glandular tissue

[wantnewlife]

Hi,
How much % of glandular tissue is typically removed during surgery? or how much is supposed to be removed for your chest to look flat?
 Do I need to tell the doctor as to how much he should remove? or is it up to the doctor?
even If I  tell the doctor, would the doctor take my advice?

Thanks

[Dr. Cruise]

It is very important to clearly convey what you wish to accomplish with your plastic surgeon. I routinely ask my patients just before going into surgery how flat they want to be. There is a wide range of what men's expectations are. This, in part, has a lot to do with what they consider normal. All want to be "normal" flat but in reality this may mean flatter than what most people would consider normal. My technique for gynecomastia involves precisely removing layers of breast tissue incrementally until the desired amount remains. This is significantly impacted on by what the patient told me preoperatively. Hence, tell your surgeon what you want.

[user87]

so the doc has to achieve the result his patient wants to have and not what he considers to be good?

[wantnewlife]

All, or as much as possible. Most people who only get liposuction are unhappy with their results.

 should I tell the doctor to remove as much gland as possible?  or
should I just tell that I want "a normal chest"? or "a normal flat chest"?

It is very important to clearly convey what you wish to accomplish with your plastic surgeon. I routinely ask my patients just before going into surgery how flat they want to be. There is a wide range of what men's expectations are. This, in part, has a lot to do with what they consider normal. All want to be "normal" flat but in reality this may mean flatter than what most people would consider normal. My technique for gynecomastia involves precisely removing layers of breast tissue incrementally until the desired amount remains. This is significantly impacted on by what the patient told me preoperatively. Hence, tell your surgeon what you want.

did u mean a concave chest by normal flat chest?

also if 100% gland is not removed, are there any chances for the gland to grow again?

so the doc has to achieve the result his patient wants to have and not what he considers to be good?

from what I read and heard, I feel that in many cases the doctor decides what's good and finally the patient ends up complaining about the result...

[RyanMace]

should I tell the doctor to remove as much gland as possible?  or
should I just tell that I want "a normal chest"? or "a normal flat chest"?

That depends on your specific case, what's causing it, and your preferences.
If you're concerned about regrowth or want a really flat chest tell him to get 100% all the gland out. If you're not, and you're more concerned with getting a "good contour" tell him that instead.

There are pros and cons with each approach, the aggressive approach and the taking as little as possible out approach. The #1 complaint I see on this forum after surgery is that "my gyno still looks the same". With an aggressive approach you run the risk of indentations, but even if that happens the gyno will be completely gone.

And do you seriously think that a patient will settle with indentations instead of his previous gynecomastia?

From what I've read, it's apparently easier to do a revision on someone, who've not got enough removed then someone who've got too much taken out.

[wantnewlife]

thanks guys. would appreciate more opinions.

[Dr. Elliot Jacobs]

There is an old saying in plastic surgery:  "It's not how much you take out -- but how much you leave." 

This couldn't be more true than in gynecomastia surgery.  The goal for this surgery is to make a patient look normal for their size and body type.  If you are skin and bones and have larger breasts, then the surgery should try to remove as much tissue (gland and fat) as possible to make your chest [i]consistent with the surrounding tissues of your body.  On the other hand, if you are overweight, then surgery should be done to remove enough tissue to get you flat but not overdone so that your chest skin is paper thin and not consistent with the thicker surrounding areas of your body.  This is known as surgical artistry -- it is the art of the operation as well as the science of the surgery.

As has been previously stated, if one were to err, it should be on the side of leaving a bit too much (one can always go back and have more tissue removed) than taking out too much (replacement of tissue is very difficult).

Remember, this is not a breast cancer operation in which every last cell of breast tissue MUST be removed.  This is basically a contouring operation in which at least some normal breast tissue must be retained under the areola to prevent it from caving in.  Please understand, in all men, the normal and natural anatomy is for there to be breast tissue under the areola -- not fat.  This is true for all men, whether they have gynecomastia or not.

To answer the original question of this thread, sufficient amounts of both gland and fat should be removed to make your chest as smooth and contoured as possible and also to make it consistent with the surrounding areas of your body.

I would suggest you have a lengthy discussion with your surgeon ahead of time in order to make him aware of your desires for surgery.  And by the same token, the surgeon is obliged to tell you what he thinks he can do for you and what his goals would be.  It is imperative that both the patient and the surgeon have similar goals for surgery -- and this should be discussed before deciding to proceed.  If there is no agreement, then perhaps another surgeon should be consulted.

And if you should consult with more than one surgeon and find that both of them disagree with you, then you should perhaps take another look at your own objectives for surgery and re-assess them -- sometimes the doctor is right.

Dr Jacobs

[wantnewlife]

Thanks Dr Elliot. that was good advice.
this question is for all forum members who got operated-
Has anybody demanded all gland to be removed and got good/bad result? could you please share your thoughts?

[Dr. Elliot Jacobs]

There is no need to remove all gland/breast tissue -- just the excess amount of tissue.  If you remove all the gland, you will end up with a sunken areola stuck (and not moving) down to the underlying chest muscle.  I have never had any patient demand that I remove all the gland tissue (we are not dealing with cancer here) -- but if I did have such a patient, I would absolutely refuse to operate on him.

Dr Jacobs

[wantnewlife]

Thanks Dr.Elliot for your reply again. I understand now that all glandular tissue should not be removed. so it sounds like how much needs to be removed is something that surgeon decides..
but I definitely want a good-looking flat chest..
what do I tell the surgeon to make sure that I get the expected result?
thanks again.

[Dr. Elliot Jacobs]

Discuss this with your surgeon prior to surgery.  Tell him you want a flat, contoured chest and that he should so everything possible, lipo, excision, or both, to obtain that result.

Dr Jacobs