Which Grade Do I Fall Under?

[bharat]

Hello Doctors,

Looking at my chest pics below, I request you to provide following information:

1. Which grade of Gynecomastia do I fall under?
2. Would I require skin tightening?
3. Is it advisable not to remove 100% gland from the chest so as not to face a crater problem post surgery?
4. Post surgery, would my nipple contract permanently to normal size as now it's comparatively little big. It only looks proper when it gets contracted.
5. Is semi-sleeping position recommended for this surgery to get best results rather than lying straight on the bed?
6. Is it recommended to do the liposuction from the same nipple incision from where the gland is removed?

I have consulted with few of the Doctors here in India and I just wanted to confirm these things again on this forum before going ahead. Would appreciate everyone's reply. Thanks.

[George Pope, M.D.]

Regarding "grade" of gynecomastia, that really doesn't mean anything.  You appear to be carrying a good bit of excess weight. I would recommend you lose a fair amount of weight before having the surgery.

Your skin envelope will tighten to a certain degree, more if you are younger, less if you are older.  Losing weight before your surgery will help, as your skin envelope will slowly contract as you lose weight.

A small amount of gland needs to be preserved to prevent a crater deformity.

Your nipple areola diameter will contract some after the surgery. Some men have better skin contraction than others.

Sleep position in my opinion is not important with this surgery.

I make my incisions at the junction of the nipple/areola complex and lighter skin - at the "6 o'clock" area of the areola.  Then I extend that incision from 3 o'clock around to 9 o'clock to allow gland removal.

Hope this helps.

Dr. Pope, MD

[Litlriki]

There are many grading systems, but you'd fall into the middle grade in most of them, with a moderate amount of tissue and a bit of skin laxity.  Tightening, as pointed out, depends on skin quality, age, heaviest weight (so, was there previous contraction with weight loss already?), and response to surgery.  I would not do a skin excision based on the photos presented.  A small amount of gland is left behind to support the areola, but generally, the areola does shrink in size following resection of the underlying tissue.  You can sleep however you're comfortable, but I do recommend compression 24/7.  I use a small incision in the axillary fold (1/4 ") as well as the peri-areolar incision for liposuction access.

Rick Silverman

[bharat]

There are many grading systems, but you'd fall into the middle grade in most of them, with a moderate amount of tissue and a bit of skin laxity.  Tightening, as pointed out, depends on skin quality, age, heaviest weight (so, was there previous contraction with weight loss already?), and response to surgery.  I would not do a skin excision based on the photos presented.  A small amount of gland is left behind to support the areola, but generally, the areola does shrink in size following resection of the underlying tissue.  You can sleep however you're comfortable, but I do recommend compression 24/7.  I use a small incision in the axillary fold (1/4 ") as well as the peri-areolar incision for liposuction access.

Rick Silverman

Thanks Dr. Rick,
Certain Doctors here in India do liposuction from the same incision made in nipple which is used to remove the gland. Also, it would avoid the extra mark which would be there if the incision had done in the axillary fold. Though I'm convinced with that reason, however would like your opinion whether that would ensure to remove the required fat from the chest just by doing a liposuction from the incision made in the areola?

[bharat]

[quote author=Dr. Pope link=topic=26816.msg175955#msg175955 date=1355759484]
Regarding "grade" of gynecomastia, that really doesn't mean anything.  You appear to be carrying a good bit of excess weight. I would recommend you lose a fair amount of weight before having the surgery.

Your skin envelope will tighten to a certain degree, more if you are younger, less if you are older.  Losing weight before your surgery will help, as your skin envelope will slowly contract as you lose weight.

A small amount of gland needs to be preserved to prevent a crater deformity.

Your nipple areola diameter will contract some after the surgery. Some men have better skin contraction than others.

Sleep position in my opinion is not important with this surgery.

I make my incisions at the junction of the nipple/areola complex and lighter skin - at the "6 o'clock" area of the areola.  Then I extend that incision from 3 o'clock around to 9 o'clock to allow gland removal.

Hope this helps.

Dr. Pope, MD
[/quote]

Thank you Dr. George

[Litlriki]

Thanks Dr. Rick,
Certain Doctors here in India do liposuction from the same incision made in nipple which is used to remove the gland. Also, it would avoid the extra mark which would be there if the incision had done in the axillary fold. Though I'm convinced with that reason, however would like your opinion whether that would ensure to remove the required fat from the chest just by doing a liposuction from the incision made in the areola?

Many surgeons use just one incision.  The small incision that I make in the armpit area is hidden in the axillary fold, and it gives me the ability to do liposuction from two different angles, which helps me to get a more even outcome.  If the surgeon does it the other way all the time, I would presume that he or she is happy with the results achieved with that technique.

RS

[bharat]

Thanks Dr. Rick,
Certain Doctors here in India do liposuction from the same incision made in nipple which is used to remove the gland. Also, it would avoid the extra mark which would be there if the incision had done in the axillary fold. Though I'm convinced with that reason, however would like your opinion whether that would ensure to remove the required fat from the chest just by doing a liposuction from the incision made in the areola?

Many surgeons use just one incision.  The small incision that I make in the armpit area is hidden in the axillary fold, and it gives me the ability to do liposuction from two different angles, which helps me to get a more even outcome.  If the surgeon does it the other way all the time, I would presume that he or she is happy with the results achieved with that technique.

RS

Thanks a lot Dr. Rick