Surgery and treatments didn't work - what are my options?

[Zim]

Hello Doctors,
Hoping to get some advice here as I'm at a bit of a loss. I'm 28, I have idiopathic gyno, started a few years ago for seemingly no reason, did not take any drugs/normal weight etc. have had multiple blood tests and everything is normal. Its always been painful gyno too, constant tenderness and aching. Have tried all the SERMS/AIs and Danazol with no success. Had gland removal, everything seemed ok for a few months post-op then the pain started again and the gland is just growing back, its at pre-op size again now.
Now, I suppose my only option left is basically a masectomy? Removal of the entire nipple areola complex?  I understand any "normal" gyno procedure leaves a tiny bit of gland connected to the nipple, for the nipple to survive, but I assume in my case, any leftover breast issue will just grow back again.
My results from my first surgery were very cosmetically pleasing, undetectable in fact. I assume my breasts are going to get permanently scarred/messed up bad with the procedure I'll now require?
Thank you in advance for any help you can give me

[Dr. Schuster]

Unless you have as yet an undiagnosed cause for your gynecomastia, the breast tissue should not return after properly performed surgery for idiopathic gynecomastia. Either see an edocrinologist or an experienced gynecomastia surgeon. I would doubt that you need removal of the nipple. You could also try Vitamin E, Primrose oil, and reduction of caffeine to help with the pain.

[Zim]

[quote author=Unless you have as yet an undiagnosed caue for your gynecomastia, the breast tissue should not return after properly performed surgery for idiopathic gynecomastia. Either see an edocrinologist or an experienced gynecomastia surgeon. I would doubt that you need removal of the nipple. You could also try Vitamin E, Primrose oil, and reduction of caffeine to help with the pain.
[/quote]


But a small amount of breast tissue is always left during surgery right? For the nipple to survive. That's what happened after my last surgery, the tiny amount of tissue left behind just started growing again. As I understand it, its almost impossible to remove absolutely all tissue during surgery.

[Dr. Schuster]

Yes a very thin disk of breast tissue is left directly beneath the nipple but it should not "grow" unless it is being stimulated hormonally. That's why you need to get a good work-up. If the work up is normal the thickening you are getting iss probably just scar tissue which could be treated with steroid injections.

[DrPensler]

post some photos

[Litlriki]

The amount that's left behind can be minimized as best possible, and if the thin disc of tissue that's left results in a depression, small fat flaps can be used to support the areola.  It's possible for small remnants of breast tissue to recur into a small mass--I've seen that before, and the remnants can be  peripheral.  
I'd be interested in seeing some photos if you can post them.