Chest wall deformity and gynecomastia

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I"m a really skinny guy (5'6) and recently had gyne surgery.  Doctor did great job (laser removal) the only problem is my chest wall deformity. One side sticks out more than the other and it indents in the middle (pigeon chest i think?).  I like to play sports but the remaining gland sticks to my shirt and makes it uncomfortable. I'm sure it can be removed. My question is have you guys dealt with situations like mine and how should i go about getting a doctor to remove the remaining gland with excision?

[DrBermant]

I"m a really skinny guy (5'6) and recently had gyne surgery.  Doctor did great job (laser removal) the only problem is my chest wall deformity. One side sticks out more than the other and it indents in the middle (pigeon chest i think?).  I like to play sports but the remaining gland sticks to my shirt and makes it uncomfortable. I'm sure it can be removed. My question is have you guys dealt with situations like mine and how should i go about getting a doctor to remove the remaining gland with excision?

Great surgery should not need revision. It is quite rare that I revise any of my patients. 

In Gynecomastia Anatomy, there are fingers of gland that run through fingers of gland. Liposuction all forms such as ultrasonic, vaser, power assisted, sharp cutting cannula, "smart," all preferentially target the softer fat before the firmer gland. The liposuction tends to dig a hole in the fat for the gland. Here is a drawing of Residual Gland After Liposuction First. Move your screen cursor over the link "Remaining Gland after Gynecomastia Surgery" to see that drawing.

Here are but a few of the many unhappy patients I have seen who were unhappy after surgery by other doctors:

• Revision Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Puffy Nipple Gynecomastia After Failed Liposuction By Other Surgeon
• Revision Gynecomastia After Liposuction and Partial Gland Excision By Other Surgeon.
• Revision Gynecomastia After Partial Gland Excision
  

That is why with my Dynamic Technique, I prefer to target the gland first and then use the remaining fat as a resource to contour the chest. Even with going after the gland first, the fingers of gland spreading through the fat tend to make some of the gland extraction in pieces. You can see graphic examples of pictures of gland removed during gynecomastia surgery. For some the entire gland came out in one piece. For most, there were still firm component remaining in the chest that I added to the removed tissue. By not depleting the fat as a resource, I was able to remove this firmer distorting tissue and still end up with a smooth natural contour that looks good with arms at the side, over head, flexing, during animation, and with areola muscles relaxing. Click on the links on the gland gallery to go to that patient's before after pictures to better see what I mean.

Hope this helps,

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

[Dr. Elliot Jacobs]

Assuming your gyne surgery was complete and successful, that is all you can expect from gyne surgery.  However, your underlying skeletal asymmetries may have been masked by your gyne and when the gyne was removed, those asymmetries may have been revealed.  This could be asymmetrical development of the rib cage, a pigeon chest (known as pectus carinatum), a depressed sternum (known as pectus excavatum), spinal deformities (such as scoliosis, etc), and even uneven development of your chest wall muscles.  There are extreme cases of mal-development of one side of the chest muscles, called Poland's Syndrome (this can be treated with one sided chest implants).

Each of these more severe chest deformities may require treatment or surgery.  Most often, however, one learns to live with it because the surgery can be complex and significant.  IMHO, the only times one might consider chest skeletal reconstructive surgery is if it interferes with your breathing and lung function.  It can also be done for cosmetic reasons as well, obviously.

Dr Jacobs