Got the mama. Could someone please with a MD look at these films and advise!

[thenewguy01]

What are your thoughts. I have the whole set. I can PM high rez individual or inverted shots if needed. They gave me the files on a disk. I want to have surgery but everyone says they would need to see what they would be working with with a mamagram or Xray. So i get one then everyone is booked out for like 3 months around here. SO how much would you charge a patent with this current level of tissue to be removed.  
Or what would you recommend I do after seeing this!
Quick history. Im 155lbs and 5.11 tall. And 21 years old. had this sense age ten. ITS TIME FOR IT TO GO
Radiology notes:
Left Breast gyno is nodular to dendritic in config. The extend of tissue measures 34x30x35mm (APxMLxSI). Tissue appears symmetric to the nipple. No findings of malignancy

There is diffuse type gyno seen in the right. The extent of tissue measures 43x48x41mm  (APxMLxSI)  Tissue appears symmetric to the nipple.  No findings of malignancy

My notes:I dont understand doctor lingo. Could one of you make this easy on me what ^^^^ this stuff means
Thanks so much! I hope my info is enough to not be one of those "we need to see you in person to know!" guys.
The image is rather long and cut off. i76DOT PHOTOBUCKET DOT COM /albums/j7/qoto/28804a24.jpg

[Litlriki]

I'm not sure how the other surgeons feel, but personally, a mammogram has next to no value in most gynecomastia patients, unless there is concern about something other than run-of-the-mill gynecomastia, namely cancer.  A 21-year-old male who has had gynecomastia since puberty without significant change other than that, which can be associated with maturation and weight fluctuation would be the last person on whom I'd get a mammogram.  And looking at your mammogram tells me next to nothing about the operation I have to do, other than the fact that you have some fatty component and some glandular component.  All the interpretation tells you is that you have gynecomastia which is about 3 cm on one side and about 4 cm on the other.

If you want information about the surgery itself, we would be better served with photographs, which would tell us much more than the mammograms with regard to what sort of procedure you'd require.  It's my sense from this mammogram and your personal description (height and weight), that you'd be a fairly routine procedure involving liposuction and direct excision of the mass, without need for skin removal. 

Hope that's helpful.

Rick Silverman

[thenewguy01]

Ah. Ya my question too. I just saw my regular doctor and talked to him about what they would need and be prepared to for a consultation with a surgeon. Routine...hm Do surgeons more base price on the operation its self or the specific work involved in that patent. Example Would an average joe with gyno like mine would pay the same even though he had a slightly higher fat count. Im just more confused on how this stuff is priced as its out of my pocket because its "COSMETIC". Already had that battle with the insurance. Sad day that was.

[Dr. Elliot Jacobs]

Agree with Dr. Silverman -- the mammograms are nice pictures but bear no relevance in performing the surgery.  The history of a young man with stable gyne for over ten years makes a mammogram virtually unnecessary -- but unfortunately that is the climate in our "do another test" society.  In particular, insurance companies frequently want documentation of gynecomastia, so a mammogram is often done.  And then they deny compensation for the surgery!!!  Another excuse that is used by insurance companies:  if liposuction is mentioned in the operative report, then it is automatically dismissed as "cosmetic."  Some insurance companies deem liposuction as "investigational."  Hah, 30 years of acceptance and wide variation in its utilization, and they call it investigational.  On what planet do they live??

As for fees, most surgeons charge a set fee for the surgery.  That is my policy.  The fee is for an operation to deliver a trim chest, no matter what is required to achieve that result.  Therefore, in my office, there is one fee for whatever is necessary, lipo alone, or lipo plus excision.

Dr Jacobs

[thenewguy01]

Thank you Dr Jacobs and silverman. Thats what happened they were like we want a histologic exam with like proof of glandular tissue. So I get it done. Then they say...NOPE only if both are over 4cm worth of tissue. Im what what the heck?! Oh well. It needs to get done anyway. Thanks for you input docs!