Surgeon Questions

[toolhead]

I just had my first consultation with a surgeon through my insurance. My insurance covers gynecomastia surgery on the basis of it being a breast issue not a cosmetic procedure. It's just that the surgeon I met with had a very different opinion. It was very apparent that he viewed gynecomastia as a "cosmetic procedure" and had very little care of the psychological issues attached to it. He believed my case was "a bit too minor" and stated since it does not cause "pain or tumors" it is not worth doing. Continually insisting the obvious, that after it is done it will be too late to cancel, he also did not seem too confident about the result of the surgery.

I am asking my insurance to refer me to another surgeon but I also have two questions to ask the experts here:

1. The surgeon said that removing the gland will cause an "indent" behind the nipple area. Giving the middle of the breast an inward appearance. Is this normal with gyne surgery?

2. He stated that if he removed the entire gland, the nipple will pop inwards instead of outwards. Making it look more like a little belly-button than a nipple. But in order for the gyne to be treated, isn't it necessary for the ENTIRE gland to be removed?

[DrBermant]

Edit:

I had my first consultation with a surgeon and have two questions to ask this board about gynecomastia surgery:

1. I was told that there will be some "contouring issues." The doctor stressed that by removing the gland, there will be a noticeable indent behind the nipple causing an inward appearance in the middle of the breast. Is this normal with gyne surgery?

2. The surgeon also stated that if the entire gland was to be removed, the nipple will go inside looking like a belly button instead of a nipple. Yet, I have heard that the only treatment for gyne is for the gland to be ENTIRELY removed. Which is right?

Input will be greatly appreciated. Thanks.

I do prefer to target the gland first with my Dynamic Technique and remove this firm distorting structure. I then use the remaining tissues to contour the chest with soft fat that moves like fat, and compresses like fat.

Excision of gland alone without appropriate contouring can lead to Crater Contour Deformity Complications from Gynecomastia Surgery. This sounds like what your doctor is warning you about. Revision Gynecomastia Surgery often costs more than doing the surgery the right way the first time. That is why trying to "save" money can be a disaster. Look for an experienced gynecomastia surgeon.

I have posted how to pick a gynecomastia surgeon here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Hope this helps,

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

[Dr. Elliot Jacobs]

Bottom line:  if you encounter a surgeon who is not, at least, sympathetic and understanding about your case, then definitely move on.  There are a number of excellent gyne surgeons around the country -- do your research.

Depending on your own situation, surgery can be targeted to removing all excess tissue (which in essence is gynecomastia == an excess of tissue on the male chest).  Breast tissue is not the problem -- this is not cancer.  Properly performed surgery can and will remove the excess tissue (gland) without leaving any type of residual deformity.  But that is why you need an expert.  Again, do your research.

Best of luck.

Dr Jacobs

[toolhead]

Edit:

I had my first consultation with a surgeon and have two questions to ask this board about gynecomastia surgery:

1. I was told that there will be some "contouring issues." The doctor stressed that by removing the gland, there will be a noticeable indent behind the nipple causing an inward appearance in the middle of the breast. Is this normal with gyne surgery?

2. The surgeon also stated that if the entire gland was to be removed, the nipple will go inside looking like a belly button instead of a nipple. Yet, I have heard that the only treatment for gyne is for the gland to be ENTIRELY removed. Which is right?

Input will be greatly appreciated. Thanks.

I do prefer to target the gland first with my Dynamic Technique and remove this firm distorting structure. I then use the remaining tissues to contour the chest with soft fat that moves like fat, and compresses like fat.

Excision of gland alone without appropriate contouring can lead to Crater Contour Deformity Complications from Gynecomastia Surgery. This sounds like what your doctor is warning you about. Revision Gynecomastia Surgery often costs more than doing the surgery the right way the first time. That is why trying to "save" money can be a disaster. Look for an experienced gynecomastia surgeon.

I have posted how to pick a gynecomastia surgeon here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Hope this helps,

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

Wow, the state of Virgina should give you tax cuts just because at the rate you're going every male suffering from gynecomastia is going to be traveling there; which would certainly benefit the state's tourism industry.

Reading through the Dynamic Technique, I saw another issue with my consultation. The surgeon I met with drew a mark around the bottom of my areola a bit longer than two inches and stated that's where he would cut to take out the gland tissue. How long is the typical excision mark?

[DrBermant]

Wow, the state of Virgina should give you tax cuts just because at the rate you're going every male suffering from gynecomastia is going to be traveling there; which would certainly benefit the state's tourism industry.

Reading through the Dynamic Technique, I saw another issue with my consultation. The surgeon I met with drew a mark around the bottom of my areola a bit longer than two inches and stated that's where he would cut to take out the gland tissue. How long is the typical excision mark?

Actually I do see many Gynecomastia Surgery patients from California and around the world who prefer my technique. That link has just a few of their experiences.

Longer scars can make the work easier and quicker but look less natural unless the additional access is needed. My current typical Gynecomastia Gland Excision Incision is now about 1.6 cm or 0.6 inch. The smaller scar looks more natural than some doctors much longer scar. It also looks better than a scar at the edge of the armpit, lower chest, or center chest. Almost all of my primary gynecomastia surgery can be done with this single at the edge of the areola scar.

Hiding the scar at the edge of the areola is a natural place to fool the eye about the scar. When performing a chest lift or revision gynecomastia surgery, the scar revision can be much longer. Here is one such longer Revision Gynecomastia Scar that I moved to the edge of the areola to better hide the scar in that anatomic feature.

Hope this helps,

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

[toolhead]

Dr. Bermant, I was not being sarcastic at all. There's no doubt you're leaps and bounds better than the surgeon I consulted with.

The more knowledge I have on this surgery, the more questions I have. In regards to this: "By removing the gland early, Dr. Bermant can better judge how much of the surrounding fat will be needed to move back under the nipple areola to prevent a deformity." What happens further down the road, like say if the person leans out, does the fat tissue used to contour the breast get burned off?

[Dr. Elliot Jacobs]

Anyone with gyne, whether prior to or after surgery, who loses weight will have an overall shrinkage of the fat volume within each of their fat cells.  If surgery has been performed properly, then the chest will simply become more taut and defined.  If surgery has not been performed, then the chest will appear to become smaller -- because the fat in between the gland has decreased in size.  But in these cases, sometimes the gyne appears more prominent.  That is because the breast, while slightly smaller, now stands in contrast to the surrounding tissue, which has become even smaller still.

Dr Jacobs

[DrBermant]

Dr. Bermant, I was not being sarcastic at all. There's no doubt you're leaps and bounds better than the surgeon I consulted with.

The more knowledge I have on this surgery, the more questions I have. In regards to this: "By removing the gland early, Dr. Bermant can better judge how much of the surrounding fat will be needed to move back under the nipple areola to prevent a deformity." What happens further down the road, like say if the person leans out, does the fat tissue used to contour the breast get burned off?

The fat I am using is the nearby chest fat with my Fat Flap, trying to preserve the blood supply to the fat.

I advise my patients to get to a weight they are happy with before surgery.  Weight loss after surgery is not predictable.  Men tend to put fat on first in the chest and stomach regions.  We take it off those areas last. Contour the chest to the local level of fat, lose weight, and if the man loses it in the typical way and not lose as much in the chest region, it will look like the gynecomastia has recurred. The exception is my extremely low percentage fat Bodybuilders with Gynecomastia. For these individuals, I prefer to sculpt them at their off season weight. When you go down to extremes such as marathon runners and other athletes, having some fat on the body opens avenues of reconstruction like my fat flap sculpture. Check out that last links before and after surgery clinical photos and the competition posing pictures.

However, the fat cells on the chest do reduce with weight loss. They just lose fat according to the normal pattern for that part of the body. Remaining gland / scar left on the chest does not. Weight loss can help with the fat component of gynecomastia. Remaining gland can stand out even further. That is why I prefer to target the gland first and then contour the remaining fat.

I approach this as a surgical sculptor and prefer the coarse tool first then the one of refinement. Losing weight is a coarse tool. The Plastic Surgery is best reserved for refinement.

I agree about the education aspect. That is why I put so much detail on my website. In my opinion, part of the result of my sculpture comes from the patient education. If you are really serious about learning, start at the first page of my gynecomastia section and follow through the entire 200+ pages of details about this condition. There are over 2000 before and after pictures / movies about this condition to demonstrate this commitment to my patient education.  Beyond that, our patients who travel a distance to see us often start out with our Preliminary Remote Discussion to minimize travel to Virginia.  

If you are interested in learning more about this process, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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

[toolhead]

The reason I ask is because I am fairly lean right now: I have some definition on my abs, shoulders, back, and even on my upper chest. I leaned down in hopes it would make my gynecomastia less noticeable, but it didn't do anything for that sake.

Regardless, I'd still like to lean down and bulk up in the future without having to worry about either leaning down so much that my nipples invert or bulking up to the point gynecomastia appears to have recurred.

[DrBermant]

The reason I ask is because I am fairly lean right now: I have some definition on my abs, shoulders, back, and even on my upper chest. I leaned down in hopes it would make my gynecomastia less noticeable, but it didn't do anything for that sake.

Regardless, I'd still like to lean down and bulk up in the future without having to worry about either leaning down so much that my nipples invert or bulking up to the point gynecomastia appears to have recurred.

I advise my patients to get to a weight they are happy with before surgery. You cannot pick where fat comes from or goes back on.

Weight loss can unmask remaining gland.

Men tend to put fat back on our bellies and chest. Fat gain after surgery can return to the chest. Have you ever seen a Sumo Wrestler without breasts?. That is the ultimate sport using bulking up as part of their profession.

Hope this helps,

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