Removal of 100% of gland tissue...

[testor0610]

As I described in a previous post, after 25 years, I am now faced with the prospect of a second gynecomastia surgery.

I am 47 years old and very muscular and extremely lean. Year round, I maintain a DEXA measured body fat percentage between 6-7%.
Since this will be my second surgery for gynecomastia, I am concerned about another reoccurrence given the fact that I follow physician-monitored testosterone replacement therapy.

From my readings, it seems most Drs leave some gland tissue in tact to eliminate the prospect of a concave nipple after surgery. I believe this was done during my first surgery 25 years ago and has allowed the condition to reoccur.

Thus, I would like to know what the Drs on this site suggest regarding 100% excision of the gland tissue during a procedure to eliminate the possibility of reoccurrence of the gynecomastia. Given the fact that I am so lean and muscular, would this concave nipple possibility even exist in my case?

Thanks for the input once again!

[Dr. Elliot Jacobs]

All men have a small amount of breast tissue under the areolas -- that is the normal condition.  Even physician-monitored testosterone replacement can result is some elevation of estrogen (even with estrogen blockers), which in turn can induce growth of breast tissue. Thus, you are playing with fire.

In my practice, I leave minimal to no sub-areolar breast tissue.  However, I perform a fat flap in virtually every case so that there is fibro-fatty tissue which is supporting the areola. Thus the chance of a crater deformity is significantly diminished.

Dr Jacobs

[testor0610]

Thanks for the input. I met with one cosmetic surgeon this week and he advised against the surgery based on the very small amount of tissue present, extremely low body fat and, ultimately, the "potential to get a less than satisfactory result." He referred me to consult another endocrinologist who he knows has addressed this type of complex hormonal issue with men like myself who are supporting their quality of life with TRT. I will see him the first week of February.

[Dr. Schuster]

I always leave a thin disk of glandular tissue directly beneath the nipple areola complex and have never had a patient develop recurrence as far as I know. If they did it would be relatively easy to go back and remove. If the surgery was done well the first time, any recurrence should be minor.

[DrPensler]

There is glandular tissue in the nipple. Also remember the nipple is different than the areola. To remove 100% of the glandular tissue, which I do for cancer, requires complete  removal of the nipple and the areola. When I operate for cancer I must stress it is not a cosmetic operation.

[Litlriki]

I deal with a lot of competitive bodybuilders, and while I leave a small amount of tissue under the nipple/areola in all patients, I try and make this as minimal as possible to avoid recurrence.  Nonetheless, I have seen recurrences--but more often from use of a pro-hormone or some other medication, rather than from steroid use.  I suspect this is because steroid users who are committed to that approach take greater caution with regard to estrogen, as compared to the casual "pro-hormone" user, who tends to not be as sophisticated.