Any doctors here have alot of experience with male tuberous breast gyne?????????

[ineedsurgery]

I have tuberous breast deformity and it's damn annoying. I know it has to be difficult to operate on. I want the best results possible and would like to know which doctors feel most comfortable with operating on someone with this type of gyne. Thanks

[DrBermant]

I have tuberous breast deformity and it's damn annoying. I know it has to be difficult to operate on. I want the best results possible and would like to know which doctors feel most comfortable with operating on someone with this type of gyne. Thanks

I have operated on many forms of Tuberous breast deformities and have documented what my techniques achieve. The loose skin factor is the sculpture element of where is just all of that extra skin component going, how is it managed, and what does it look like in more than just still pictures. You need to understand the nature of the scars of both the surface and deeper structures to see what compromises were made or what skills that doctor demonstrates.

In another post about how much nipples shrink on this forum, I have added 2 examples of minor tuberous like breasts.

Large Gland Removed Through Tiny Edge Areola Incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

The after surgery images are only 7 days after surgery. The steristrips are there for both wound support and areola splinting.

I am sorry that the patient holding the calipers for the pictures could not maintain the edge of the calipers at the edge of the areola. When I am demonstrating the effect, I am holding the instrument myself. But it is hard to do the pictures and hold the calipers at the same time.

These are not exaggerations nor manipulation of pictures, just an amazing deflation of nipple areola gland deformity achieved by targeting the gland first.

The vertical deflation measurement or pictures is even more dramatic. For that measurement, I have the patients look down at their chest with the caliper set in place. Here is an example from the prior post patient's projection change:

Calipers Set to Before Surgery Dimensions


Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

I agree with Dr Bermant.

In virtually every gyne operation, the skin  will tighten and the areolar diameter will diminish -- in a range of 10-20% decrease in size.  Of course, this depends on the natural elasticity of the skin, which diminishes with exposure to the sun, smoking, age and presence of obesity (at present or in the past).

I have witnessed very significant decrease in areolar diameters with gyne surgery alone -- and I frequently caution my patients to wait and allow everything to settle down (usually around 6 months) before considering further attempts at areolar reduction.  Bear in mind, reducing the areola further will require an incision completely around the areola.  I very rarely do this because my patients are satisfied with the reduction that the original surgery provided.

Dr Jacobs

For years have been documenting this issue by measuring the nipple areola complex before and after surgery. I take measurements of the

• long axis
• short axis
• angle the axis varies from the horizonatal
• height projection

I perform this measurement with calipers.

Just like Dr. Jacobs mentions I see an areola shrinkage with surgery. Just how much the areola shrinks, I think is technique dependent. By targeting gland first in every case where there is a gland contour component, the differences can be really radical. The tissues of the nipple areola complex can attach to the gland just at the anatomic nipple or more commonly through a diffuse attachment to the edge of the areola and beyond. When this gland attachment remains behind, the nipple areola can be forced to the larger remaining gland size. The remaining gland can also be one of the causes of the term I coined Residual Puffy Nipple Deformity, where the shape of the areola maintains the gland shape and size.

The changes I was seeing were so dramatic, that I started using the calipers on the patients' chest in front of a mirror to show the differences. This became a component of my program for the emotional healing component for each patient who permits me to take off the dressing in my office or who returns for a long term followup.

Large Gland Removed through tiny 1.6cm incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

Notice the radical change in size and shape of areola. In some dimensions we have been recording a 70 percent decrease in size of some of the dimensions. There is also a concentration of pigment color. The same number of color cells in a smaller results in a darker areola.

I prefer to start the emotional healing component as quickly as possible. What becomes fun is seeing the expressions on the faces of my patients as they look at the mirror seeing what changes have happened. This has gone way beyond the documentation of a technique, it has become part of the healing.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

There are 2 patient sets of images demonstrating the caliper measurements I perform on each of my patients to document the amazing amount of skin reduction, projection decrease, and help with emotional healing of my patients. The issue is that tuberous breasts come in different degrees and you need to see just what a doctor offers. Unfortunately, the images I am referring to on gyn.org are not my normal complete patient presentation of what results look like such as for the tuberous breast deformity you are asking about. The post was about the areola reduction seen with this technique. They were not posted for a presentation of tuberous breast surgery evaluation. They were a demonstration of the degree of skin shrinkage I see by targeting gland first.

To understand just what a doctor's results are like you need to see at least a standard set of images with flexing, arms up overhead, and all angles. You are looking to see if that doctor needs to remove a band of skin to achieve the results. That skin reduction scar is a significant compromise, so close up pictures of what the scar looks like are important. This is a loose skin issue and videos are even more critical in evaluating the results.

Hope this helps,

Michael Bermant, M.D.

[Miguel Delgado MD]

I agree with Dr Jacobs and Dr.Bermant.  The skin will certainly contract and the areola also. I find that the skin shrinks more consistently than the areola and alittle more predictable.  However, with a tuberous  breast the skin may become significantly stretched and thinned to a point of very little contraction. You still can not do the gynecomatia reduction surgery with a areolar reduction safely.  I always wait and do it secondarily.  Sometimes you can avoid a periareolar incision depending on the issue.

[ineedsurgery]

Wow impressive pictures/results. I thank you doctors for taking the time to respond to my post. How much is this surgery?

[DrBermant]

Wow impressive pictures/results. I thank you doctors for taking the time to respond to my post. How much is this surgery?

Thank you for your kind words about my sculpture. However, as mentioned, that is not the best way to fully evaluate the results with just a few pictures posted on this site for another purpose. You do want to see the entire chest from many different angles and how the excess skin has been managed by that method of surgery: in this case my Dynamic Technique of targeting gland first and then managing the fat and other structures with an artist's pallet of surgical options.

Each doctor has his / her own skills and you should not assume that one doctor's pictures will be achieved by another surgeon. The societies of Plastic Surgery and Aesthetic Surgery ethics rules mandate that surgeons post typical before and after surgery pictures on their own websites and shown during office presentations for their patients.

I have seen many unhappy patients from other doctors asking for my help after surgery that complained that they did not carefully investigate just what they were getting into. Just because you like a statue you see in a museum does not mean you can go to any sculptor and get the same quality work.

Cost of Tuberous Male Breast Reduction varies in my office since we see so many different variations of this deformity. Jane is my office manager and can better discuss our typical costs and fees.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737. Private message or E-mail me to learn more.

Hope this helps,

Michael Bermant, M.D.

[Dr. Elliot Jacobs]

For a gyne surgeon, coping with a tuberous breast deformity (which is the ultimate "puffy nipple" problem) is one of the most difficult aspects of gynecomastia surgery.

Here are some before and after photos of an adolescent who had a very challenging case of gynecomastia, including asymmetry plus tuberous breast deformities on top of already enlarged breasts.

Before:  

After:  

Before:  

After:  

Notice the shrinkage in diameter of the areola -- all of which occurred spontaneously without need for areolar reduction.

By the way, he was overweight and so I reduced the excess fat on the side of his chest but at the same time had to maintain a certain amount of fat on his chest so that it would be consistent with the surrounding areas of his body -- a real challenge.

Dr Jacobs

[ineedsurgery]

Wow dr Jacobs that is remarkable. His condition was serious and the after pics were unbelieveable. Here's my condition. https://www.gynecomastia.org/smf/index.php?topic=16389.msg114150#msg114150 I'm getting so desperate. This condition is killing me. My whole life is Waiting in limbo until I get this surgery. All I want to do is join the military and serve this country but my chest doesn't allow that. My credit got denied for a loan. My mother passed away and I was left with alot of debt including a mortage and other expenses. Typical adult problems. I wear a compression vest everyday n have been for the past 4years and I'm just sick of it. Haven't been in a pool or the ocean since a kid and I live 4-5min from the beach. Just want to cry sometimes

[Dr. Elliot Jacobs]

I sent you a PM -- let's talk and see what can be done for you.

Dr Jacobs

[ineedsurgery]

Thank you Dr. Jacobs for the pm. I just wrote you back. Thanks again

[DrBermant]

Here's my condition. https://www.gynecomastia.org/smf/index.php?topic=16389.msg114150#msg114150 I'm getting so desperate. This condition is killing me. My whole life is Waiting in limbo until I get this surgery. All I want to do is join the military and serve this country but my chest doesn't allow that. My credit got denied for a loan. My mother passed away and I was left with alot of debt including a mortage and other expenses. Typical adult problems. I wear a compression vest everyday n have been for the past 4years and I'm just sick of it. Haven't been in a pool or the ocean since a kid and I live 4-5min from the beach. Just want to cry sometimes

In the thread you quote,

https://www.gynecomastia.org/smf/index.php?topic=16389.msg114150#msg114150

you can see resources to full examples of tuberous breast sculpture that I gave you 1/3/2009.  I see you have adopted the contouring garments also demonstrated in that thread. They can be a help, but do not remove the deformity. My patients who cannot afford surgery, but want to get into the water use variations of a wet suite to permit enjoying water activities. Neither the vest nor the wet suite will work on the beach. For that they use sun protective garments which are baggy.

I have had patients come to see me while in the military with such deformities, so it did not prevent them from serving. Yes, it was embarrassing, but the limiting factor is your personal stress not their requirements. When problems do not have easy fixes, passing on our patients' prior creativity is what we offer. It can be quite frustrating living with such contour issues. Have you tried these other options that my patients have used with success while they waited to have surgery?

To compliment the caliper pictures in my post above here are only two views of the many really required to evaluate the condition result. The first is arms on hips muscles flexing which helps better understand if there are wrinkles in the skin sculpture when flexing the muscles. The second is the oblique. The full set is seen in the link discussed above. However this example for the calipers is closer to your actual deformity than those on my site.

Puffy Nipples Tuberous Breasts Before Surgery

15 Months After Surgery

Puffy Nipples Tuberous Breasts Before Surgery

15 Months After Surgery

No skin reduction was done. The videos before and after surgery for that patient are even more demonstrative of the deformity and sculpture.

Hope this helps,

Michael Bermant, M.D.

[ineedsurgery]

Is it possible to also remove my "extra nipples"? Lol I know it seems dumb but do you doctors ever remove them? I have two really small nipples below my pecs

[Dr. Elliot Jacobs]

Yes, I do this frequently.  It will leave a little scar -- but the scar tends to fade with time.  I actually use the incision in order to do some liposuction -- so it serves as an access port.  And then it is carefully sutured and allowed to heal.

Dr Jacobs

[ineedsurgery]

^oh ok thanks doc! I was just wondering if alot of males have those "extra
nipples" lol just everything about having my shirt off scares the hell out of me. Thanks again doc for the quick responses. Truly amazed at the pictures you posted on this thread. I can't wait to get this surgery done and to start living a normal life. I only have $2400 saved up right now but dammit one day I will have enough and I refuse to go to a cheaper doctor and have my chest butchered up.

[DrPensler]

As I am sure you know tuberous breast deformity can occur in both men and women. As with other types of gynecomastia there is a spectrum of severity. In males treatment requires resection of the abnormal breast tissue ( glandular and adipose ) and management of the skin. The tissue resection is straight forward. The management of the skin varies with respect to the individual patient's specifics , for instance skin elasticity and quantity of excess skin.
Jay Pensler,MD

[George Pope, M.D.]

Dr. Pensler is right.  Most of us who perform any number of gynecomastia surgeries have come across a large number of men with tuberous breast deformity.  Women can have it too, as you've read here.
It's not as straightforward a reconstruction as are those more routine cases of gynecomastia; each patient has to be treated individually. 

Don't worry - tuberous breast deformity in men can be treated effectively.

Dr. Pope, MD