Making private appoitment with PS, can someone advise on these questions

[rockstar6181]

Hi everyone,

Basically I have £1 pound coin size lumps behind both nipples(maybe a tad bit bigger on right side), I have seen 2 NHS people who have given me drugs to try cure it but dont want to put me under the knife, safe to say after trying both arimdex and tamoxifen it hasnt made any difference other than taking the pain away.

I am booking an appointment with a PS through BUPA on tuesday when they open back up after the easter break.

When I get to see the PS I want to be clear on what I want, I want to ask him to remove ALL gland and also take out any fat in there, I also want to ask him to not make any pitting in the chest and to make it look natrual.

There seems to be a bit of debate about how much gland to take out, the NHS people said even if they were to do surgey they wouldnt remove all the gland just shave a bit off, which to me felt like they were just tryingto put me off the idea.

Is it normal practice then for a private PS to remove all the gland totally 100%?

[Time_to_fix_it]

Hi Rockstar6181,

On reading your first paragraph several questions sprang to my mind which, depending on the answers, would affect my reply to you.  I did look back through your previous posts, but it just raised more questions.

1.   How old are you?  Your age may be a critical factor here.

2.   When did the lumps and pain first appear?  The timing in relation to your age is very important.

3.   You said in a previous post that the breast clinic prescribed you Arimidex, but you didn’t take it.  In this post you say you have tried both Arimidex and Tamoxifen.  What, if any, was the effect of each medication on the lumps and the pain?  These are very different medications, performing very different functions, so any effect they may have had might give a clue to the cause.

4.   What, if any, other tests or examinations have the doctors performed?  Male breast cancer is rare but I was given a mammogram and had biopsies taken of the boobs.

5.   Have you stopped taking the Arimidex and Tamoxifen, and if so did the pain return?  Pain or discomfort to the breast is for some people (including me) a sign oestradiol levels are up and that growth is taking place.

6.   Are you taking any medication/drugs at all .. including herbal?  You may already be aware that various drugs (steroids, hair treatments, anti depressants etc) can affect the hormone balance and give rise to gyne.

7.   Did you get the blood tests back and what were the results?  The phrase “within the normal range” is often used by medics who sometimes have little understanding of the balances required by the body and different trigger points for different patients.

I apologise for the questions but they are based around the need that anyone considering surgery should be absolutely sure that growth has stopped and hormone levels have returned to a “normal” balance.  The last thing anyone wants is to have surgery and then find the boobs re-grow because any underlying cause has not been corrected.

The questions in your post should be addressed to the surgeon himself once he has examined you.  There is always the chance that if too much is removed you will be left with craters; and if too little is removed you might need a revision.  Your choice of surgeon is very important.  Any PS can get in there and hack away, but if I were you I would be looking for one that does Gyne correction regularly.  He, or she, would be better placed to tell you what could be achieved and what couldn’t.  I would be asking the PS questions like:

1.  How many of these procedures has the surgeon done before?  I would want to be sure the surgeon is well experienced in this procedure otherwise I would find another.

2.   How often does he do them (different to how many, as he could have done 30 but over the last 30years)?  I would want to know if he does them regularly.

3.   Is he going to do the operation himself or is he going to supervise someone else?  I wouldn’t let anyone practise on me.

4.   Does he have “before” and “after” photos for you to see the results of previous patients?  This would give me an idea of how good he was.

5.   Is he going to remove the gland and perform liposuction to remove the fat as well?  It is pretty much the experience of patients on here that liposuction to remove only fat doesn’t give a good result.  The gland needs to be removed as well.

6.   What method does he use?  Some make small cuts around the underside of the areola to remove the gland and lipo out the fat.  Some make small incisions under the armpit to remove both gland and fat through a long canula.  Some (and I would avoid these surgeons) make large cuts across or under the boob to basically perform a full mastectomy.  Note gynecomastia reduction is NOT a mastectomy.

7.   Does the surgeon recommend the wearing of compression vests for weeks or months afterwards?  Most do, and I would want to know why a surgeon doesn’t (I’d keep an open mind).

8.   Lastly and very importantly.  If you need a revision, do you have to pay again?
  Some surgeons will include all or part of any revision surgery free (but many don't).

I would add that how you feel about the surgeon when you first meet him is important, so I would suggest you have initial consultations with at least 2.

Get back to us with the answers to my questions if you can.

[rockstar6181]

hi Time_to_fix_it, thank you for taking time to reply, I am 26 by way.

I first devloped lumps under my nipples in Aug 2006, I took a herbal testerone booster(fully legal consisting of plant herbs etc) about 2 weeks after finishing this herbal supp I got a pain under one nipple and then the other start hurting a few weeks after, my GP thought it was a cyst and refered me.

Upon seeing the first NHS professional he said if I was happy to live with it he was happy to leave it, he checked my testicles etc and asked questions anout steroids as I have a fair amount of muscle(nothing to stop trafic though). I said I wasnt happy and he gave me a perscription for Arimdex and a blood test, I intailly didnt take it but then decided too, I only took it for about 8 days then devloped flu like symptoms so I stopped, I noticed no change what so ever while taking arimdex, blood test came back showing everything in normal range, I was a bit woried as test was only just normal(result 9.5, range 8-27) however it was taken mid afternoon(3pm).

During this time I got a new job and moved citys.

I registed at a new GPs and started the process again, first they gave me a blood test which showed everything normal(test was twice as high than before, result 19, range 8-27), i was pretty worried leading up to this blood test and didnt get much sleep night before as i thought i had really low test levels etc). My GP then refered me to a local NHS professional.

He was a lot nicer than the other guy, but kind of put me off sugery, he gave me a rolling month by month perscription for tamoxfien, after about 2 weeks of taking tam all the pain went and the lumps shrunk a tad, i really thought they were going to go, however 6 weeks later it dawned on me the lumps prob were not shrinking it was just the pain wasnt there any more making them feel like they were gone etc. I got prety depressed and concerned about putting this drug into my body so I came off it about a month ago.

1 month on the pain hasnt come back and lumps have stayed the same, I feel going back to my NHS breast consaltant would be a waste of time so am looking to go private.

the PS I have in my view hs male breast reduction down as his intrests according to his profile.

As I am going to be paying for this treatment I really want it to be as good as can be andgo for total gland removal like how it was before I got the lumps.

[Time_to_fix_it]

Ok,

it is highly possible that the herbal testosterone booster you took caused your gyne.  Just because something is classed as herbal doesn’t make it safe.  I think there is little point in going into the reasons why this can happen, just suffice to say that messing around with our hormonal system is frankly foolish, but it happens a lot because people don’t realise the possible consequences.

Your first blood test did appear to show a low testosterone level but as you say it was taken in the afternoon when it should have been taken before 11am.  More importantly would have been your oestradiol level and equally important your LH, SHGB, Prolactin, TSH and FSH levels.  A calculation of Free Androgen Index is common too.

Your second blood test was more encouraging regarding testosterone levels but again no mention of other hormone results.  You will most likely have read that the balance of testosterone to oestradiol is vitally important in patients who have developed gyne.

As I mentioned before, anti-oestrogens (like Tamoxifen) and aromatise inhibitors (like Arimidex) perform different functions but there is some medical research that suggests that both of them are effective in reducing gyne if taken during the early stages of growth (the first 6 to 12 months).  After that time the gland changes texture and format and is not responsive to these medications.  These medications appear to really help but only in the early stages and can reduce, or remove completely, the need for surgery.  We are all different and we each make our own choices based on so many factors.  In your shoes I would have persevered with the Tamoxifen for a year but only under the strict guidance of an Endocrinologist.  Only after that time, if the gyne remained, would I have looked around for surgery.  I can’t tell you what you should do.  I’m just giving you a little information that you may not have been aware of.  I can refer you to medical papers if you would like to read up a little more on this.

The one thing I would suggest to you is this.  If you take the surgical route (now or in the future), please go and see an Endocrinologist first.  Make sure that you have been off ANY medication for gyne for at least 4 weeks (otherwise it will throw any blood tests the Endo will run).  He will give you a good physical, take a medical history and perform the blood tests I mention above and more.  If everything comes out fine then you can go into surgery knowing that there is little chance of the gyne growing back because of an underlying or pre existing condition.  You don’t want the damn boobs growing back again do you?

My points regarding a choice of surgeon in my earlier post would be worth noting.

Good luck and keep us posted.

TTFI