Questions regarding Gynecomastia

[BlueX]

Hello there I am a new member on this forum. And there are some questions I would like to ask regarding gynecomastia. I'll give you a summary of how I developed it.

In the beginning of July 2017 I was prescribed Risperidone and Prozac by my Psychiatrist who I am no longer with. Over the course of 12 days I took both medications and developed glandular gynecomastia quite rapidly as evident by the fibrous buds under my areola. I discontinued the medication since. But the gynecomastia worsened as the medications have induced a prolactinoma further feeding the buds. Though at the moment it has stabilized.

As you can imagine I have hyperprolactinemia though judging from the blood test results it is a micro adenoma that is probably a few mm in length. I have an MRI scheduled on the 14th December and am expecting an endocrinologist appointment soon. I probably will take cabergoline and clomid to cleae up the tumour.

Would the stemming of the source cause atrophy to the gynecomastia? Or would I have to consider surgery? I am 19 now so I am more or less finished puberty. I never had gynecomastia as a teen as far as I can remember. 

Do adults have a chance of ridding gynecomastia without surgery? 

If I do undergo surgery what are the risks and can it return? Can those risks be mitigated? 

Can the fat that develops around the glandular tissue be burned off like the rest of body fat or not?

My blood work has shown below average estrogen, average testosterone and high prolactin, so estrogen wouldn't be much of a factor in it's growth. 

And lastly would you know of the cost of surgery? I live in Ireland I hears prices can range from 2k to 5k. Either way it is still expensive and is unfortunate that it cannot be covered by insurance despite the psychological effects it brings.

Thanks for reading.

[Litlriki]

Sorry to hear about your recent experience and the development of gynecomastia from your medications.  Once your various levels are back to normal, you should allow for six months to a year to see if your gynecomastia resolves on its own.  I don't generally recommend any sort of "medical" treatment in the meantime, but you will need to have the prolactinoma addressed and hormone levels should be returned to normal.  If the gynecomastia doesn't resolve at that point, you would probably need surgical correction.  
Risks and benefits of gynecomastia surgery are detailed elsewhere on the site and on the internet.  Recurrence risk should be low if all other hormonal issues are resolved and you aren't put on medications that will put you at risk again.  The fat may or may not respond to normal dietary maneuvers to address fat loss--many patients with gynecomastia have fat that's resistant to dieting, and that can be true with the gynecomastia that starts during puberty or the condition that results from mediation or steroid use.  That's one of the reasons that liposuction at the time of resection is critical to get a stable outcome. 
Finally, cost in the US will vary, and in the Boston area, $6000 to $8000 is typical of most reputable local plastic surgeons. That cost includes everything.  
I hope that information is helpful. 

[Dr. Schuster]

I agree with everything that Dr. Silverman said. it will take a while to correct the hyperprolactinemia. I would recommend a healthy diet and regular exercise to see how the fat will respond. Good luck.