Breast Ultrasound

[spooon]

Hi All,
Is it commonplace to have a breast ultrasound before surgery to remove gyno or pseudogyno? I do not read too many, if any, accounts here of ultrasounds done. I would have thought it was vital information to plan surgery to establish the structural mix of fat and gland but appreciate I may have this wrong.
I had an ultrasound done and there is the brief report :
Both the retroareolar regions were examined ultrasonically. There is normal subcutaneous adipose tissue in both the retroareolar regions and there is no evidence of any glandular breast tissue
I am now at a loss. I have finasteride induced breast enlargement i.e. clear appearance of gyno. I have moderate size cones of very squidgy flesh on my chest. These cones crater easily on touching. Does this ultrasound definitively say I do not have gyno but just pseudogyno? Does this change surgical management? Can I get away with liposuction alone? Is it even correct to speak in these terms? 

[Miguel Delgado MD]

This is exactly why ultrasound is not routinely done, at all; it is confusing at best.   The mix of tissue doesn't alter how you would treat the gynecomastia. he tissue is removed to create an aesthetic male chest. If you have peudogynecomastia this is due to fat only and not gland. A good history and physical exam by a gynecomastia specialist can help determine this. 

[Dr. Elliot Jacobs]

I agree with <a class="underlinelink" href="https://www.gynecomastia.org/doctors/migueldelgado/profile">Dr Delgado[/url].  I NEVER order a pre-op ultrasound unless my physical exam reveals something suspicious that must be evaluated.

Be aware, gynecomastia is defined as excess tissue (doesn't matter whether fat, gland or in 99% of cases, both) on a male chest, which causes a feminine shape.  The diagnosis is often made by visual inspection alone.  It is not dependent on the absolute presence of breast tissue.

Further, even if (such as in your case) the ultrasound reveals no breast tissue, be assured that indeed there is some there (100% of males have some degree of breast tissue) and it has absolutely no predictive value as to what would be needed during surgery.  Most of the time, there is a mixture of breast tissue and fat -- and liposuction alone is only rarely successful in removing everything so that the patient is satisfied.  Even if there is more fat than breast tissue, the fat is so very fibrotic that lipo may be incomplete.  How many times have we read on this forum that a patient's surgeon reassured them that lipo alone would suffice -- and then the patient was dissatisfied with an incomplete result.  And then they needed a revision operation, which is more difficult to do because there is scar tissue throughout the chest from the initial operation.  It is always necessary to go into surgery with the anticipation that lipo and gland excision would probably be needed.  That being said, I have my own specially designed sharp cannulas which on occasion allow me to complete the operation satisfactorily without direct gland excision.

Bottom line:  do not base your surgical decision on a sonogram of the breasts.  The presence or absence of breast tissue on the sonogram will not change the surgical plan whatsoever -- so why bother?  Do your research and visit a gyne specialist in your area or consider traveling for such expertise.

Good luck!

Dr Jacobs

[Dr. Schuster]

I agree with the others. I do not routinely order an ultrasound for the evaluation of gynecomastia. History and physical exam is enough in 85% of guys.

[spooon]

Sorry for the delay in acknowledging and thanks to all those that replied in this thread. I am sold on surgery now.