PrologueI am in my mid-30s and I am suffering from bilateral gynecomastia. When I was in my skinny teens, I did have the unusual pointed nipples, but I didn’t have gynecomastia back then. My buddies and I would go to the beach without shirts on with no problem on my part.
The problem began when I was gaining weight in college. I had noticed that my pointed nipples blossomed into something like a pubescent girl experiences. There was a mound growing underneath the pointed nipples much to my surprise and dismay. People started to notice this embarrassing abnormality and made reckless remarks. My male buddies would make fun that I was “nagdadalaga” which I just ignored, but deep inside, I was boiling with anger. What was surprising was that my female friends and girlfriends over the years didn’t find anything wrong with my gyno. One of them even said that she didn’t know that it looked abnormal till I said so.
Way back in 1999, in an attempt to resolve the problem, I turned to bodybuilding. I worked out for a year obsessively hoping that this was just fat and it would burn away. When I saw that I wasn’t really achieving noticeable muscle gains, I heed the advice of my huge gym buddy who was into anabolic steroids. I started using cycles of combined steroids: stanozolol, deca-durabolin, and testosterone ethantate. There were others I could not remember the names, milder steroids used for combinations too. To counter the aromatization of testosterone to estrogen, a terrifying situation that leads to gynecomastia, I used what was recommended: tamoxifen and another drug, one I can’t recall. And man! Did I gain weight!
This crazy regimen I carried over for more than a year. Luckily, I got busy with a new job, that I was forced to stop it. But all the time I was doing it, I didn’t get the results I wanted; all the hard effort to waste! My chest didn’t flatten. In fact, the steroid use led to enlarged mammary glands, compounding my predicament to a hellish nightmare!
As I started to recognize that my bodybuilding and steroid use didn’t help but only worsened my condition, I searched for another viable solution. I serendipitously found an article in Star Newspaper in 2002 that discussed gynecomastia, and I found out that surgery was a definitive solution. I hastily researched this over the net and found several American plastic surgeons who had had websites discussing the issues behind gynecomastia. It immediately dawned upon me that this maybe was what I needed: surgery.
I immediately consulted my close friend who was a brilliant surgeon. What came next was unexpected. As we were discussing gynecomastia with the Star newspaper clipping I brought along, I was taken aback by his recommendation of just ignoring it. He reasoned that surgery was a traumatic experience with deleterious effects—a thing to be avoided. He argued that if the cause of gynecomastia was anabolic steroids, if I withdrew from using these offending agents, the gyno would subside eventually. In my mind, I was not too convinced with his arguments because I read from the websites that the use of anabolic steroids lead to permanent glandular hypertrophy and can only be removed through surgery.
I was depressed after this consultation. During this period, gynecomastia websites were mostly American; meaning, if one required this corrective surgery, you should have to go to the USA and the operation costs were in thousands of dollars—Mission Impossible!
To the years that followed, embarrassment and shame became an issue. The teasing were occasional, but, nonetheless, they hurt my pride! Wearing dark and oversized shirts came in handy. A sando was worn underneath a favorite t-shirt to hide this monstrous deformity.
In the last two years or so, I started seeing stories in the Filipino websites about gynecomastia surgeries. I found two plastic surgeons who had websites that talked about gynecomastia and male breast reduction surgery among the other services they offer. The only thing that stopped me from seeing them was the restrictive costs—the amount mentioned in one of these sites was in U.S. dollars!
Lately, to my good fortune, I stumbled upon a forum in Gynecomastia.org Asia that discussed one formidable plastic surgeon again and again. This forum had pre-op and post-op pictures too. Prior to this, I contacted three plastic surgeons, but this new discovery, I wouldn’t and couldn’t afford to pass! I immediately emailed Dr. Benjamin Herbosa, and called Nurse Rain for an appointment.
Here my operative experience begins.
Intra-operative ExperienceAugust 16, 2011It was late evening on my first day after arriving in Manila. I was very tired from going around the city for work-related purposes, yet I couldn’t sleep due to anxiety. My gynecomastia corrective surgery was at 7 a.m. the following day as advised by Dr. Benny Herbosa when I visited him earlier today at Humana Clinic in Makati. I had these mixed emotions of anxiety, fear, and excitement – anxiety, because I haven’t gone into surgery my entire life and this was the first time I would go “under the knife;” fear because I was knowledgeable about what happens during surgery (the loss of blood, the pain, and the potential complications of surgery); and excitement, because more than half a lifetime’s worth of shame, embarrassment, and paranoia of getting scorned at will all be over after this critical 2 hours or so of operation. I couldn’t sleep so I drank my sleep aid supplement and prayed for a successful operation.
Click. Lights off.
August 17, 2011The moment had finally arrived. This was the thing that I have been waiting for more than a decade and this was the conclusive resolution to my psyche’s agony and the sweet end to my resentment of this ugly deformity. I was very anxious that I kept on sweating on our way to Humana Clinic in Makati City.
As we arrived very early for the scheduled surgery, the beautiful nurses at the front desk asked us for our purpose as the clinic was still closed. I mentioned the surgery with Dr. Herbosa, and they were kind enough to let us in and promptly called the O.R. Nurse, Ms. Rain, whom I contacted only through calls and text messages while I was still in the province. As she came in, she immediately assisted me to the pre-operative process of taking the vital signs, health history, and making me sign the consent form. I asked questions about the surgery, things which I already read in the blog on numerous occasions, but I just wanted to hear it from her to reassure myself and try to vent off some of the fear and anxiety.
In spite the light conversation with Nurse Rain, my anxiety worsened as 7 a.m. was fast approaching. I went to the restroom twice to relieve myself. After which, my stomach started grumbling, and I asked Nurse Rain to use the restroom again. She smiled, understanding my predicament, and told me yes, I could.
Suddenly, the distinctive voice of Dr. Benny broke the silence of the adjacent rooms, asking if I was already in. After Nurse Rain replied, the humorous doctor blurted, “alam ba nya na first time natin gawin ang procedure na to?” Hahaha! I thought. What he doesn’t know was that I read the blog over and over again and that the forum was the only website I visited after my hotmail and my two FB accounts everyday in the last two months.
I discovered Dr. Benny Herbosa after reading the forum in Gynecomastia.org Asia. He had three (3) patients among several others (codenamed braless, sadgyne, & looseshirt) who were kind enough to post their pre-op and post-op pictures and related their stories and intra-operative experiences. Yes, the forum almost sounded like they were building and selling Dr. Benny’s professional image, but hell! You should see the pictures! The excellent results speak for themselves.
Prior to this, I had contacted three different plastic surgeons through email. They were cordial enough to reply. But honestly, you could not help but reconsider after hearing of the success stories of the patients of Dr. Benny. And anything that involves surgery, one can never be too choosy of the doctor who does the operation. Not only is pain the trauma behind undergoing a revision surgery if the first one fails, the cumulative expenses are too!
To be specific, the decisive factors in choosing my plastic surgeon were: 1. Dr. Benny’s track record of success in gynecomastia corrective surgery (and F.Y.I., he has done 250 gynecomastia cases over the last few years, not counting mine in), 2. His uncanny understanding of the issues that lie behind gynecomastia, and 3. His flexibility when it comes to one’s budgets—a major and undeniable consideration to most gyno patients.
As I met him again, he led me into the O.R theater. He asked me questions which progressed to a jolly conversation with a few laughs. I laid down the operating table and Nurse Rain did the necessary skin prep, and there it went! The anticipated pain—the first anesthesia shot! Man! The blog stories about it, Nurse Rain and Doc Benny’s earlier relation, was true. It really did hurt. Tolerable? Yes, but damn, it hurt! In the pain scale of 1 to 10, it was about an 8. It was really ironic that to anesthetize the pain during surgery, one had to experience this seething pain first.
The 2nd shot was a bit unexpected. As my case was bilateral gynecomastia, the anesthetic injection to the left breast brought lesser pain than the first one to the right. Just a thought. I am not really sure if this works, but I think a generous swab of local anesthesia cream applied to the nipple and areola prior to giving these anesthetic shots would probably ease some of the pain.
Trying to rationalize after these shots were given, my thoughts centered in the gym adage “No Pain, No Gain.” I repeated it like a mantra to gather the necessary will and confidence needed for this operation. Hahaha!
As related by the 3 kind bloggers, Dr. Benny was very adept at doing the surgery, and was even very conversant during the entire operation, easing my anxiety and making me feel relaxed. Time and again, he would ask me if I was okay. This time, I tried to do deep breathing too for my nerves to calm down. Doc laughed when he noticed what I was doing and told me that deep breathing was unnecessary.
The thing that I remember most about the surgery were four: first, the anxiety before and during the operation; second, the pain of the incision and cutting of fibrous mass and fatty tissues and the pain during cautery; third, the weird feeling of pressure when the tissues were held by clamps; and fourth, the relief I felt when the operation was over and that my chest went beautifully FLAT!
My anxiety before the operation manifested in my nervous talk, frequent urination, and stomach disturbance. During the operation, it manifested by getting jerky once the cautery was applied. As I said earlier, Doc Benny engaged me in conversation all throughout the operation to ease my obvious anxiety.
Like all surgeries, pain is certainly expected unless if the patient is placed under general anesthesia where one is also sedated. This operation, however, made use of local anesthesia--a rather bold proposition for a subcutaneous mastectomy. Normally, surgeons would give G.A. for this type of surgery. This one made it similar to a cyst removal. But if one would think analytically about it, it made a lot of sense. Local anesthesia lessens the operative costs. It allows the doctor and patient to interact during the surgery. It also enables the patient to have the operation on an OPD basis; i.e., he walks out of the clinic right after the operation. And finally, the risks of general anesthesia are avoided totally.
Dr. Benny actually discussed the advantages and disadvantages of G.A. while he was skillfully cutting through my tissues. As I was focusing on the conversation as a way of diversion, I agreed with him on all points.
Personally, I approved of his decision of using local anesthesia over G.A. in performing this corrective surgery even prior to the operation. Yes, G.A. masks the pain during surgery, but when it subsides post-op, it appears that rebound pain is inevitable. Also, the risks of hypotension and cardio-pulmonary arrest in G.A. are daunting. And if you have had experience as a PACU nurse, majority of G.A. patients would go into a delirious state once awake; some, if not most, are combative too. Finally, the worst downside of G.A. is catheterization which is utilized in most cases. What man would like to have a rubber tube inserted into his pistol?
I have to be honest. There were times during the surgery, in spite the proficient skills of the good doctor and the nurse, that the pain was remarkable. Just like what the blogs said, when the incision went deeper and the anesthesia was not sufficient, the pain was off the hook. Doc Benny warned me in advance before going deep into tissues that it was going to hurt, but the warning didn’t help at this point. Damn, did it hurt! It was like getting pricked all of a sudden by a large gauged needle into one’s skin. Similar pain went with the cautery when applied where anesthesia was not enough. It was at this time that I got a better glimpse of Doc Benny’s personality. Once I complained, or in some instances, suddenly jerked or cringed due to the pain (which jolted the good doctor and Nurse Rain), Doc Benny immediately applied the needed additional anesthesia, making me thank him every time he gave a shot. Know why I said this? I know of some surgeons who would get pissed when a patient complains of pain, and would heedlessly go incising and cutting. In one word, Dr. Benny was patient.
The pressure I felt during the early moments of the operation was weird and I easily confused it to pain. This peculiar sensation started once the clamps were applied to the tissues and was pulled back and held by the steady hands of Nurse Rain, and also during the pulling back of tissues using an army-navy retractor for better tissue visualization. Doc Benny explained that this unusual feeling should not be mistaken for pain. I decided that he was right. It certainly was a queer feeling but it wasn’t pain. Weird but not painful.
The first moment of relief came during the closing of the right breast. Seeing that the nipple was flat and not pointed like the cone of a volcano, oh! What a wonderful promise of a successful operation it was!
And true to what the doctor said, the larger left breast that I had was operated with lesser pain. It took longer though because of the relatively bigger size. At this point, I was very thankful how Doc Benny and Nurse Rain were completely thorough at removing the enlarged glands inside. They would check and re-check it to see if all the abnormal tissues were removed. Only then did they start closing with the appropriate sutures.
After two hours, the welcome second moment of relief came: the operation was finally over. Thank God! Whew! Thank you, God!
The Moment of Truth. As they were cleaning my chest and sides prior to applying the pressure bandage, a downward glance over my chest said it all—it was all worth it! For the first time in my life, I saw my chest absolutely FLAT! No pointed nipples, no boob-like mound on my chest!
Doc Benny asked me then to sit up as he took some post-op pix. He was apparently happy with the results. The pressure dressings and binder were then tightly applied by Nurse Rain and Doc. They reminded me of the importance of applying the binder tightly 24/7 to prevent the dreaded seroma. Having seroma, Doc explained, delays healing.
I saw the extracted fibrous glands and fatty tissues as I was sitting. It made my eyes glow like a flashlight and made my jaw drop for a moment! They were laid on a cover of sterile gloves which conveniently placed the extractions to their appropriate Left or Right markings. Man! I could not believe the amount laid before my very eyes! They probably were more than 200 grams in weight! The post-op picture I saw at gynecomastia.org forum was true: the extraction from my left breast was about a full saucer!
Doc Benny asked me to come closer and touch and feel the tissues with my fingers. I poked the fibrous glands first with much interest and they seemed really thick and rubbery. I bore this crazy idea of bringing back the specimen home and chop it with a butcher’s knife, grill it charred, chop it minced and feed it to the dogs! I would have loved to pound the darn thing there and then for giving me so much misery, but I decided not to because it may surprise Doc Benny and Nurse Rain and think that I went nuts.
Doc then explained that this fibrous gland was the problem when only fat was extracted through liposuction. After some period, the patient would complain about the remaining fibrous gland, and would ask for a revision surgery. So to those who read this, the earlier write ups were correct. If enlarged glands are involved in a gynecomastia case, liposuction alone is not enough! Ask your plastic surgeon for a thorough glandular excision.
Doc and I went to his office and we discussed post-op management as I was about to leave Manila after two days. After settling my balance, I thanked him and Nurse Rain profusely as I was very satisfied with the results.
I went back to the hotel where I stayed and rested. After lunch, we went on scouring Malate again for overseas work agencies. I took the necessary precaution of drinking NSAIDs and an antibiotic as prescribed. It was about 7 or 8 p.m. when I started to feel sore.
At the end of this day, my next prayer was that I would heal fast and that the results would be good after the swelling subsides. Amen.
Note to the Reader: I wrote a long account of my intra-operative experience so that others too may learn from it. Nothing more.
Topic: Gynecomastia Corrective Surgery (Read 10870 times)
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