[NEED OPINION] So I've had my first consultation today: Pseudo but going for it

[ahm2307]

Hi,

I had my first (and last) consultation today with a doctor I know and trust today and his diagnosis was, disappointingly, that I do not have gynecomastia. I have what has come to be know as "fatty gyneco" or "psuedogynecomastia". He kept telling me the case is mild and went as far as telling me he wouldn't undergo surgery if he were in my shoes.

But he doesn't understand; I tried so hard to get rid of that fat (and yes, there is plenty enough to fool you into thinking it was glandular), but I failed. My body is quite well defined except in the "love handle" area and in my breast. Other than that, my weight is well within what is considered normal and my body is quite muscular.

...I have scheduled surgery nonetheless for next Tuesday with lower expectations than I had going in...but perhaps too low. I'm asking you guys if any one of you has done THIS particular surgery after HAVING TRIED to get rid of the problem using dieting and excercise. Pictures would be awesome, but I really would like to know how much happier you are now. And understand: my expecation is that the surgeon will only HELP me, not flatten my chest; I just want the guy to give me a headstart...so yeah, my expectations, I believe, are realistic...

[GE]

You just going to lipo don?

[Noseguard]

Im confused.

You state early in your post that you are only having one consult and you trust the doc.  Then you go on to say he "doesn't understand", advises you against surgery and despite you being in shape he is convinced you have pseudo G?

He sounds exactly like a doctor I would not trust without a second opinion.

Instead of "lowering your expectations" find a better doc and ELEVATE them.

[ahm2307]

No no, I do trust him fully. He's a brilliant surgeon and that's why I said "first and only" consultation. When I said he didn't understand, I meant he didn't comprehend the psychological implications of having the condition I have, citing much more severe cases and repeatedly telling me I rate no higher than a 2/10 in severity.

Not according to my gf though; she has made a derogatory comment about my imposing chest, one I believe many here have heard before: "wow, your boobs are bigger than mine!." My mind is set, I'm having this surgery...I've wasted 5 years of my life exercising only to have my chest grow even larger. The muscles simply grew on top of the fat!

Anyway, does anyone here know the extent of pseudo G surgery's success in terms of improvement in appearance?

Oh yeah, it's gonna be lipo all the way. He said, judging by my chest, he should be able to suck out around 250 cc.

[DrBermant]

Hi,

I had my first (and last) consultation today with a doctor I know and trust today and his diagnosis was, disappointingly, that I do not have gynecomastia. I have what has come to be know as "fatty gyneco" or "psuedogynecomastia". He kept telling me the case is mild and went as far as telling me he wouldn't undergo surgery if he were in my shoes.

But he doesn't understand; I tried so hard to get rid of that fat (and yes, there is plenty enough to fool you into thinking it was glandular), but I failed. My body is quite well defined except in the "love handle" area and in my breast. Other than that, my weight is well within what is considered normal and my body is quite muscular.

...I have scheduled surgery nonetheless for next Tuesday with lower expectations than I had going in...but perhaps too low. I'm asking you guys if any one of you has done THIS particular surgery after HAVING TRIED to get rid of the problem using dieting and excercise. Pictures would be awesome, but I really would like to know how much happier you are now. And understand: my expecation is that the surgeon will only HELP me, not flatten my chest; I just want the guy to give me a headstart...so yeah, my expectations, I believe, are realistic...

Living with Gynecomastia can cause great emotional concerns.  Take some time to listen to the entire video.

Gynecomastia comes in many different sizes, shapes, and forms.  Unfortunately, it can be difficult to distinguish just what is causing the problem.

Men tend to put fat on first their chest and belly regions.  We take it off there last.  Unfortunately, it can be difficult to distinguish just what is causing the problem.  Gynecomastia male breasts can be fat, gland, or most commonly a combination of both.  Sometimes skin and sagging tissues can be a factor.  Pseudo Gynecomastia is supposed to be fat only gynecomastia.  The problem with that "classification" is that in almost every case of gynecomastia I have seen there is some component of gland.  This gland can be very small, but it is present almost all the time.  So do you have Pseudo gynecomastia when there is a 1%, 10%, 50%, or 90% deformity from fat?  Reality just does not work that way.

Defining the problem with photographs sometimes can help.  However, it is impossible to tell from photographs if the deformity is from fat or gland. The dynamic images, of my standard set of images can show a region that compresses differently.  Even clinical examination differentiation can be difficult.

Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this drawing and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

Men with excessive fat do tend to have certain contour issues.  Check out this link about Sumo Wrestlers.  Men tend to carry excessive weight in their chest and stomach.

Weight Loss Before Surgery is typically better than weight loss after surgery.  Losing weight is a coarse tool.  Plastic Surgery is best reserved as a refinement tool.  You cannot pick where the weight comes from, nor goes onto.  Men typically gain weight first on the stomach, love handles, and chest.  We typically take weight off the same areas last.  Major weight loss after surgery may not come from your chest.  If like most men, you do not lose as much from the chest, it may look as if your gynecomastia has recurred.  Some of my patients loose their weight after surgery and get away with it.  However, weight loss after surgery is a gamble.

Getting to a weight you are comfortable with is often best.  Taking weight off, having surgery, and then putting weight back on is a problem.  If as with most men, weight is put on the breasts, it can look like the gynecomastia has come back.

After major weight loss, there may be loose drooping tissues.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture