Chest fat and gland

[mizuno]

A couple questions regarding the above mentioned topic.
If the cause of the gyne is primilarly chest fat. Won't it come back after surgery?
In my pics : http://community.webshots.com/user/gotgyne

I believe there is a combo of both. But, I'm fairly slim and I worry that after the surgery it
will come back (the fat) and store onto the chest. I can't believe it can just sit their all these years.
Or is it because of the gland in front of it causing it?

Right know I'm gong crazy because it looks and feels like it getting slight worse.

Any thoughts ?

[gettingrid]

if you do lipo with gland then fat cells are removed permanently. Adults cannot grow additional fat cells so if you gain weight there should be lower probability of putting on fat on the chest (since there are fewer fat cells to store the additional fat). So other parts of the body shd take on the fat more than the chest. Of course if u put on a lot of weight it could still happens coz they cant remove all the fat cells in the chest.

Gland excision with lipo is preferable to get a good contour. You are getting cut anyways, might as well do the lipo if you arent already

[mizuno]

Are you sure ?
I thought fat would likely return to place it was before.

[gettingrid]

yes I am sure...because they are removing the fat. The way to remove fat is to remove fat cells that grow larger as they store fat. So if there are fewer fat cells in that area, they also cannot store the same amount of fat so other cells in other parts have to take over. Of course if enough fat is put on, the remaining fat cells in the chest may store enough fat to make it look like gyne again,

[mizuno]

Any other comments ?
from the 2 regular doctors.

[puff916]

The above information is pretty much dead on.  I am in dental school and have taken years of science classes, exercise bio etc etc and what he is saying is right on.

[outertrial]

Gyne does come back sometimes but by all reliable accounts its very rare.

[mizuno]

Anymore thought or opinions ?

[gettingrid]

if you do lipo with gland then fat cells are removed permanently. Adults cannot grow additional fat cells so if you gain weight there should be lower probability of putting on fat on the chest (since there are fewer fat cells to store the additional fat). So other parts of the body shd take on the fat more than the chest. Of course if u put on a lot of weight it could still happens coz they cant remove all the fat cells in the chest.

Gland excision with lipo is preferable to get a good contour. You are getting cut anyways, might as well do the lipo if you arent already

I take this back. I was misinformed. THe correct thing to say is Adults do not grow additional fat cells *unless* there is "significant" weight gain e.g 20 pounds for a 200 pound person. However again since lipo removes fat cells and assuming 1. u put on lot of weight 2. the new cells formed from fibroblasts are uniformly distributed on your body, the area of liposuction shd have a much lower probability of growing back.

So what I said above only holds if you do not put on more a large amont of weight.

[gettingrid]

Sorry for the wrong info in case it misled people. I should have been more careful before spouting what views were posted on the Internet. The following information is gleaned from scientific journals so it has more credibility.

The number of fat cells within an adult does not usually change, except when a high percentage of the cells are completely full of fat. i.e. significant weight gain occurs. If you have reasonable weight fluctuation, the existing fat cells will grow in size but not increase in number.

A paper abstract with info is here http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=9038586&dopt=AbstractPlus

"1. Adipose tissue mass is dependent on both the average volume and the number of its constituent adipocytes. Significant alteration in body mass involves alteration in both adipocyte volume and number. 2. Increases in adipocyte number occur via replication and differentiation of preadipocytes, a process which occurs throughout life. Decreases in adipocyte number occur via preadipocyte and adipocyte apoptosis, and possibly adipocyte dedifferentiation."

This is a nice article about this topic http://www.abc.net.au/science/news/health/HealthRepublish_1317822.htm

"The finding contradicted the existing belief that human adults have a finite number of fat cells that either expand as they store excess fat or shrink as fat reserves are depleted. "Changes in fat mass couldn't just be explained by changes in the size of cells, but by their recruitment and loss""

Bottomline, if you dont put on too much weight lipo should be permanent.whew!

[DrBermant]

A couple questions regarding the above mentioned topic.
If the cause of the gyne is primilarly chest fat. Won't it come back after surgery?
In my pics : http://community.webshots.com/user/gotgyne

I believe there is a combo of both. But, I'm fairly slim and I worry that after the surgery it
will come back (the fat) and store onto the chest. I can't believe it can just sit their all these years.
Or is it because of the gland in front of it causing it?

Right know I'm gong crazy because it looks and feels like it getting slight worse.

Any thoughts ?

Gynecomastia Surgery Does Not Prevent Regrowth


I caution each of my patients that surgery does not typically stop male breast growth.  If there is a problem with growing breasts, recurrence can happen.  Any of these medical problems and or these medications can cause gynecomastia. So, if you want to get worried about regrowth, you could get yourself evaluated for each of these conditions to see if they could be a factor.

Surgery also does not prevent weight gain in the chest.  Men tend to put weight on the belly and chest regions.  I educate each of my patients that this surgery will not prevent further breast growth.  It is like changing/fixing a tire with a nail.  Fixing/changing the tire will not prevent you from getting a new nail in that tire.

I take care of many patients with gynecomastia, as many as 8 in one day alone.  With all the gynecomastia surgery I have done, it is very rare to have regrowth for patients I have sculpted.  One patient (who had surgery on only side by another doctor) came to me with pro hormone induced gynecomastia that only came back on the side that had no surgery.  His growth was massive on the one side and none on the other.  His surgery by that other doctor had left a massive crater - the skin was adherent against the chest wall with normal fat surrounding the ugly deformity.  One side looked like the deformity seen here.  The other side was almost a B cup breast so tender that I could barely examine it.  As with each patient who presented to me with current breast growth, he was referred for an endocrinology evaluation and stabilization before considering surgery.  I do not know if such radical surgery was a factor or not.   Even if it did, removing all fat under the skin just gives an unnatural look.

I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.  Any surgery technique, even radical breast mastectomy for male breast cancer can leave gland behind.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest.

You can see what I mean by fingers of gland here.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and red flag before surgery evaluation system, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention of gynecomastia, when possible, is much better.

Surgery also does not prevent someone from getting gynecomastia from gaining fat.  Men tend to put fat on the chest and belly first.  Unless all fat is removed with the skin plastered down to the muscle and fascia, and that looks terrible, remaining fat cells can put on more fat.  I have seen patients with crater defects from other doctors' surgery that when the patients gained weight, the crater walls just get deeper from the surrounding fat.

Secondary Surgery is often an option for those who had prior surgery.  Such issues are better discussed during a consultation with your surgeon or someone who can advise you about your options.  We help patients explore such issues during consultations or preliminary remote discussions.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture