Unsure what to do next..

[gynosucks81]

I have not posted on here in some time but here goes.. I am 28 years old, 6'2 and 85kg. I am thin but have been working out at the gym so put on some muscle mass. I had a gyno op around 5 years ago but unfortunately the surgeon did not remove the gland so it grew back. It has become more obvious now due to my pec muscle increasing in size. I saw the surgeon three months ago and he put me on a course of Danol as he seemed to think they would get rid of it. I did not think so but thought it may reduce the size. The only thing they did was give me an awful temper! I stopped them and went to see him again.

I asked about the removal and he said due to it being the second op i may lose the whole nipple or have really bad scarring. I said i would think about it and although i want the gland gone i do not want to lose the nipple. I have recently moved to Edinburgh and i remember reading on here there was a good surgeon here? Does anyone know who this is? I would go private but there is no way i could afford it.

[DrBermant]

I have not posted on here in some time but here goes.. I am 28 years old, 6'2 and 85kg. I am thin but have been working out at the gym so put on some muscle mass. I had a gyno op around 5 years ago but unfortunately the surgeon did not remove the gland so it grew back. It has become more obvious now due to my pec muscle increasing in size. I saw the surgeon three months ago and he put me on a course of Danol as he seemed to think they would get rid of it. I did not think so but thought it may reduce the size. The only thing they did was give me an awful temper! I stopped them and went to see him again.

I asked about the removal and he said due to it being the second op i may lose the whole nipple or have really bad scarring. I said i would think about it and although i want the gland gone i do not want to lose the nipple. I have recently moved to Edinburgh and i remember reading on here there was a good surgeon here? Does anyone know who this is? I would go private but there is no way i could afford it.

Building muscle can result in whatever is sitting on top of the muscles getting pushed out further. Many of my Bodybuilding Gynecomastia Patients complain about this issue.

Working on stable gynecomastia is better than having regrowth. 

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. 

If you are using something that can stimulate breast regrowth, shreds of gland remain behind with any surgical technique.  It is just not practical to remove all elements of gland.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest. Take a look at the Anatomy of Gynecomastia to see what I mean.  Even with a radical mastectomy (a disfiguring technique used for some male breast cancer problems), some gland can remain.  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.

Regrowth of gland from stimulation can occur where shreds of gland remain behind. This can be behind the areola, along the deeper edges or margins of a zone of excision. 

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 for patients I have sculpted.  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 prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and my Red Flag Evaluation System before surgery, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention of gynecomastia, when possible, is much better. We help patients explore such issues during consultations or preliminary remote discussions.

Your surgeon is correct, revision surgery is working on a compromised blood supply. Such revisions are an art form and they take a great deal of skill to minimize the chance of complications. Check the link on the bottom of this post to see examples of such revision surgery to better understand what I mean. We see many UK gynecomastia patients who prefer my techniques.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery