Seeking advice / my diary thread

[improving]

Hello.

I have attached some pictures as i would like to know whether or not i require surgery.

I have been to my doctor and he has assured me i don't have Gynecomastia, but i do have fatty tissue on top of my pecs. I train quite hard in the gym and i run about 10 miles per week. I basically know that to give me a perfect appearence i need surgery, but i'd just like someone an opinion of an expert/someone who has been through it.

I have tried lots of things. Cleaned up my diet. Took fat burning supplements. Ran my ass off.  I feel i have done as much as i can.

The way i see it is that i have 2 options

1) lose my hard earned chest muscles to reduce the fat sticking out by quitting lifting weights and cardio only
2) have it sucked out

The only time my chest looks good is in cold conditions where the skin tightens and has a less saggy appearence.

Thank you for any help.

Improving.

ps - have deliberately slouched to try and give the worst angles, apart from number 3 where i pulled my shoulders back and tensed my abs.

I am 6'1 182lbs.

[303MattS4]

I'm no expert, but in my opinion you probably do have a mixture of gland and fat, but the truth is the only way to tell if you have gland there is surgery. Even the doctors that regularly post on this forum indicate they can't tell, through physical examination alone, what the true anatomy of a particula case of gynecomastia is. Gynecomastia can be caused by fat, gland, or a mixture of both. It's the appearance of the chest that is gynecomastia, not the underlying structures.

With that being said, you do not have a severe case, but if it bothers you then it is obviously somewhat of a problem. If you have done all that you can physically to no avail, the only other route would be to consult with a few plastic surgeons that have an interest in gyne surgery. If I were you though, I would not stop lifting because I don't think that will do anything for you aside from losing the muscle that you have. The appearance of your chest will probably stay the same minus the muscle.

Good luck!

[improving]

Thanks Matt, i wasn't aware that it could be a mixture of gland and fat. I thought that because its simply soft tissue it was just fat. My nipples arn't sensitive to touch, never hurt, there are no lumps. So for that im thankful.

I think your probably right about the lifting, i think its just because i have tried many different things since the start of the year im willing to try anything. Surgery is approx £4200/$6500~. Its a cost i could do without to be honest. I'd say it effects me probably every day to some degree. Thanks again.

[Dr. Elliot Jacobs]

Yes, you do have a mild case of gyne with puffy nipples -- and from your photos, height and weight, I would doubt that further improvement would occur simply with diet and exercise.  Most likely, you would require surgery to achieve a smooth, flat and contoured chest.

Dr Jacobs

[henry 41]

Your chest is normal in every way. What exactly would surgery be necessary for? I don't see any breasts. Nipples are borderline larger than average, but certainly normal. Chest muscle tone doesn't appear to be very tight, and looks consistent with the level of subcutaneous fat around the waist area. Your body doesn't appear to be the "lean mean machine" and so the pecs & lower abs as well as other parts have a somewhat soft look. This has nothing to do with gynecomastia (woman-like breasts: Latin derivation)

My opinion is to advise you to reduce bodyfat ratio even more, and the testosterone level might increase, giving your pecs a firmer, harder aspect. Why risk possible deformation from surgery? There's nothing there to fix! This is my opinion only, which I trust I am allowed to give on this site?

[improving]

Yes, you do have a mild case of gyne -- and from your photos, height and weight, I would doubt that further improvement would occur simply with diet and exercise.  Most likely, you would require surgery to achieve a smooth, flat and contoured chest.

Dr Jacobs

Thanks Dr Jacobs, thats what i was aiming to clear up, basically a yes or no as to whether i have a mild case. My plan is to continue to diet/run in January and see where i am at the end of 2011, and if its still bothering me then i will certainly get to a cosmetic surgeon.

-henry
Your chest is normal in every way. What exactly would surgery be necessary for? I don't see any breasts. Nipples are borderline larger than average, but certainly normal. Chest muscle tone doesn't appear to be very tight, and looks consistent with the level of subcutaneous fat around the waist area. Your body doesn't appear to be the "lean mean machine" and so the pecs & lower abs as well as other parts have a somewhat soft look. This has nothing to do with gynecomastia (woman-like breasts: Latin derivation)

My opinion is to advise you to reduce bodyfat ratio even more, and the testosterone level might increase, giving your pecs a firmer, harder aspect. Why risk possible deformation from surgery? There's nothing there to fix! This is my opinion only, which I trust I am allowed to give on this site?

Hi Henry, thank you for your reply. I appreciate your input. I agree it is perhaps consistent with my waist fat. Your advice has been my action plan for a while, i have lost 14+lbs in the last 3~ months to try and get really lean. I've fell off the wagon since christmas is creeping up and have started on the chocolate and sweets early.

Thanks again folks. I've only mentioned my concerns to a close family member as i've been a bit embarassed to talk about it, making a thread about it has made me feel more positive about feeling happier in my own skin.

[DrBermant]

Hello.

I have attached some pictures as i would like to know whether or not i require surgery.

I have been to my doctor and he has assured me i don't have Gynecomastia, but i do have fatty tissue on top of my pecs. I train quite hard in the gym and i run about 10 miles per week. I basically know that to give me a perfect appearence i need surgery, but i'd just like someone an opinion of an expert/someone who has been through it.

I have tried lots of things. Cleaned up my diet. Took fat burning supplements. Ran my ass off.  I feel i have done as much as i can.

The way i see it is that i have 2 options

1) lose my hard earned chest muscles to reduce the fat sticking out by quitting lifting weights and cardio only
2) have it sucked out

The only time my chest looks good is in cold conditions where the skin tightens and has a less saggy appearence.

Thank you for any help.

Improving.

ps - have deliberately slouched to try and give the worst angles, apart from number 3 where i pulled my shoulders back and tensed my abs.

I am 6'1 182lbs.

You have subtle Puffy Nipple Gynecomastia. This is a contour problem and when a man has female like breasts, even if they are small like a woman's early developing breasts, it is gynecomastia just like their early breasts are still breasts. The Anatomy of Puffy Nipple Gynecomastia will consist of fat, gland, and skin.

Your BMI calculation is in the normal range, but there may be a fat component better demonstrated with a Body Fat Analyzer. With weight loss, you will not get rid of the residual gland component, but the fat component can improve. The issue is that you cannot pick where the fat comes from with weight loss. I work with many Bodybuilders with Gynecomastia. A common complaint is that as they built up their muscle, what sits on top of the muscle gets pushed out further.

Suction does not manage the gland of gynecomastia. I have seen just so many patients unhappy after other surgeons' claims that liposuction will manage the gland of their gynecomastia. It can dig a hole in the fat leaving a Puffy Nipple Complication. The residual gland left behind in particular does not look good on animation. In evaluating just how effective a surgeon's claim for their technique working is to see how the contour looks with muscles flexing, arms up over head, or even better movies.

Hope this helps,

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

[improving]

You have subtle Puffy Nipple Gynecomastia. This is a contour problem and when a man has female like breasts, even if they are small like a woman's early developing breasts, it is gynecomastia just like their early breasts are still breasts. The Anatomy of Puffy Nipple Gynecomastia will consist of fat, gland, and skin.

Your BMI calculation is in the normal range, but there may be a fat component better demonstrated with a Body Fat Analyzer. With weight loss, you will not get rid of the residual gland component, but the fat component can improve. The issue is that you cannot pick where the fat comes from with weight loss. I work with many Bodybuilders with Gynecomastia. A common complaint is that as they built up their muscle, what sits on top of the muscle gets pushed out further.

Suction does not manage the gland of gynecomastia. I have seen just so many patients unhappy after other surgeons' claims that liposuction will manage the gland of their gynecomastia. It can dig a hole in the fat leaving a Puffy Nipple Complication. The residual gland left behind in particular does not look good on animation. In evaluating just how effective a surgeon's claim for their technique working is to see how the contour looks with muscles flexing, arms up over head, or even better movies.

Hope this helps,

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

Thanks for your input Dr Bermant. I think you hit the nail on the head with what i have bolded out. I feel like as my muscles have developted they have essentially pushed out the fat/gland tissue.

I would like to continue down the exercise route, i understand you can't "spot reduce fat", ie: pick where the fat comes from, and you lose fat all over as you decrease your BMI.

When you say it possibly can't be solved with suction, how is the gland stuff removed, is it cut out?

I could make a short video clip for further analysis, basically it dissapears as i raise my hands above my head.

Thanks.

[DrBermant]

You have subtle Puffy Nipple Gynecomastia. This is a contour problem and when a man has female like breasts, even if they are small like a woman's early developing breasts, it is gynecomastia just like their early breasts are still breasts. The Anatomy of Puffy Nipple Gynecomastia will consist of fat, gland, and skin.

Your BMI calculation is in the normal range, but there may be a fat component better demonstrated with a Body Fat Analyzer. With weight loss, you will not get rid of the residual gland component, but the fat component can improve. The issue is that you cannot pick where the fat comes from with weight loss. I work with many Bodybuilders with Gynecomastia. A common complaint is that as they built up their muscle, what sits on top of the muscle gets pushed out further.

Suction does not manage the gland of gynecomastia. I have seen just so many patients unhappy after other surgeons' claims that liposuction will manage the gland of their gynecomastia. It can dig a hole in the fat leaving a Puffy Nipple Complication. The residual gland left behind in particular does not look good on animation. In evaluating just how effective a surgeon's claim for their technique working is to see how the contour looks with muscles flexing, arms up over head, or even better movies.

Hope this helps,

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

Thanks for your input Dr Bermant. I think you hit the nail on the head with what i have bolded out. I feel like as my muscles have developted they have essentially pushed out the fat/gland tissue.

I would like to continue down the exercise route, i understand you can't "spot reduce fat", ie: pick where the fat comes from, and you lose fat all over as you decrease your BMI.

When you say it possibly can't be solved with suction, how is the gland stuff removed, is it cut out?

I could make a short video clip for further analysis, basically it dissapears as i raise my hands above my head.

Thanks.

Some doctors prefer to start with liposuction, which is great for fat. The problem is that all liposuction techniques: sharp cutting cannula, ultrasonic, vasor, power assisted all preferentially target fat instead of gland. I have tried many types of cannula and even though I use a keel tipped sharp cannula as one of the elements of my liposuction, it does not get the gland. This is even the case when the cannula is brand new. It is in the literature that liposuction supposedly takes care of gynecomastia. The problem is that I have seen just so many unhappy patients after surgery by other doctors. The patients complained that the contour did not look good, especially on animation. I have seen so many of these unhappy patients that I even built a page for Puffy Nipple Complication After Gynecomastia Surgery that demonstrates some of the many variations I have seen.

That is why years ago I decided to reverse the order of the surgery and thus developed my Dynamic Technique about which I have published and lectured. The hallmark of this methodology is Targeting the Gland first, and then using my artist's pallet of different surgical tools to sculpt the remaining tissues:

• Excision,
• Liposuction,
• Microliposuction,
• Nipple Sculpture,
• Mastopexy Male Chest Lift,
• Skin Reduction,
• and other techniques.

You can follow the methodology by checking out each component in the links above. So yes, I start by cutting the gland out and then have the remaining tissues as a resource to rebuild the contour. When starting with the liposuction first, if you end up with a gland contour problem, then those resources are not available and your options become leave the gland or create a crater. Leaving the gland behind would not be an issue if it were not for how the firm gland moves and compresses differently than the fat. That is why it does not look as good and many who claim "success" with liposuction only techniques seem to feature only a few select pictures showing their results. I have actually seen unhappy patients from other doctors who had results posted on that Surgeons' website as examples of a "good result." My philosophy has been make the chest look good for my patients while living life, playing basketball, swimming, and with their shirts off.

When contour problems disappear with arms up over head, there may be a skin component of the contour. Slouching bringing shoulders forward tend to loosen the skin, while lifting up over head and bringing shoulders back will tighten the skin. I evolved these Standard Pictures for Loose Skin on the Male Chest to show this issue having gravity help show the problem. However, loose skin is one of the hardest things to document with pictures / video. The in office exam is so much more effective when extra skin is a factor, especially if it does not show on the images.

Hope this helps,

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

[improving]

I understand what you are saying.

I know pics can't replace a proper examination but I feel like i have a better idea of whats going on so thank you for taking the time to post.

Certainly with me, the appearence is worse when i slouch, or most noticably when im sitting at the computer shirtless leaning forward slightly, i look down and its depressing. Maybe i have a combination of loose skin (never been overweight?), fat and gland. As i say i'll keep working on the fat element with healthy lifestyle and see how i feel in 12 months. Or i'll move to live in a really cold country so my chest is always tight

[JamesDawson]

Yours looked like mine when I had it, not as bad as mine though but you have some gland, if it bothers you that much surgery would fix it no problem.

[thetodd]

its definatley glandular gyne mate, end of the day £4200 is a lot of money and it was to me at the time but i wouldnt go back in time to get the 4 grand back trust me. Its a minor case but definatley will be approved with surgery if i was you i would make it my new years resolution to set aside money per month to pay for it. If you can afford it id strongly reccomend you going to karidis youl get looked after (I say this cause im assuming your UK based)

When i was in your situation and saving i cut my gym membership off and started saving and in the free time i had from the gym i made some cash on ebay. Going the gym is great but it is time consuming and when i wasnt achieving results from it i just found myself getting a bit depressed about it.

I wouldnt say youve got any loose skin either, youl snap back into place after the op.

[improving]

Thanks James, Thetodd.

I am going to start saving and continue the gym as i love being in the gym, and training my other muscles takes the focus off my chest a bit. I might go for a consulatation with Karadis as he seems to produce good results.

To be perfectly honest i know its not a bad case and it doesn't show through my shirts or anything, its just annoying.

I will post an update when I get surgery, or if my dieting reduces my Gyne (which i don't expect but its good to be healthy, isn't it).

I'm glad i found the forum as its cleared up so much, there is alot of false information out there and im happy that what i need to do is now clear.

Im a bit apprehensive about surgery, i've never had any operation but everyone says how theres nothing to worry about, thats good enough for me.