Hey guys, was hoping for a little advice here if anyone can offer any up.
I used steroids in my early 20's and developed gyno. I had surgery 11 months ago at age 31. It was bilateral, excision plus lipo. The doctor told me definitively that it would not come back but unfortunately it has. About 5 months ago I went to see an endo to try to figure out what was happening with me. He determined that my testosterone levels were low and recommended I go on testosterone replacement therapy. He told me that the gyno was likely caused by this imbalance and that this would correct it. Well it hasn't.
I decided to go see another endo to get a second opinion. She is one of the top rated endo's in the state I live. Long story short she has me on letrozole as she thinks that I might be prone to an increased level of estrogen conversion. I've only been on the letrozole for 5 days but don't feel like my lumps are getting smaller. I've heard others say it works almost immediately.
I guess my question is two fold. One, since I've only had these lumps for about 6-8 months, are they fibrotic already and is that why they're not shrinking? I was convinced that the letro would shrink them. Two, if I went back to my Plastic Surgeon is it commonplace for them to correct the recurrence without charging me? I realize a simple appt with him will answer this but I was wanting to know if anyone else has experienced something similar.
I guess the good news is my gyno does not seem to be getting worse on the letrozole but my God, am I going to need to take this for the rest of my life while on test therapy? I mean that can't be good for my body.
I'm so frustrated with all this and part of my post is just being able to get this off my chest (no pun intended). Any input or suggestions are most welcome. Thanks guys.
Gland under hormonal stimulation swells. Remove or stabilize that stimulation, and the swelling shrinks. As gland remains stimulated, it actually grows and eventually becomes fibrotic. Stabilizing the problem is the first step. Keep an unbalanced system and even more gland will grow. Once stabilized, then see how much of the gland will shrink.
As far as revision cost, each surgeon has his / her own policy. Did the doctor know the breast was tender and growing? If so, why was the surgery done? The question is are you going to trust a doctor who did the first operation? Revision gynecomastia surgery is much more difficult. Does that doctor have examples of his / her skills with revision 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
Topic: Recurring Gyno Post Surgery (Read 4158 times)
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