type 5 or 6. Would removing all of the gland tissue be the only approach for me if I have to continue on Avodart and Casodex and not risk further growth? Two local surgeons said they would not remove all the tissue because of contouring aspects. Scarring and aesthetics are the least of my concerns. These things are swollen and hurt - they've go to go!

[Dr. Elliot Jacobs]

I have very little experience with this, since taking the medications is an absolute necessity.

In some ways, it is analogous to a woman who has treatment for breast cancer on one side and then requests a prophylactic mastectomy on the other side.  A prophylactic mastectomy, at best, can remove 80-85% of the breast tissue.  If one tried to remove 100% (which is still impossible), the result would be a scars and mutilated breast.  The general medical thinking is that one can remove 80-85% of the potential breast cancer and in truth, a reduction of breast cancer has been achieved with prophylactic mastectomy.  But cancer can still develop in the small amount of remaining tissues -- the patient has merely reduced the odds.

For men on these drugs, development of gyne is very common.  It can be tender and painful because the breast tissue is being stimulated to grow.  If one were to have gyne surgery, the total amount of breast tissue would be significantly reduced -- but with continued treatment with the meds, there is the very real possibility that the remaining breast tissue could be stimulated to grow, leaving you back where you started.  The only way to deal with the problem would be to cease taking the medications -- which really isn't an option.

Unfortunately, there are no real good answers for you.  Sorry.

Dr Jacobs

[Bonfunkjc]

Hi Dr Jacobs,

Thank you very much for your reply.

I would have agreed that your approach, ie leaving some of the gland remaining, would be the best option. However the consultant still believes in removing all the gland.

Do you know of any reason why they might be doing this? Is it because it could save them money, or is maybe an easier technique for them to perform?

All advice appreciated, and hopefully this will also prove of use to others interested in this specific issue.

[Dr. Elliot Jacobs]

Sorry, But I cannot answer for them.  Why don't you discuss this with your doctors and pose the question to them.  Ask them for their rationale in what they plan to do.

Dr Jacobs

[Bobby - LAgyne]

I have asked the very same question from the surgeon I'm going to have the surgery with, he said he needs to leave a little gland behind the areola for the whole chest to look normal. I asked how much is going to be left, he said he will know once he's doing the procedure. He said he will sit me up and lay down a few times during the surgery to achieve a normal looking results.

Good luck!
 

[George Pope, M.D.]

Bonfunkjc,

Have you asked your surgeon specifically about the possibility of producing a crater deformity if all gland tissue is removed?  Has he shown you photos of his patients where he has removed all of the gland tissue?  I think it's important to get several surgical opinions.  There's no rationale for removing all of the gland.  You need sufficient support of the nipple areola complex.

Dr. Pope, MD