Author Topic: Research  (Read 4575 times)

Offline discontented

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Anyone know if anyone is actually researching alternate methods for removing tissue? Or if we, collectively, can pool together some ideas? Any researchers? Med students here?

Offline JamesDawson

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Their are plenty of alternative methods of removing tissue such as liposuction, medication, radiation therapy etc but surgical excision of the gland is still the most reliable and dependable method.

On another note about new ideas my hope is that in 50-100 years medicine will have advanced so much that treating gynecomastia will be as simple as visiting the dentist with simple inexpensive operations.

Offline Dr. Elliot Jacobs

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With research money really tight, it is doubtful whether medical researchers will be investing a lot of time and money to treat a condition which many people consider "cosmetic."  Obviously, for those who have it, it is a burden both physically and emotionally.  But realistically, it will not shorten your life by one day.  There are many more virulent diseases which demand our attention.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
4800 North Federal Highway
Boca Raton, Florida 33431
561  367 9101
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.c

Offline discontented

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It'll shorten my life significantly if I kill myself.

And I'm wondering if I can donate my body to gynecomastia research - does it sound unlikely that volunteers will be sought?

Offline Grandpa Bambu

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It'll shorten my life significantly if I kill myself.

Touche...   ;D ;D ;D

He has a point Doc J...

GB...
Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline Dr. Elliot Jacobs

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Touche.

Dr Jacobs

Offline JamesDawson

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And I'm wondering if I can donate my body to gynecomastia research - does it sound unlikely that volunteers will be sought?

Their is probably some way of volunteering for a med school. Like the way you can get your hair cut for free when you volunteer for a hairdressing course/school. To be honest though if I wouldn't trust my hair with a trainee you can tell how my feelings are towards a medical operation.

DrBermant

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Anyone know if anyone is actually researching alternate methods for removing tissue? Or if we, collectively, can pool together some ideas? Any researchers? Med students here?

There are many who continue to research alternate methods to remove gynecomastia. This has been one of my passions for decades. The search begins with what is in the literature. I did not like the extremely high revision rates I quote in this post here:

https://www.gynecomastia.org/smf/index.php?topic=21754.msg147318;topicseen#msg147318

I also did not like the high rates of recurrence seen in the literature and from patients coming to me after recurrences by other doctors. I then set out to evolve a methodology to document a patient's specific gynecomastia history and exam. I evolved a series of measurements to define the problem and surgical solution. My Standard Pictures evolved over the years to special sets for the drooping male chest, then revision gynecomastia surgery. How tissues moved evolved from images to Standard Movies for Gynecomastia which then added the emotional component of the problem before, the surgical process, and the healing after. I have been keeping track of the comfort of the patients, bruising, healing, and sculpture evolution. I have posted such picture progression and videos on my site. Working with a number of endocrinologists I evolved my Red Flag System for evaluation to minimize which patients needed Endocrine evaluations. This method was received well during my invited Gynecomastia lecture at the American Association Of Clinical Endocrinologists 2008 national meeting.

I challenged what was in the literature where many start with the liposuction component first and then take gland by evolving my Dynamic Technique about which I have lectured and published. By targeting gland first, with the specific variations in tumescent technique, and patient education I have achieved my goals of decreasing bruising, increasing comfort after surgery, and limiting the need for revision operations, cortisone injections, or subsequent recurrence.

Over the past 14 years my research also has been in the area of public education about what plastic surgery has to offer. Through building a massive web site, posting on forums, and conversations with other Plastic Surgeons, I am happy with what has changed over the years. Take a look back on this forum itself, look at older posts by using the search function for oldest posts first and compare to what is going on now to see the evolution of what has been done for this surgery. Make is simple and look for pain / comfort and time of use of pain pills.

Some of my patients have taken years before they come in for some operations. Watching the evolution in my own documentation techniques has also been fascinating as I update their details during examination or evaluation.

That is what non academic clinical research can offer. Review what is being done, postulate a different method, evolve documentation to see what that method offers, and then share the information with others. Continued evaluation, re-evaluation, cross specialization education, and discussion of problem cases further helps refine what surgeons and endocrinologists have to offer.

And I'm wondering if I can donate my body to gynecomastia research - does it sound unlikely that volunteers will be sought?

Some places such as centers that train doctors may offer reduced rates. However, the surgeon performing the operation usually will have limited experience. The supervising physician may be responsible, but this is a hands on sculpture skill. Yet, many of the finest sculptures of history had journeymen helpers creating the work.

Hope this helps,

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


Offline Grandpa Bambu

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I also did not like the high rates of recurrence seen in the literature and from patients coming to me after recurrences by other doctors.

How many recurrences do you think there are from your surgeries?

GB...

DrBermant

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I also did not like the high rates of recurrence seen in the literature and from patients coming to me after recurrences by other doctors.

How many recurrences do you think there are from your surgeries?

GB...

I know of only a few. Here is one such case of Male Breast Regrowth After Surgery on one of my own patients. He first told me that his breasts were growing, then said they were not growing, put that they were not growing in writing when I asked first for an endocrine evaluation before I would perform surgery. He did have hypogonadism that if he had followed my advice would have been picked up before surgery and the recurrence prevented. Each of my patients is cautioned that Male Breast Reduction Does not Prevent Recurrence. The images on the next link are the regrowth after another surgeon's reduction without appropriate evaluation and stabilization before surgery on an untreated Congenital Adrenal Syndrome female with a male birth certificate, male driver's license. living as a male but was XX female who needed medical management first. I have seen many such undiagnosed cases with regrowth after other surgeons' operations without appropriate stabilization first.

Hope this helps,

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

Offline Grandpa Bambu

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Dr. B...

So the person in your CAH video, was born as an XX female but was thought to be, and lived her life as a male? Would you suggest that everyone be tested by an Endocrinologist prior to corrective surgery?

In your opinion doc, what is a 'rough percentage' of recurrence?

GB...

DrBermant

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Dr. B...

So the person in your CAH video, was born as an XX female but was thought to be, and lived her life as a male? Would you suggest that everyone be tested by an Endocrinologist prior to corrective surgery?

In your opinion doc, what is a 'rough percentage' of recurrence?

GB...

Yes, that was a genetic female who was misdiagnosed at birth, and by the many doctors taking care of "him" throughout his many years of examination including the plastic surgeon who operated on him without that evaluation. He had a female body fat distribution, female pitched voice, and ambiguous genitalia among other symptoms that should have triggered such an evaluation before surgery. If he had been appropriately diagnosed at birth and treated, he could have grown up as a normal female, had children if desired, and be at less risk of disasters of living with Congenital Adrenal Hyperplasia. Look at the body fat distribution in clothing and listen to his voice on the video on that page!

No, that is the entire concept of my Red Flag System on just who should require the Endocrine work up. Testing everyone with gynecomastia, the endocrinologists told me would not be cost effective nor productive. Yet, someone with a major red flag such as ambiguous genitalia should have had such a work up at birth. Any surgery without addressing the destabilzing factor soaking a body in estrogens and androgens will result in a 100% recurrence rate.

The problem with defining recurrence rates is where do you stop. What percentage of men over 60 years old do not have some degree of gynecomastia? Are individuals that just gain weight later in life recurrences? Are those who  later in life need medications that have a near 100% risk of gynecomastia recurrences? Is someone who gambles again with something like another cycle of anabolic steroids a recurrence?  That is why pinning a number of such concepts is quite difficult.

Yet, take someone with an unstable problem, breasts that are still tender and growing, the underlying factors not evaluated nor stabilized, and the risks for recurrence shoot way up there and I have seen just too many examples like that from doctors who are just not appropriately careful in their before surgery evaluation like with that CAH patient.

Hope this helps,

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

Offline Grandpa Bambu

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Doc B...

Very interesting post... you make some good points...

Thanks for the info...

GB...

DrBermant

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Doc B...

Very interesting post... you make some good points...

Thanks for the info...

GB...

You are welcome.

To be fair to the doctors at birth, there would not have been the female body fat distribution, high pitched voice or other issues formed later in life. The missed ambiguous genitalia however, is just inexcusable miss making a mess of that individual's life that should have been caught at birth or in the next few weeks of life.

Hope this helps,

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

Offline discontented

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I was less looking for discount surgery to train doctors, and more looking for drug trials and such. I mean, I just thought I'd sacrifice my life in some way to a cause that I care about.


 

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