Advice on choosing a surgeon

[sdparis]

I have suffered from gynecomastia for over 30 years. Recently, I was able to suppress my humiliation and embarrassment to do something about it. Side note: I had never said the word "Gynecomastia" (or any facsimile of) out loud to another person until three weeks ago.

Anyway, I have consulted with three surgeons and need some guidance in choosing the right one. Two of them said they could remove the fat and breast tissue with incisions along the bottom of the areola. The third surgeon said that in addition to the removal of fat and tissue, she would have to excise skin through cuts along the bottom of the breasts, causing smile-like scars.

Obviously, I would rather have the surgery without the scars under the breasts. Can a surgeon achieve the same contouring without excising skin?

[Dr. Elliot Jacobs]

In general, removing skin (with additional scars) is a last resort.

Obviously, you have not posted any photos, so that would be a first start for you.

Dr Jacobs

[sdparis]

I am 44 years old and have lost 35 lbs since November.

[Dr. Elliot Jacobs]

Based on these facts (age 44, 35 lb weight loss) and your photos, you have two strikes against you -- sorry.  Please understand that the best gyne surgery results -- with minimal scars -- are obtained when the skin has reasonable elasticity.  Skin elasticity declines with age -- so that is your fist strike -- and there is nothing you can do about this.  Skin elasticity also decreases when you have been overweight -- as you have been -- and there is nothing that can be done about this either.

Net is that minimal scar surgery could reduce the size of your breasts and there would probably be a little bit of skin tightening due to whatever elasticity you have left, but you would not have a chest as tight as a drum head.  Instead, you would probably end up flatter and more comfortable but with a residual fold under the breasts and perhaps nipples that lie low on your chest.

The only other alternative is to have more extensive surgery and more scars -- but end up with a flatter, tighter chest with nipples in their correct position.  It is essentially a trade-off of scars for a better shape.

Tough choices -- but that is your reality.

Good luck!

Dr Jacobs

[sdparis]

Dear Dr. Jacobs,

I appreciate your honesty.

I have thought about the scars/better shape conundrum.  I would be happier with a better shape because one of my goals is to feel comfortable with my shirt off in public and would rather explain additional scars than saggy skin and off-set nipples.

Another question:

The one surgeon who wants to excise skin has been practicing for only two years and has performed 5 gynecomastia procedures this year. I am going to her office to look at before/after photos.  Should I be concerned with her short tenure as a surgeon?

Thank you again.

[Dr. Elliot Jacobs]

[The one surgeon who wants to excise skin has been practicing for only two years and has performed 5 gynecomastia procedures this year. I am going to her office to look at before/after photos.  Should I be concerned with her short tenure as a surgeon?/quote]

Most plastic surgeons who enter practice are accomplished surgeons, having completed many years of training.  So most likely the "hands" of the surgeon would be just fine.

What is of concern is the experience in doing gynecomastia surgery.  Most surgical training programs provide experience in performing female breast surgery.  Gyne surgery has different goals from female surgery.  It would be great if your surgeon could provide before and after photos of several cases similar to yours.

Dr Jacobs

[DrPensler]

I am not sure what is going on with your photos the one from the front appears to have a large crease in both breasts below the areola which is not apparent from the side views. A large crease would indicate substantial skin laxity but it certainly should be visible from every view. 5 cases and 2 or less years out in practice  is far,far from any reasonable experience.

[Litlriki]

As noted, your photos are tough to see.  As Dr. Jacobs has indicated, your age and previous weight fluctuation are factors working against you. I have had success, however, in patients with similar issues by splinting the skin after completion of a fairly aggressive excision/suction procedure using a sticky-backed foam, and leaving that in place for a week.  The skin tightens up nicely with corrected nipple position, though there's always a chance that the long term results may suffer from lax skin. Unfortunately, I don't think I have any of these patient images on my website, but I can e-mail to you directly if you'd like. 

Rick Silverman