Could gland have been missed or is it excess skin causing gyne

[april24th2007]

Would like to ask the respected surgeons, when you perform gland excision, nipple flattens but does the skin adjust to the new "reduced" chest or do you cut skin as part of the operation and stitch it back so its tighter.  The reason I ask is because it still looks like I have gynecomastia after more than a year of surgery.  I went to the surgeon as a consultation and he informs me that he removed the gland (I have hardly any fat 150 lbs, 5' 9") and he said that the reason I have pointy nipples is because I needed the skin to be cut?? I'm quite confused..  Surgeon's first language isn't english and he is from a different country and he spoke through a translator.

I would be grateful to anyone who could shed some light on this matter.   Thank you.

[Litlriki]

After removal of the gland, the skin of the nipple and areola will retract to a certain extent.  Sometimes, however, this is not enough, and if the patient is still unhappy with the appearance, then excision of the skin (peri-areolar skin reduction) can be performed.  This can be done in the office with local anesthesia at a fairly nominal cost.  This is something I discuss with my patients at the initial consultation.  In those patients with nipples and areolae that are "borderline" large, doing the reduction in a delayed manner is reasonable, particularly since some will avoid the skin removal (and associated scarring) completely.  In those for whom later skin reduction is required, the cost is the same as if I had done it at the initial surgery--It's just the difference in the surgical fee for gynecomastia surgery with skin removal and without skin removal.  There is no facility or anesthesia fee in the office.  The delayed option is also safer, in that risk of nipple loss is less when skin removal is done at a second setting.

Rick Silverman

[DrPensler]

If you have some photos it would be helpful.More often than not the contraction of the skin  is rapid after surgery.

[april24th2007]

Thank you for informative answer.
What type of test, x-ray etc do I need to do in order to know exactly whether it is fat, left over gland or nothing (just skin excision needed).
When cold, nipples go hard and chest looks very flat (if this info helps).

i will put up pictures tomorrow for your review and further opinion.

If it is case of skin excision, are the results permanent?  Is recovery swift or compression vest and rest needed for weeks?

[april24th2007]

To be more helpful for your input/feedback, I should add to my initial query that I did not have liposuction.  Only gland excision.

[april24th2007]

my pics.  pls see if they help you analyze.  thank you.

[april24th2007]

more photos

[april24th2007]

close up

[april24th2007]

Doctor, any input you can provide after seeing these pics?

[Litlriki]

It looks like there's still glandular tissue and/or fat present.  Skin actually looks okay, and I wouldn't anticipate a need for skin removal.

Rick Silverman

[april24th2007]

Thank you Doctor