Need help about what step to take next

[Davor]

Hi my fellow gynecomastians!

My name is Davor and I come from a small country in Europe.

This is my story. When I entered puberty at the age of 12-13 my gland started to get bigger and soon I had puffy nipples. I had the same problems like most of the guys here and finally two months ago I decided to get a surgery and get rid of my problem.

I chose my surgeon, scheduled the surgery and eventually took it exactly 6 weeks ago. My surgeon told me that he deals with gynecomastia by liposuction method. At that time I knew little about methods used in surgery.

After the surgery I read a lot here on the forum and I found out that this method cannot extract my glad and it is better method to use when you have lots of fat. Today I realise why because my nipples look the same as they did before the surgery.

The problem is that I think my surgeon thinks he has done s great job. The reason why is because when he inspects me, my skin is almost always _______ - I do not know the word to use - when your cold, your skin ______. I hope you understand. And then, my nipples look fine as if I have no gynecomastia. And I think he didn't extract my gland completely because during the operation, my nipples probably looked like that too so he thought he did a great job.

Even the nurse told me that he extracted everything! But I can feel that there is still a lot of gland tissue beneath my nipples. She also told me that I could never be perfectly flat. I know that, but my nipples look the same!

So my question is to you - what should I do next? Should I change my surgeon and find someone who can better perform the surgery? Or should I try to explain my current surgeon the situation? I thought I should take pictures of my nipples so he can see how they look when my skin is not ______ (the word I'm looking for ).

One more question - is there a possibility that that serome started to fill up and that's the reason why my nipples look the same? Because it still hurts me a bit below my nipples after 6 weeks.

I know there are some surgeons here that reply to questions, so I would really appreciate it if they could also help me.

Thank you very much, I wish you all the luck in solving this stupid anomaly and finally having the freedom of taking of your shirts on the beach.

And btw, this is an awesome forum - thank you so much! It is one of the reasons I decided to take the surgery in the first place.

Have a nice week and take care!

[damgyno]

i say you should get a consultation from two other surgeons, if both say your nips are unfixable then its probably just something will go away or will stay with you, however its hard to make any kind of judgement without pics but anyways one of them wil probably say that they could do more to your gyno and it would probablly cost less because its not a full gyno procedure.

[DrBermant]

Hi my fellow gynecomastians!

My name is Davor and I come from a small country in Europe.

This is my story. When I entered puberty at the age of 12-13 my gland started to get bigger and soon I had puffy nipples. I had the same problems like most of the guys here and finally two months ago I decided to get a surgery and get rid of my problem.

I chose my surgeon, scheduled the surgery and eventually took it exactly 6 weeks ago. My surgeon told me that he deals with gynecomastia by liposuction method. At that time I knew little about methods used in surgery.

After the surgery I read a lot here on the forum and I found out that this method cannot extract my glad and it is better method to use when you have lots of fat. Today I realise why because my nipples look the same as they did before the surgery.

The problem is that I think my surgeon thinks he has done s great job. The reason why is because when he inspects me, my skin is almost always _______ - I do not know the word to use - when your cold, your skin ______. I hope you understand. And then, my nipples look fine as if I have no gynecomastia. And I think he didn't extract my gland completely because during the operation, my nipples probably looked like that too so he thought he did a great job.

Even the nurse told me that he extracted everything! But I can feel that there is still a lot of gland tissue beneath my nipples. She also told me that I could never be perfectly flat. I know that, but my nipples look the same!

So my question is to you - what should I do next? Should I change my surgeon and find someone who can better perform the surgery? Or should I try to explain my current surgeon the situation? I thought I should take pictures of my nipples so he can see how they look when my skin is not ______ (the word I'm looking for ).

One more question - is there a possibility that that serome started to fill up and that's the reason why my nipples look the same? Because it still hurts me a bit below my nipples after 6 weeks.

I know there are some surgeons here that reply to questions, so I would really appreciate it if they could also help me.

Thank you very much, I wish you all the luck in solving this stupid anomaly and finally having the freedom of taking of your shirts on the beach.

And btw, this is an awesome forum - thank you so much! It is one of the reasons I decided to take the surgery in the first place.

Have a nice week and take care!

6 weeks is very early after some techniques.  Tissue does evolve after any operation.  Firm healing tissues can also distort the areola on animation.  Posting Standard After Gynecomastia Surgery Pictures can help others understand your concerns. 

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite sime time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge.

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL or Ultrasonic techniques. 

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Davor]

Thank you Dr. Bermant for you reply!

Your reply is beyond what I expected.

I will contact you directly with my further questions.

Thank you again!