Dr. Advice PLEASE....

[Keep_It_Moving]

Doctors and people who have had gyne surgery-

I'm trying to do my research about gyno surgery and what the difference is between someone who has steroid induced gynecomastia (also called 'True Gynecomastia' by Dr. "removed doctor") vs. someone who is well overweight with gynecomastia who hasn't ever used anabolic steroids or medications that can cause gynecomastia?

The 3 that I'm familiar with are:
-Glandular excision
-Lipo
-Smart lipo

From what I've gathered, steroid induced gynecomastia is easier to operate on as it is mostly glandular tissue buildup behind the nipple with little fat surrounding the chest area, where someone who is overweight will have more fat to be taken out and less glandular tissue or fibrous tissue.

Could someone please give me your experiences and thoughts on the differences between these operations and how they are typically performed?

I have steroid induced gynecomastia but naturally have a thick chest even when bf% is near 10%. One way to think of it is I can train every part of my body except for my chest and it will still appear that my chest has been trained thoroughly, maybe even more than the rest of my body.

I thank you in advance for those who respond.

Best Regards,
K

[Litlriki]

In most cases of mild to moderate gynecomastia, no matter what the cause, the best way to manage it is with a combination of liposuction and direct excision.  Steroid induced gynecomastia will invariably require excision of the glandular tissue under the nipple, which tends to be more fibrous, but this same tissue is frequently present in patients who develop gynecomastia during puberty, and even in those patients who have gynecomastia related to obesity.  In the latter case, some skin excision might be required as well, whereas in most steroid-induced cases, there is not typically skin excess. 

From your description, you would benefit from liposuction and excision, which will be most effective at eliminating the fibrous tissue and reducing the fat in order to give you the best contour.

I hope this is helpful.

Rick Silverman

[DrPensler]

I would agree with Dr. Silverman. A combination of liposuction and excision typically is what is required to optimize the result.

As far as the surgery being easy to perform I have done a couple thousand procedures and do not think the surgery is easy.Often the two sides are asymmetric and while removal of adequate tissue is necessary, over resection will produce a depression or saucer deformity.When one paints a portrait you put some pigments on a palette and then place them on a canvass to mimic the appearance of the subject. The concept is straight forward but the devil is in the details.

[Dr. Elliot Jacobs]

It has been  my observation that the tissue from pubertal gyne is different from steroid induced gyne.

Pubertal gyne has fibro-glandular tissue, most dense under the areola and then spreading out in all directions and interspersed with fat.

Steroid induced gyne is extremely dense -- it resembles a solid white ball.  In fact, when one cuts across it, it doesn't even bleed!  It frequently is limited to the area under the areola but can enlarge in all directions.  It is not interspersed with fat.  If often extends down to the muscle fascia.

When surgery is done for steroid induced gyne, there is often a large open space which will probably require a drain (this is one of the few times when I think strongly about using a drain).  Also, after removal of the tissue, there is the possibility of a doctor-induced crater deformity.  In these cases, I routinely utilize fat flaps from the surrounding areas to fill in the defect and thereby head off any possible crater.

One more thing:  Smart Lipo offers no advantage whatsoever in doing this surgery -- I am sure my colleagues will agree.

As Dr. Pensler aptly said, this surgery is very tricky!

Dr Jacobs

[Keep_It_Moving]

Thank you doctors who replied...

It sounds like my odds of having a crater are pretty high?
Do you believe that I shouldn't have the surgery?

[Dr. Elliot Jacobs]

The fear of having a post-op crater should not dissuade you from getting surgery.  What you need to do is lots of research to find the best surgeon to handle your issues.  Would suggest at least 2-3 different consults -- it will be money well spent.  Remember, not every one who has surgery for gyne will get a crater -- in fact, it is not common.

Dr Jacobs

[Keep_It_Moving]

Thank you doctor for your kind words.