Paging Dr. Bermant.... Gyne regrowth?

[Grandpa Bambu]

Dr. Bermant....

I read on your Site that gland can regrow. Why and how does the body do this?

Does it happen to everyone who has had gland removal? If not, what is the percentage of patients where gland does and does not regrow?

Why would Dr. Fielding not tell me this before my surgery?

I am approaching 3 months post-op and have no sign of regrowth. Does this mean that I am okay?

D@mn this is starting to freak me out now....     :-/

John.

[DrBermant]

Dr. Bermant....

I read on your Site that gland can regrow. Why and how does the body do this?

Does it happen to everyone who has had gland removal? If not, what is the percentage of patients where gland does and does not regrow?

Why would Dr. Fielding not tell me this before my surgery?

I am approaching 3 months post-op and have no sign of regrowth. Does this mean that I am okay?

D@mn this is starting to freak me out now....     :-/

John.

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.  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 have seen many patients from other doctors who have had so much tissue removed, that the skin was adherent to the muscle.  The vast majority still wanted more removed!  When I get the chance, I will try to post more examples of such defects.  It can be very difficult if not impossible to repair such deformities.  When someone gains a lot of fat elsewhere, the craters can get deeper as the surrounding fat walls grow.  Even with such radical excision, gland remains and a few patients had new gland growth.

Negative endocrinology evaluations do not prevent breast regrowth. I have seen one patient who had 3 prior operations by other doctors for gynecomastia.  The patient brought a nicely documented series of images showing breast regrowth after each surgery.  The amount of tissue removed on each operation was substantial, so I doubted it was a case of inadequate removal.  I sent that patient for an Endocrinologist evaluation which came back negative.  After talking with his endocrinologist, further endocrinologists were consulted and further testing was done.  These tests were negative.  There was quite a bit of money spent on these endocrinology evaluations, yet no cause was found.  Of the large number of gynecomastia patients I have sent for Endocrinology evaluations, only a few have ever come back with an actual condition that needed treatment before surgery.  

My plastic surgery practice brings me patients from around the world giving me a very nice exposure to a wide range of Endocrinologists.  My lectures about gynecomastia also gives me the opportunity to discuss this condition with many Endocrinologists specializing in the treatment of gynecomastia.  I have been speaking with Endocrinologists about gynecomastia for over 30 years.  Almost all have told me that good screening by history and physical examination is the standard of care for a gynecomastia patient considering surgery. I recently polled 10 Endocrinologists on this matter.  9 out of the 10 said that automatic endocrinology referrals for gynecomastia patients was not warranted.  A number of Endocrinologists specializing in the treatment of gynecomastia helped me set up a series of red flags for evaluation instead of automatically sending each gynecomastia patient for testing.  For some, an endocrinology evaluation helps set their mind at ease and is a great idea.  For others I mandate it before surgery because of my findings during my evaluation of the patient.

Yet, for all the many years that I have been treating gynecomastia, extremely few of my patients have actually had glandular regrowth that I know of.

Surgery is best on a stable problem - not one getting worse.  Surgery typically does not prevent regrowth.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Gine2D]

I caution each of my patients that surgery does not typically stop male breast growth.  
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Surgery is best on a stable problem - not one getting worse.  Surgery typically does not prevent regrowth.

Hope this helps,

Michael Bermant, MD

This is what I have been telling this group for over a year.  Surgery is not a cure for growing breasts.  They can grow back if the underlying growth cause is not corrected.

This is why many PS will not operate on teens.  The growth pattern is not stable.  Even adults have conditions that cause breast growth through out their life if not corrected.

You breasts do not make you do anything, it is your attitude about yourself that controls what you do in life.

G

[hypo]

The endocrine research shows that that underlying causative conditions are far from rare when it comes to gynecomastia.

According to Ismail and Barth, Glen D Braunstein and many other endocrine sources which I can gladly provide you with, 25% of all gynecomastia patients are found to have underlying causative conditions.

Re-growth does not occur without some underlying condition or causative agent being present.  It just doesn't!

Regarding the individual you spoke of who had re-growth- but no cause for re-growth was found;

To that I say given the complexities of possible endocrine abnormalities (some conditions are very complex and relate to ER receptors in the breast or excess aromatase etc) it is highly likely that the underlying causative factor for the re-growth in the individual was simply not discovered.

Either that or something far more obvious;

That the endocrinologists concerned themselves far too much with ridged supposedly normal reference ranges instead of looking at the ratio of androgens to estrogens.    

Or  

That many additional endocrine factors were missed such as liver and renal function, Human Growth hormone, dihydrotestosterone, or thyroid status.  

The latter being very easily missed with basic TSH tests that do not give the whole picture.


Even if it is at a complex cellular level something made that mans breast develop- the development of glandular tissue was driven by a causative factor.  

[Grandpa Bambu]

Yet, for all the many years that I have been treating gynecomastia, extremely few of my patients have actually had glandular regrowth that I know of.

Thanks very much for your input Dr. Bermant. Much appreciatied! You have put my mind somewhat at ease....

John.

[Grandpa Bambu]

Your breasts do not make you do anything, it is your attitude about yourself that controls what you do in life.

Agreed!