Gland regrowth

[bozo]

What causes this gland tissue to regrow?

I had surgery yesterday (lipo and excision) and I was just reading up on this site to see if there was anything I could learn about post-op care.

My gyne wasn't the worst in the world, but it was enough to make me feel self-conscious swimming or wearing fiting t-shirts.  I'm 30 and it hasn't really grown in the 15 years or so since I was in my teens when it developed.  So it seems pretty stable.  I'm not overweight (about 65kg/169cm) and I've been the same height and weight since my late teens.
I don't know exactly how to call the condition, but I have XX rather than XY chromosomes.  I needed hypospadias surgery when I was born, but I'm otherwise not very ambiguous, in terms of build and outward appearance.  My facial hair growth is pretty normal and I seem to be suffering some hairloss.  I'm not tall or gangly like Klienfelters.

I'm now worried that I might have wasted my money and gone through a lot of discomfort for something that's just going to grow back.

[Litlriki]

The glandular tissue in gynecomastia tends to re-grow if the stimulus that caused it in the first place remains after surgery, as it would if there were an undetected hormone producing tumor, or recurs, such as in steroid or medication use.  It's important to have a stable endocrine study in cases where testosterone and estrogen levels have been abnormal in the past.  I'm guessing that you've had a work-up for your endocrine system, since you mention your XX chromosomal make-up. If you were found to be hypo-gonadal, then you should be on hormone replacement to minimize your risk for recurrence, but you didn't mention that as an issue.  Also, the fact that your condition was stable for 15 years suggests that your hormonal milieu was also stable.

I'm interested that you paid for your surgery yourself, since even in Massachusetts, where insurance companies don't like to pay for much of anything, they do consider coverage in patients who have a genetic abnormality, such as XX males.

Hope that information is helpful.

Rick Silverman

[DrBermant]

What causes this gland tissue to regrow?

I had surgery yesterday (lipo and excision) and I was just reading up on this site to see if there was anything I could learn about post-op care.

My gyne wasn't the worst in the world, but it was enough to make me feel self-conscious swimming or wearing fiting t-shirts.  I'm 30 and it hasn't really grown in the 15 years or so since I was in my teens when it developed.  So it seems pretty stable.  I'm not overweight (about 65kg/169cm) and I've been the same height and weight since my late teens.
I don't know exactly how to call the condition, but I have XX rather than XY chromosomes.  I needed hypospadias surgery when I was born, but I'm otherwise not very ambiguous, in terms of build and outward appearance.  My facial hair growth is pretty normal and I seem to be suffering some hairloss.  I'm not tall or gangly like Klienfelters.

I'm now worried that I might have wasted my money and gone through a lot of discomfort for something that's just going to grow back.

Stable gynecomastia is the best to contour. But the question is what is the problem of being male with an XX chromosome?  There are many genetic conditions and medical problems that can Cause Gynecomastia. When the problem is like the Congenital Adrenal Hyperplasia also an XX male, then without knowing what the underlying problem would subject the patient to less safe surgery by not giving the missing stress hormones. That is why having a problem defined when possible is much better before surgery than after surgery.

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.

Here is another example of Gynecomastia Breast Regrowth on my site.  Caution this is a graphic picture of the massive gland regrowth removed on the operating table.

This patient is rather unusual. He was a misdiagnosed genetic female who has lived his entire life as a male.  His birth certificate says male as does his driver's license. Yes, a terrible mistake labeling him male made from birth and early on not recognizing his Congenital Adrenal Hyperplasia.  His body has been exposed to high levels of androgens and estrogen since within his mother's womb. This results in an a condition better called Intersex than the older phrase Hermaphroditism.

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 and stabilizing the problem(s) causing gynecomastia, when possible, is much better. We help patients explore such issues during consultations or preliminary remote discussions.

Hope this helps,

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

[bozo]

The glandular tissue in gynecomastia tends to re-grow if the stimulus that caused it in the first place remains after surgery, as it would if there were an undetected hormone producing tumor, or recurs, such as in steroid or medication use.  It's important to have a stable endocrine study in cases where testosterone and estrogen levels have been abnormal in the past.  I'm guessing that you've had a work-up for your endocrine system, since you mention your XX chromosomal make-up. If you were found to be hypo-gonadal, then you should be on hormone replacement to minimize your risk for recurrence, but you didn't mention that as an issue.  Also, the fact that your condition was stable for 15 years suggests that your hormonal milieu was also stable.

I'm interested that you paid for your surgery yourself, since even in Massachusetts, where insurance companies don't like to pay for much of anything, they do consider coverage in patients who have a genetic abnormality, such as XX males.

Hope that information is helpful.

Rick Silverman

Thanks for the feedback.
I was diagnosed as XX when I was born and things didn't quite look how they should have, but I was never put on any kind of HRT or medication.  I just had the hypospadias repair early on and a check up in my late teens, where the doctor said everything seemed to be OK.  Perhaps if I had been diagnosed later (b. 1980) they might have recommended some treatments...

Either way, I've done the operation, and frankly, if it grows back, I think I'll just live with gyne.

With regards to me paying for it myself - I'm not American, and I'm not in the US.  I don't think I qualify for anything where I am.