why do we have to pay for revision surgery ???

[aceace]

if we already pay a huge 5000 dollars to have a 45 minute operation... and that operation is not done successfully to our satisfaction,, why do we need to spend 1 thousand or more per side for revision?

the doctor totally agreed i needed another operation and said it would only take 30 minutes this time round, he'll just cut me open and put it out.... then he says how much i have to pay... sounds ridiculous to me. pay more money to the guy that couldnt get it right the first time

[aceace]

well atleast my dentist does free revisions, so does my barber, and so does my cable guy... when you pay a company or person to do a job,, they oughta do it over and over untill the job is done correct or give the money back... if you pay honda dealership to fix your car and pay 5 grand and its not fixed then they better Refix it,,,

i think most doctors dont realize how much this effects men, even atleast 1 of the doctors on this site wont Fix his orignal surgeries and he charges about 6400

[skyhawk]

I agree! Any other business that provides a service is accountable untill the service is done correctly.

 Granted there are surgeons that will perform a revision free of charge, but there is the anesthisia and surgical center charges that remain.

I beleive that when a gynecomastia surgery fails due to the incompetency of the surgeon ( such as failing to remove gland resulting in gyne still being present) Then the surgeon should be held liable for his own mistake. Not the patient.

It should be the surgeons responsibility to make the neccesary corrections, and bear the expense of anesthesia and surgical center to correct his own mistakes.

Thats just good business. Thats the way it works at the honda dealer, the auto paint and bodyshop, Walmart, The builder of my home , and every other legitimate responsible business that has integrity. Yes integrity. The guts to say "I screwed up and I am going to fix my mistake at my expense."

[Dr. Elliot Jacobs]

Revision surgery is not always necessary.  If the operation is done properly, then there will be a smooth contour to the chest with a uniform "pinch" of skin and fat.  I do not leave the operating room unless I have achieved this result on both sides and I spend as long a time as necessary to do so.  When my patients see themselves for their first shower (at two days after surgery), that is what they see.  However, Mother Nature always becomes involved in the long healing process and some patients develop thickened, hard scar tissue on the chest under the skin and under the nipples.  In some patients it is hardly noticeable; in others it can be seen easily.  The development of scar tissue is not under control by either the patient or the surgeon nor is it a "mistake" by the surgeon. THIS IS NOT RECURRENT BREAST TISSUE!  Rather, it is thickened scar tissue and the treatment I recommend, invariably, is not further surgery but proper administration of cortisone to melt the scar tissue away.  If a surgeon does go in for a "revision" of properly performed initial surgery, he will invariably remove white scar tissue, not breast tissue. (Just have your surgeon submit the tissue to pathology and review the report -- is it scar tissue or breast tissue?) In many of these cases, the patient will have had, in my opinion, unnecessary surgery when a cortisone injection may have worked better!

This all goes to the point that the very best chance to get a good result is to consult with a plastic surgeon with lots of experience doing gynecomastia surgery.  If the initial surgery is not complete in removing tissue, then additional revision surgery is definitely indicated.  However, this is always much more difficult to do (because you have to work through the scar tissue resulting from the initial surgery) and the results are always less predictable.  In essence, you are always playing "catch-up" -- and it is NEVER as good as doing it right the first time.

My office policy:  No charge for cortisone injections or, in the very rare case, for a revision procedure (except for a minor charge for anesthesia).

Dr. Jacobs 
Diplomate, American Board of Plastic Surgery
815 Park Avenue
New York, NY 10021
(212) 570 6080

[G-Man99]

Revision surgery is not always necessary.  If the operation is done properly, then there will be a smooth contour to the chest with a uniform "pinch" of skin and fat.  I do not leave the operating room unless I have achieved this result on both sides and I spend as long a time as necessary to do so.  When my patients see themselves for their first shower (at two days after surgery), that is what they see.  However, Mother Nature always becomes involved in the long healing process and some patients develop thickened, hard scar tissue on the chest under the skin and under the nipples.  In some patients it is hardly noticeable; in others it can be seen easily.  The development of scar tissue is not under control by either the patient or the surgeon nor is it a "mistake" by the surgeon. THIS IS NOT RECURRENT BREAST TISSUE!  Rather, it is thickened scar tissue and the treatment I recommend, invariably, is not further surgery but proper administration of cortisone to melt the scar tissue away.  If a surgeon does go in for a "revision" of properly performed initial surgery, he will invariably remove white scar tissue, not breast tissue. (Just have your surgeon submit the tissue to pathology and review the report -- is it scar tissue or breast tissue?) In many of these cases, the patient will have had, in my opinion, unnecessary surgery when a cortisone injection may have worked better!

This all goes to the point that the very best chance to get a good result is to consult with a plastic surgeon with lots of experience doing gynecomastia surgery.  If the initial surgery is not complete in removing tissue, then additional revision surgery is definitely indicated.  However, this is always much more difficult to do (because you have to work through the scar tissue resulting from the initial surgery) and the results are always less predictable.  In essence, you are always playing "catch-up" -- and it is NEVER as good as doing it right the first time.

My office policy:  No charge for cortisone injections or, in the very rare case, for a revision procedure (except for a minor charge for anesthesia).

Dr. Jacobs 
Diplomate, American Board of Plastic Surgery
815 Park Avenue
New York, NY 10021
(212) 570 6080

Very interesting. Thanks.

This is the first time I'm seeing this post-op problem adress like that. I've read a lot of posters who are saying they had a flat chest a week after surgery but now have puffy nipples. So according to you that would most likely be due to scars tissue.

This is also my experience, I've had surgery, everything looked fine, then the swelling and after the swelling was done I still felt something under my nipples (but like I've said a few days after surgery I felt nothing under my nipples). Now, one year after surgery I have puffy nipples to a lesser extent then before but it's still bothering me. I hope it's scars tissues...

[jumpman23]

Revision surgery is not always necessary.  If the operation is done properly, then there will be a smooth contour to the chest with a uniform "pinch" of skin and fat.  I do not leave the operating room unless I have achieved this result on both sides and I spend as long a time as necessary to do so.  When my patients see themselves for their first shower (at two days after surgery), that is what they see.  However, Mother Nature always becomes involved in the long healing process and some patients develop thickened, hard scar tissue on the chest under the skin and under the nipples.  In some patients it is hardly noticeable; in others it can be seen easily.  The development of scar tissue is not under control by either the patient or the surgeon nor is it a "mistake" by the surgeon. THIS IS NOT RECURRENT BREAST TISSUE!  Rather, it is thickened scar tissue and the treatment I recommend, invariably, is not further surgery but proper administration of cortisone to melt the scar tissue away.  If a surgeon does go in for a "revision" of properly performed initial surgery, he will invariably remove white scar tissue, not breast tissue. (Just have your surgeon submit the tissue to pathology and review the report -- is it scar tissue or breast tissue?) In many of these cases, the patient will have had, in my opinion, unnecessary surgery when a cortisone injection may have worked better!

This all goes to the point that the very best chance to get a good result is to consult with a plastic surgeon with lots of experience doing gynecomastia surgery.  If the initial surgery is not complete in removing tissue, then additional revision surgery is definitely indicated.  However, this is always much more difficult to do (because you have to work through the scar tissue resulting from the initial surgery) and the results are always less predictable.  In essence, you are always playing "catch-up" -- and it is NEVER as good as doing it right the first time.

My office policy:  No charge for cortisone injections or, in the very rare case, for a revision procedure (except for a minor charge for anesthesia).

Dr. Jacobs 
Diplomate, American Board of Plastic Surgery
815 Park Avenue
New York, NY 10021
(212) 570 6080

Hi there Dr.Jacobs,

You mentioned "Just have your surgeon submit the tissue to pathology and review the report -- is it scar tissue or breast tissue?". How would the surgeon submit the tissue? Would the patient have to go under the knife again to determine if a revision is necessary or is this done by blood tests, x-rays or the like? My doctor did lipo and excision, however i was seeing puffiness the same day. I've never seen the nipples completely flat so I don't know if gland was left behind under the nipple or if scar tissue formed immediately after surgery? Your thoughts would be greatly valued

Thanks!
Mike

[Dr. Elliot Jacobs]

Mike

If you liked what you saw soon (days or a week) after surgery, then the original surgery probably removed whatever tissue was appropriate.  However, if you gradually lose that nice improvement over time, then it is probably scar tissue which has developed.  I try to avoid this by having my patients wear a very tight compression garment for a minimum of 3-4 weeks after surgery.  It doesn't always do the job-- but it helps.  Yet some of my patients do develop scar tissue -- is it due to poor patient compliance with my instructions or would it have developed in any case?  Don't know.

I usually try to have them massage the tissue and give Mother Nature a chance for the scar tissue to settle down.  If nothing has improved, then I will begin cortisone injections to "melt" the scar tissue.  The timing of when to do them varies with every patient.

If, however, you did not like the results of the surgery from the gitgo, then probably insufficient tissue was removed.  This would require revision surgery to remove both the residual tissue plus the scar tissue which formed after surgery.

In your situation, if the nipples were never flat, then perhaps insufficient tissue was removed. Scar tissue does not form "immediately" -- it takes time.  A pathology test of the tissues always requires surgery -- there is no blood test or X-ray to help with the diagnosis.

Hope this helps!

Dr. Jacobs 
Diplomate, American Board of Plastic Surgery
815 Park Avenue
New York, NY 10021
(212) 570 6080
www.gynecomastiasurgery.com

[cody sockeye]

Hello, Dr. Jacobs. I've never seen you here on the boards, so welcome! You sound like you know what you're talking about and you sound like you really care about your patients! Just thought I'd take the time to introduce myself because I am looking to get this procedure done sometime before the next school year starts. I have no idea where I'm going to go, so I must keep all of my options open 

To stay on topic, I believe that you should not be charged a doctor's fee for revision surgery. But then again, corporate minds think alike. And if they got you by the balls, they're probably not going to loosen their grip! Most people who want to make money off of you want to make as much as possible.

--CS

[outertrial]

If the initial surgery is not complete in removing tissue, then additional revision surgery is definitely indicated.  However, this is always much more difficult to do (because you have to work through the scar tissue resulting from the initial surgery) and the results are always less predictable.  In essence, you are always playing "catch-up" -- and it is NEVER as good as doing it right the first time.

Interesting.

[Grandpa Bambu]

To stay on topic, I believe that you should not be charged a doctor's fee for revision surgery. But then again, corporate minds think alike. And if they got you by the balls, they're probably not going to loosen their grip! Most people who want to make money off of you want to make as much as possible.

--CS

Dr. Jacobs...

If a revision is necessary of a GRS that you have done, will you perform the revision at no extra charge?

GB

[Dr. Elliot Jacobs]

GB

My office policy:  If a revision (for my own work) is necessary (I average about one a year), then there is no charge for the revision surgery or for the operating room (if done under local anesthesia).  If an anesthesiologist is required, then there is a small fee paid to the anesthesiologist.

Dr Jacobs