Surgery Possible During Florid Phase?

[fguss01]

Hi,
I have posted here before, in summary;

Itching nipple/tissue growth after 5 days of Domperidone in July 2012.

All bloods normal range but E2 consistently "high normal".

Tamoxifen for 10 weeks from Sept-Nov 2012 - slowed growth and helped with pain - no reduction in breast size.

Off Tamox and all supplements for 10 weeks now - exercising regularly (swim/football/cycling) and eating well, growth continues slowly with nipple pain/ sensitivity, axillae heat (worse on biggest side).

Just had a raft of bloods done to check LFTS and hormone levels one last time before the endo basically says there is nothing to treat - results back later this week.

If all the bloods come back clear is it possible to operate soon? - or will the body just replace the tissue removed by surgery? How does the body know when to stop developing the breast tissue? can this be predicted in any way?

51 years old, 6ft 2ins, 176lbs - in good health and grateful for this.

Thanks as always for any inputs.

[fguss01]

Hi, Hope I have not broken any protocols here - would appreciate some inputs  - not going to hold anyone to an opinion expressed on this forum - just want to know whether or not I should bear the pain and wait before getting a consultation with a surgeon.

Thanks.

[Dr. Elliot Jacobs]

There really are no medical guidelines for this situation.  One can only go with "gut" feelings.

When I have a patient similar to you, I recommend that all supplements be stopped for at least six months or more and that all symptoms such as tenderness, itching, etc totally stop as well.  Surgery can then be contemplated and probably will be successful, particularly if most of the sub-areolar breast tissue is removed.  But a surgeon cannot possibly guarantee against possible re-growth -- ever.

Dr Jacobs

[fguss01]

Doctor,
Thanks for the reply, this is very helpful.

I am now ~5months into my Gyne and although I appreciate that I have delayed matters by trying the Tamoxifen I am hoping that within a year I will get to a point of stability. It is very frustrating being in this situation - I have found that herbal elements (Nettle Root + Vitex) helped with the pain and enhance energy levels but the issue with these is that they also distort the hormone panel and therefore potentially put off the point of stability.

Thanks again for the response - my intent is to stay off all drugs/vitamins/supplements and hope that i quickly get to a point of stability.

One final question - in addition to the Gyne although I am of slim build I am also carrying more stubborn fat on my hips/torso than previously - legs and arms still very lean as they should be with the ammount of exercise I get! My exercise is exclusively cardio - dont, and never have done, any weights.

Is this weight gain something that you typically see in confunction with gyne - can it be rectified at the same time as the gyne?

[Dr. Elliot Jacobs]

Deposits of diet and exercise resistant fat on the chest, abdomen and hip rolls (love handles) are the bane of many many guys -- even those who are otherwise slender and in good shape.  Fat deposited in these areas is the first to appear and the last to disappear -- even with stringent dieting, etc.  There are even people who have died of starvation who had stubborn fat deposits on their abdomen, etc.

As for additional liposuction, the simple answer is "yes."  For many of my patients in similar situations, I offer a "torsoplasty", which consists of gyne surgery as well as liposuction of the abdomen and hip rolls.  You can read about Torsoplasty on my website.  Remember one thing however -- it is not meant for men who are significantly overweight -- it will only work for guys who are in reasonable shape but who want to rid themselves of those stubborn excess fat deposits.  It will take a good body and turn it into a great body.

One word of advice -- to be in good shape actually requires three types of exercise:  cardio, weight training and flexibility training (such as yoga).  Cardio alone, while good, is not the complete answer.  Building more muscle with weight training will actually increase muscle mass and in turn increase your metabolism and contribute to weight loss. And yoga will keep your joints and your spine flexible and your posture straight and aligned into your older age (it works for me!!)

Good luck!

Dr Jacobs

[fguss01]

Doctor,
Thanks again, I plan to consult a personal trainer to get some advice on weights but had not considered yoga which I will now do.

I am 6'2" and 176lbs so I think I am in reasonable overall shape.

I will post back on progress later in the year when I am hoping to be stable and in a position to consider surgery.

Best regards.

[Litlriki]

Like Dr. Jacobs, I would recommend six months free of all supplements to allow normalization of your hormone levels.  Many of the "herbal" and "homeopathic" remedies and supplements are touted for certain benefits, but in many cases, the benefits may not be as stated, and they may have other side effects.  Additionally, with sports supplements, those that bear the words "Proprietary Blend" on the label may put in ingredients that aren't indicated in the detail, and if these are hormonally active, they might alter your levels, leading to persistent stimulation. 

With regard to your resistant fatty deposits, I too have seen patients--marathon runners and tri-athletes--with love handles and belly fat, in spite of high levels of cardio activity and careful eating.  I loved reading Dr. Jacob's recommendations to include resistance/weight training, since this can often be a factor that makes or breaks a great outcome.  The more lean mass you have, the more effective your fat-burning efforts are, so bigger muscles mean more fat burning.  When the only exercise you do is cardio, your body becomes incredibly efficient at that particular activity, and over time, you may burn less energy (and therefore, less fat) while engaging in that activity than you might as a beginner.  By adding resistance training and changing up your cardio workouts, you can maintain some inefficiency and burn more fat.

Good luck,

Rick Silverman

[fguss01]

Doctor Silverman,
Very interesting - your observations struck a chord with me, I primarily swim with some cycling and soccer thrown in also - over the years I have found that i am needing to do more and more exercise to keep my fat levels where I want them - I have lost weight in the past year but the fat remains - I thought it was just me getting old :-)

I will incorporate some weights also as recommedned by Dr J above, I guess that provided I adopt this as a consistent practice it can only help in respect of the gyne.

All my bloods have come back normal range again - E2 is 130pmol/l which is 35pg/l - this has been between 99-157pmol/l for the past 6 months on a lab range of 10-150 so not great but within normal limits, Serum Test is 18.8nmol/l on a range of 9-40 and has been between 18-24nmol/l over the past 6 months. SHBG and Albumin are mid-range.

So my endo does not see anything to treat which I am actually relieved about, he was worried about my liver as I had some spider naevi on my torso but I think this is part of coming off the tamoxifen which can persist in tissue for a long time, comprehensive liver tests + ultrasound confirm no probs there - so I will wait for the gyne to stabilise and then consult on the surgery.

Many thanks Doctors for your help and advice.