gynecomastia revisional, pseudo? Fat from chest area to back.

[gemidude]

I had gynecomastia surgery around 2012. I believe most or all glandular tissue was removed, and liposuction was done in chest area. However I see room for improvement. I don't have any before photos at the moment, (I might have posted some back then),but this is an improvement from what it was before. My concern now is the fat in the area, from my chest to my back, and under armpit. I'm assuming liposuction can be done on this area. I had a skype consultation with Dr. Lebowitz, and he said in his words it was "fat, fat, fat". Now mind you, I know shedding weight would help this, but the fat in my chest doesn't seem proportionate with the rest of my body. I'm looking into other consultations with board certified plastic surgeons in my area. Dr. Lebowitz said my previous plastic surgeon did a horrible job.(He was a board certified plastic surgeon). If price weren't an issue I would go with Dr. Lebowitz, only because I've seen cases on his websites that look like mine before, and he has resolved. But he quoted me something like 15,000.  I've attached pics, and circled the problem areas.

Thank you

[Dr. Schuster]

It looks like fat to me. Breast tissue does not generally extend that far to the sides. If wieght loss through diet and exercise is not an option or unsuccessful than surgery should be able to help. You look to also have some excess fold. In order for this to be completely flat and smooth you might need to have it excised which would leave you with a potential visible scar. Be careful and get a few consultations before you proceed.

[gemidude]

Thank you Dr. Schuster for your input. I sent these pictures to one plastic surgeon, and he said the same thing. Fat and excess skin. But, you don't think liposuction alone would help? Another doctor told me skin excision would be a bad idea.

[Litlriki]

I'm not sure if you just had glandular excision previously, or the liposuction that was done with your procedure just wasn't enough.  If it's the latter, you should be consulting with your original surgeon, who should be able to do some additional liposuction at a nominal charge (something you should have discussed pre-op--revision cost).  If the original surgeon isn't capable or available, I would agree that additional suction is required, and this can be done aggressively on the sides to gain some improvement.  If the skin tightens after adequate fat removal, you might have a smooth outcome, but I would have concern that you may still have some skin redundancy laterally. Then the decision over skin resection becomes an issue and that would leave a visible scar. 

[gemidude]

Thank you doctors. I had a couple of consultations with surgeons. Two of them recommended skin excision, which I’m terrified of. They said it is skin because it’s less then 1 inch thick, and that fat is normally more than 1 inch thick. I may have to live with this, because I know skin excision is a major and serious surgery. Unless there are non surgical skin tightening alternatives.

[Dr. Elliot Jacobs]

When considering surgery for gynecomastia, I am guided by the philosophy that each man wants a great looking chest with the most minimum of scars.  That is why, with rare exception, I prefer to do no skin resection at the initial operation.  Rather, in cases such as yours, I opt for extensive and aggressive liposuction (plus gland excision if needed) and then give the patient's body at least 6-12 months for the skin to spontaneously tighten.  And in many cases, it will tighten considerably.

At the end, we sit down and have another discussion about the results.  IF the patient is satisfied, then certainly I am satisfied.  However, if the patient states that there is some concern about loose/redundant/overhanging skin, then various surgical options to remove the excess skin are discussed.  No matter what, since the original skin excess has tightened at least to a certain extent, there will be less excess skin down the road and hence smaller surgery and incisions needed to do the job.

In gyne surgery, conservatism as regards possible primary skin excision is always best, IMHO.

Dr Jacobs

[Dr. Schuster]

I think that an examination is very important before a treatment decision can be recommended. The quality of your skin will determine final results and whether or not additional skin removal is worth the scar. I think there is definite room for improvement but I don't think you will ever get a sculpted "cut" chest. Your skin is not going to cooperate.

[gemidude]

Once again thank you drs. I found some old pre operation photos from before I had my surgery 7 years ago. And I believe the pictures speak for themselves, the mystery has been solved. It is excess SKIN!!! I don't have the same volume in the axila, as I do now. My gynecomastia was so severe that once removed the skin didn't snap back into place. I did wear the compression garment as instructed. This is why when I lift my arms up my chest appears flat, but when arms are down you see excess skin in axila area and chest. I knew my doctor wouldn't of left residual gland, or fat in my chest! The question now is who to go see to have the skin excised. Or if there are non surgical options such as j plasma/renuvion. It seems I need more of a chest lift, rather than liposuction or additional gland removal.

[gemidude]

Here is another current pic, with arms up to better illustrate what I'm talking about. Notice everything is flat.

[Dr. Elliot Jacobs]

You have been posting on several separate discussion groups.  Please see my reply to you in the general discussion group dated Mar 15.

Dr JAcobs

[Dr. Schuster]

I am not surprised with the result you got based on your original pre op photos. In my opinion I might have suggest a peri areolar skin reduct ion initially because I would not have thought your skin would shrink enough. I think additional lipo will help but you will still be left with a skin fold along your lateral chest. You need to prioritize between getting a smoother chest with a scar or just some relative improvemne without an extended scar. I don't ordinarily recommend tattoos but I have had a few patients who preferred tha the sides were smooth and then they got tattoos over the residual scars.

[DrPensler]

There are a couple of issues.Optimal results include 1)surgery 2)diet and 3)exercise and optimal results are not obtained unless all three areas are worked on. As an aside I have never heard of Dr Lebowitz , perhaps he should one day write something related to gynecomastia.

[gemidude]

Thank you once again doctors. I’m having revision surgery this Monday. I’m hoping this will finally be resolved. The plan is skin excision, additional residual gland removal, plus lipo as needed. No free skin nipple graft. I will report back after surgery. And post pics, if successful.