Dr. Bermant/ Experience

[plifter]

I drove 14 hours round trip to see him for a revisional gyno surgery. I got butchered by a local doctor who turned out to be uncertified despite his assurances to me that he was board certified. I had too much fat liposuctioned from my lower chest. Bermant's procedure to correct this type of defect is to pull fat from the upper chest down to the lower chest to fill in the void. In one breath he told me that he couldn't fix me because I didn't have enough fat on my upper chest to fill the lower chest and then he proceeded to tell me that I was obese and if I lost weight the defect would not look as bad. What? I'm obese but yet I don't have enough fat to do the procedure? For the record, I'm 5'9" and weigh 190. Although I haven't worked out in 18 months, I was a powerlifter for 16 years. His hand held bodyfat analyzer said I was 21% bodyfat. Twenty one percent isn't considered obese. That's just borderline overweight. Anyway, I found a quote from Bermant where he states that he rejects way more patients than he actually operates on. I suspect he has so many people seeking his skill that he cherry picks his patients and refuses any case that is too difficult.

[Aperture]

Maybe he meant you didn't have enough fat on your chest to do it.

[plifter]

I realize that's what he meant, but it still is puzzling that an obese person would not have enough fat in a specific area.

Another thing I found odd was that I indicated on the forms that in a previous surgery I developed (quite rapidly) a dependence on hydrocodone. I listed that so that he would know not to prescribe that to me for post op pain. He kept bringing up the topic of my hydrocodone issue and how I need to (duh) stop using it. I have gone a considerable amount of time without using it except for a one time slip up about 8 months ago. I didn't understand why a plastic surgeon would be lecturing me on substance abuse. The hydrocodone issue is a completely different battle for which I am seeing another doctor and a counselor. If I had my chest fixed, it might boost my self esteem enough to help remove the desire to take hydro.

[DrBermant]

I drove 14 hours round trip to see him for a revisional gyno surgery. I got butchered by a local doctor who turned out to be uncertified despite his assurances to me that he was board certified. I had too much fat liposuctioned from my lower chest. Bermant's procedure to correct this type of defect is to pull fat from the upper chest down to the lower chest to fill in the void. In one breath he told me that he couldn't fix me because I didn't have enough fat on my upper chest to fill the lower chest and then he proceeded to tell me that I was obese and if I lost weight the defect would not look as bad. What? I'm obese but yet I don't have enough fat to do the procedure? For the record, I'm 5'9" and weigh 190. Although I haven't worked out in 18 months, I was a powerlifter for 16 years. His hand held bodyfat analyzer said I was 21% bodyfat. Twenty one percent isn't considered obese. That's just borderline overweight. Anyway, I found a quote from Bermant where he states that he rejects way more patients than he actually operates on. I suspect he has so many people seeking his skill that he cherry picks his patients and refuses any case that is too difficult.

I take on many incredibly difficult cases of gynecomastia and see up to 8 gynecomastia patients a day.  It is very common for us to be working with patients from at least 3 different continents each week.  That is why I created my Preliminary Remote Discussion to help minimize travel to Richmond.  A few of the many cases I have done are posted on my website.  It has been these difficult cases that stimulated me to evolve new techniques to tackle such problems. 

There are unfortunately limitations as to what Revision Gynecomastia Surgery has to offer.  When someone is "sucked dry" by "a local doctor who turned out to be uncertified" and most of the tissue between the skin and the chest removed, options are sometimes limited.  For reconstruction, local resources of fat can be critical for a natural result.  When there is nearby fat, Fat Flap Surgery can be advanced into the defect filling in the void of a
Crater Deformity Complication.  However when most of the chest is involved, there is just not enough local fat for this option. 

While an overweight individual might have more fat available, this is not a good choice to obtain reconstructive resources.  There is only so far a fat flap can be pushed.  Adding the extra weight will increase the difference in height of the remaining fat and the deepest aspects of the deformity.  Losing body fat can narrow the differences between the crater edge and the deeper components.  However, the extended scar adherence deformity on animation remains. 

Some doctors like fat grafts to fill in craters.  However, I have never seen a result from any surgeon that the fat moved naturally on the chest.  Fat grafts need to get a new blood supply unlike my fat flaps that already are supplied.  Fat grafts tend to get firm, just like the firm gland that causes such distortion on the male chest - especially on animation.  Watching such fat graft reconstruction move, looks terrible sometimes worse than the original problem.

I can understand your disappointment.  Perhaps you should consider directing your anger at the doctor who made the mess instead of the doctor who took the time to explain why he did not have anything to offer.  That is why surgeon choice is so important.  Primary Surgery is the best opportunity to come up with the good result.

I just added this topic: How to Choose A Gynecomastia Surgeon here in this forum
http://www.gynecomastia.org/smf/index.php?topic=16474

and check out the reference to another bad choice of a Radiologist who told people he was a cosmetic surgeon / plastic surgeon:
http://www.gynecomastia.org/smf/index.php?topic=16457.msg114733;topicseen#msg114733

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[DrBermant]

I realize that's what he meant, but it still is puzzling that an obese person would not have enough fat in a specific area.

Another thing I found odd was that I indicated on the forms that in a previous surgery I developed (quite rapidly) a dependence on hydrocodone. I listed that so that he would know not to prescribe that to me for post op pain. He kept bringing up the topic of my hydrocodone issue and how I need to (duh) stop using it. I have gone a considerable amount of time without using it except for a one time slip up about 8 months ago. I didn't understand why a plastic surgeon would be lecturing me on substance abuse. The hydrocodone issue is a completely different battle for which I am seeing another doctor and a counselor. If I had my chest fixed, it might boost my self esteem enough to help remove the desire to take hydro.

Since I was discussing limitations of revisions surgery, the hydrocodone dependence is an issue for surgery consideration.  Patients with pain medication dependencies can relapse when having surgical intervention.

[plifter]

Dr. Bermant, do you remember making this quote to the New York Times in an article regarding revision surgeries?

"Dr. Bermant said he refuses far more patients than he treats."

If you were upfront about this fact I probably would not have paid a total of over $400 to make a trip to your office knowing that the odds were high that you wouldn't be able to help me. There was your $125 fee, fuel costs, hotel costs, plus I had to miss a day of work without pay. All of that is on top of two days of driving. Your website boasts of revisional surgeries and I finally thought I'd found a solution to my problem. Then after my appointment I find that quote from the NYT article.

As for hydrocodone, that's a non-issue. Simply don't prescribe it or any of it's more potent relatives. I can just take Ibuprofen. The NSAIDS woud probably work better because my tolerance for opioids is just too high for any doctor to sanely prescribe. 

[DrBermant]

Dr. Bermant, do you remember making this quote to the New York Times in an article regarding revision surgeries?

"Dr. Bermant said he refuses far more patients than he treats."

If you were upfront about this fact I probably would not have paid a total of over $400 to make a trip to your office knowing that the odds were high that you wouldn't be able to help me. There was your $125 fee, fuel costs, hotel costs, plus I had to miss a day of work without pay. All of that is on top of two days of driving. Your website boasts of revisional surgeries and I finally thought I'd found a solution to my problem. Then after my appointment I find that quote from the NYT article.

As for hydrocodone, that's a non-issue. Simply don't prescribe it or any of it's more potent relatives. I can just take Ibuprofen. The NSAIDS woud probably work better because my tolerance for opioids is just too high for any doctor to sanely prescribe. 

Yes, I did make the quote, here is the original article:

http://www.nytimes.com/2005/08/04/fashion/thursdaystyles/04surgeries.html?pagewanted=2&fta=y

The quote was taken a little out of context by the reporter.  We were talking about patients who had 3, 5, and more revision surgeries and still seeking more.  I was explaining about patients who had no tissue left between the skin and muscle, yet still wanted more removed.  In reference to such patients, I said that.  When a patient has unrealistic expectations about what surgery has to offer, I do not offer further surgery just to operate.

I do perform many revision gynecomastia surgeries on deformities from other doctors' operations.  For the vast majority of patients who come to my office, I offer surgical solutions.

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[plifter]

Dr. Bermant, accept my apologies if I misunderstood the situation. However, I do hope you understand the position of your patients that have been butchered by a greedy surgeon who is misrepresenting themselves as a plastic surgeon. I have been at wits end just to find a doctor who understood my problem. My primary physician went as far to say that "I was naturally built that way" despite my showing him the pictures of me before the operation.

I'm self conscious of this defect to the point that I would be happy to see a 50% improvement.

[MSJ108]

Dr. Bermant, accept my apologies if I misunderstood the situation. However, I do hope you understand the position of your patients that have been butchered by a greedy surgeon who is misrepresenting themselves as a plastic surgeon. I have been at wits end just to find a doctor who understood my problem. My primary physician went as far to say that "I was naturally built that way" despite my showing him the pictures of me before the operation.

I'm self conscious of this defect to the point that I would be happy to see a 50% improvement.

I am so sorry that you were operated on by surgeon who misrepresented himself. I feel for you man.

On side note, Dr. Bermant seems like a standup guy and helps many on the board. I am sure he would really like your business and be able to help you if he was able to.

Hang in there man and keep us posted. Hopefully, there is a solution out there for you.

[sabercut]

Dr. Bermant,

Could you reflect your opinions on the following questions -

- When you speak of fat grafts - they cover both terms - live fat grafts as well as fat transfers, right? Are there no other ways of soft tissue implants.

- Also There is some hype about stem cells being mixed with fat cells to increase the acceptance of grafts. Do you think, that would be helpful for patients like us (those who dont have enough fat on chest.)
http://www.cytoritx.com/

- Bio-alcamid has been promoted as a permanent filler for soft tissue defects. What are your opinions on it. Some before and after pics located here - http://ascentemedical.com/content/view/45/223/

- There is a newer trend about pec implants, what are your opinions?

- To be very honest I really dont mind having smaller male boobs (really tiny fillers as that probably look more natural) than to have craters which look terrible.

Thanks.

[DrBermant]

Dr. Bermant,

Could you reflect your opinions on the following questions -

- When you speak of fat grafts - they cover both terms - live fat grafts as well as fat transfers, right? Are there no other ways of soft tissue implants.

- Also There is some hype about stem cells being mixed with fat cells to increase the acceptance of grafts. Do you think, that would be helpful for patients like us (those who dont have enough fat on chest.)
http://www.cytoritx.com/

- Bio-alcamid has been promoted as a permanent filler for soft tissue defects. What are your opinions on it. Some before and after pics located here - http://ascentemedical.com/content/view/45/223/

- There is a newer trend about pec implants, what are your opinions?

- To be very honest I really dont mind having smaller male boobs (really tiny fillers as that probably look more natural) than to have craters which look terrible.

Thanks.

answered in:
http://www.gynecomastia.org/smf/index.php?topic=16490.0

[plifter]

Dr. Bermant, we discussed pec implants during my consultation. You mentioned that they look horrible when moving. What happens if I were to get really thin implants? I have seen some implants that looked great with the person standing and arms at sides. I'm thinking that if the implants were thin, it would still look pretty natural when moving. I'm desperate at this point to get this fixed.

My case is beyond the statute of limitations to sue the original surgeon. He was misrepresenting himself as being board certified. At least I get the satisfaction of testifying at another person's malpractice trial against him. He botched her breast implants causing infection on one side and a complete rupture on the other. He told her that he was certified as well. I get to testify that he told me the same thing to corroborate her story.

Regardless, I would trade any amount of money won from a lawsuit to have my pecs look normal.

[CK]

Plifter, 

A  Do you really think a gyne sufferer will avoid surgery because when they are doing the "Baywatch lifeguard run down beach" their chest will not bounce up and down naturally!  NO!  They just want to go out in public with a tshirt and swim in a pool, and not have the mental day to day pain!  We love you because your a perfectionist, but don't let that get in the way of being a "good surgeon."  Good surgeons help people!

Amen to that!

[plifter]

I'm still considering the implant route. However, if I have it done I will know damn well for sure what the surgeon's qualifications are. I would like to talk to someone with implants to hear if they are satisfied with them.