Gyno but with normal hormone levels

[January]

I recently went to an endocrinologist for blood work because of gyno taking place in both nipples. 
The results came back and all levels are normal. The Endo. Dr.  said there' s no more she can do for me to see a breast Dr. which doesn' make sense to me. 

Background I had successful gyno surgery w years ago. The cause from that was reaction to mild testosterone shots. Literally mild feom a TRT clinic. 

It coming back now and I haven't touched Test in over 3 years. Any input also which Dr should I seek next? Im 39 years old by the way

[Litlriki]

Early testosterone use for performance enhancement can have long-term effects on hormone levels, and sometimes patients show up with a story similar to yours with unclear etiologies for new onset or recurrent gynecomastia. Alternatively, if you've had abnormally low testosterone in the past, compelling treatment, that might also support recurrence based on some abnormality that wasn't picked up on recent testing.  I'm not entirely clear on what's going on in your case, and whether or not your original procedure might have left you with some tissue that's recurring or if your levels aren't as "normal" as they appear to be. Photos and more detail could be helpful in deciding what to do next. 

[Dr. Schuster]

I suspect that a significant amount of breast tissue was left behind at your initial surgery. A photo would be helpful but I hink you should really go see an experienced gynecomastia surgeon for a good exam. Your story is a bit complicated and an exam would shed a lot of light. Good luck.

[January]

After surgery and even months after there was literally no physical appearance of anything remaining. I was worried that too much of the tissue was taken out. Now theres constant sensitivity and growing of glandular tissue behind both nipples. It went from nothing - to then be able to pinch a half inch of glandular tissue behind borh nipples - a couple months later an inch could be pinched and now an inch and a half. 
My question is - isnt it true that if the sureon removes ALL of the gland there will be an an inversion or a concave look?
Even if and since the surgeon removed 99% of it as he did, why would it continue to grow if my bloodwork came back perfect?I would like to have surgery again but not if it will come back again. There should be some underlying reason as to why but even if thats never discovered, can permanant removal take place without a concave appearance? I appreciate an feedback. Thank you

[Dr. Schuster]

If the gland was correctly removed and all of your endocrine work up is normal, it is possible that what you are feeling is scar tissue and not gland. Steroid injection can often help in this case.

[January]

Drs have seen it and it is definitely not scar tissue. Please let me know if I'm wrong but it appears that Drs on this site blame everything on scar tissue and go out of their way to not admit that 
Gyno comes back  even when surgery was done properly like it was in my case. Drs on this site seem to stray from the obvious that the only way to make sure it doesn't come back would be to remove all matter behind the nipple which causes major indentations. 
I understand why this sites Drs don't speak openly about this since it would hinder their potential clients from moving forward. 
The Drs responses on this site ten to be extremely lopsided. If I'm wrong I would love to be proven wrong.

[Dr. Schuster]

I can only respond to questions based on my experience. After many years I have not yet seen a patient who had residual breast tissue that continued to grow larger. That is not to say that I have never had to revise a patient in whom I did not remove enough. I would always prefer to err on the side of needing to remove more rather than fix a dent. I discuss this with all of my patients prior to surgery. Fotunately it is very uncommon but always a risk. I have also seen scar tissue form that feels very much like glandular tissue but responds very well to steroid injections. Again, if you are really having recurrent glandular enlargement after supposedly a well performed removal, I would b suspicious of an, as yet undiagnosed, hormonal stimulation of the residual breast tissue. In this case I would suggest a consultation with an endocrinologist. I assume you are not taking any medications or supplements at all.

[DrPensler]

post some photos.

[Dr. Elliot Jacobs]

January

You are indeed wrong.

Having performed gyne surgery on thousands of patients, there are less than a handful who had recurrent gynecomastia -- and that was because they went on certain meds or anabolic steroids that can produce gyne.  On the other hand, I have had many patients who have developed some scar tissue just beneath the areola.  I am not sure why it happens there and nowhere else on the chest.  All of these patients respond to cortisone injections.

Bear in mind, cortisone works on scar tissue, not gland.  One cannot differentiate between scar tissue and gland merely by feel.  But if the tissue responds to a cortisone injection, then indeed it was scar tissue or it would not have worked.

Yes, it is possible to remove virtually all of the breast tissue directly under the areola.  I do this in virtually all of my cases -- yet my patients do not have post op crater deformities.  I am very careful to check if there is any contour deformity present before I terminate the operation.  If there is, I immediately rectify it with a small fat flap.  The result is a smooth, contoured chest with minimal breast tissue beneath the areola -- only fat.  And even some of these patients develop scar tissue under the area.  

Finally, there is no conspiracy among the doctors who post on this forum.

Dr Jacobs