How long should I wait before surgery?

[amethyst tint]

It's been about 2.5 months since I developed meds-related gynecomastia (mild to moderate). I'm 39 years old. I'm considering surgery, but am not sure how long I should wait first. I've been told 6 months should be the minimum waiting period (to see whether the problem resolves on its own). My main concern is to make sure that the underlying cause is taken care of and to get my endocrine system back to normal, so that the problem doesn't come back if I do have surgery. 

My current plan is to meet with a few prospective surgeons over the next two or three months and see how things progress in the meantime. Does this seem like a sensible plan? Any suggestions on how long I should wait before safely going under the knife, assuming I go that route?

[George Pope, M.D.]

I think 6 months off the offending med sounds reasonable.

Dr. Pope, MD

[DrBermant]

It's been about 2.5 months since I developed meds-related gynecomastia (mild to moderate). I'm 39 years old. I'm considering surgery, but am not sure how long I should wait first. I've been told 6 months should be the minimum waiting period (to see whether the problem resolves on its own). My main concern is to make sure that the underlying cause is taken care of and to get my endocrine system back to normal, so that the problem doesn't come back if I do have surgery. 

My current plan is to meet with a few prospective surgeons over the next two or three months and see how things progress in the meantime. Does this seem like a sensible plan? Any suggestions on how long I should wait before safely going under the knife, assuming I go that route?

When gland has been stimulated by an imbalance of hormones, getting the problem stabilized first is essential to minimize recurrence. Surgery will not stop breast regrowth. If factors are still there causing gland stimulation, no surgery removes all gland and regrowth occurs.

A specific time frame is quite difficult to pick before considering surgical intervention. As any woman after multiple pregnancies how long after did her breast swelling stop. I have seen patients years after medication caused imbalance still having breast growth even despite other surgeons' attempts at removal. That is why getting the problem stabilized first, waiting for the Gynecomastia Symptoms such as pain, tenderness, nipple discharge to resolve before considering what options are needed. I have also seen many cases of when the gland swelling goes down, that there is no remaining deforming factor and surgery was avoided. Again why it is important to be patient and not rush nor put a specific time frame on resolution. Resolution on its own without any surgery will be a better scar than the best surgeon's sculpture.

I ask my patients with such issues to have an evaluation by an experienced Endocrinologist. I am looking for 3 factors from that Endocrinologist. 1 that that have been evaluated, 2 that no further testing is indicated, and 3 that they plan no endocrinology intervention or modification of a current treatment a patient is using (ie someone needing Testosterone therapy.)

Hope this helps,

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

[amethyst tint]

Thanks for these comments.

I plan on being patient, and I hope that things improve or at least stay stable. However, I've been assuming that since there hasn't really been any improvement since the condition developed 2.5 months ago, it's unlikely to resolve on its own. Dr. Bermant, you're saying that this isn't necessarily the case (i.e., that the condition could stay unchanged for months or longer, then start to get better for no apparent reason)?

On a general note, one of the hardest things about this condition is the uncertainty. Not knowing the cause, whether it will get better or worsen over time, whether there is anything you can do about it apart from surgery (apparently not, unless you want to start taking drugs like tamoxifen), whether an endocrinologist can help, whether surgery is worth the risk, and if so, how long to wait before surgery, whether the condition will come back after surgery...

What's frustrating is that I feel basically healthy, except for the fact that I now have unwanted moobs, which in turn is stressing me out.

[DrBermant]

Thanks for these comments.

I plan on being patient, and I hope that things improve or at least stay stable. However, I've been assuming that since there hasn't really been any improvement since the condition developed 2.5 months ago, it's unlikely to resolve on its own. Dr. Bermant, you're saying that this isn't necessarily the case (i.e., that the condition could stay unchanged for months or longer, then start to get better for no apparent reason)?

On a general note, one of the hardest things about this condition is the uncertainty. Not knowing the cause, whether it will get better or worsen over time, whether there is anything you can do about it apart from surgery (apparently not, unless you want to start taking drugs like tamoxifen), whether an endocrinologist can help, whether surgery is worth the risk, and if so, how long to wait before surgery, whether the condition will come back after surgery...

What's frustrating is that I feel basically healthy, except for the fact that I now have unwanted moobs, which in turn is stressing me out.

Some of my patients have had problems resolve on their own. Others not. Timing varies. The balance of the beautiful hormone system is quite delicate and insults upset this balance to different degrees and for different lengths of time. Even the testing of this condition can be a bother since it is normal for the hormone levels to bounce all over the place during the day. (Timing of the lab drawing and the quality of the specific lab doing the testing are all factors.) If the symptoms are gone, size not changing, then the swelling phase has probably resolved and the breast is in the fibrotic phase which will not resolve without surgery.

Yes, this condition is one of extreme frustration. That is why starting out with an experienced individual can be critical in timely solutions. Many pick my office in such an endeavor since we focus on trying to solve the problem, not just get the next case in the operating room. When Red Flag(s) come up during an in office consultation or Preliminary Remote Discussion, I send the patient on for an Endocrinology evaluation. Even this can be frustrating due to the nature of the beast and that this can be a taxing investigation that some Endocrinologists do not want to be bothered with or feel that they are getting paid enough to take their time to solve.

That is another reason I came up with No Surgery Compression Garments as a temporizing measure for problems that are in the process of stabilization.

Hope this helps,

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

[Dr. Cruise]

6 months is an adequate amount of time to overcome the affect of the hormonal in-balance caused by oral medication.