pseudo gynecomastia revisional, reposted from doctors forum

[gemidude]

I just wanted to get some input, from non-doctors as well, as to my situation.
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. Elliot Jacobs]

You are overweight and that is contributing to your gyne problem.  You would do yourself a service by dedicating yourself first to losing as much weight as you are comfortable.  Then, consult with several board certified plastic surgeons who specialize in gyne surgery. I am sure you can find a surgeon whose fees are more reasonable.  And BTW, it is inappropriate, at a minimum, for a doctor to criticize another surgeon's results without at least reviewing your "before" photos.

Dr Jacobs

[gemidude]

Thank you Dr. Jacobs for your professional opinion. I’m overweight, yes but my BMI is not high enough to qualify for any kind of weight loss surgery. I’m 6’5 and it would be nearly impossible for me to lose weight without starving myself, but anyway that’s another subject altogether. I exercise all the time, maybe need more cardio.

Dr. Lebowitz raised fee to 18,000-20,000, which not to defame any doctor, but I think it’s absurd, no written quote just told me over the phone. Anyway, I have another consultation with a local plastic surgeon booked next week. I just don’t think my chest looks proportionate to my abdomen, and I don’t like the extra over hang of fat/skin.

[gemidude]

I was told by two different plastic surgeons that I have excess skin. And that liposuction alone would not help the loose skin. I’m scared to have to have my skin cut off, which is what the surgeons are advising me to do, along with liposuction. One even recommended a nipple skin graft. Does anyone know if there are other non surgical ways to tighten skin like mine? Or is surgery the only option?

[Dr. Elliot Jacobs]

Yes, you are overweight and you would be wise to lose some weight prior to any surgery.  However, given my experience with guys built like you, I would not expect to need skin excision.  If sufficient tissue is removed (both fat and gland) and with wide skin undermining, I think your skin would tighten reasonably well.  It helps if you are younger (ie less than 25 yo) and have never been significantly heavier than you are now, for then your skin elasticity should be able to accomplish the self tightening alone.

If you have that type of surgery, then give it six months at least for the skin to tighten.

Good luck!

Dr Jacobs

[gemidude]

Here are some pre operation photos from way back 7 years ago before I had the surgery. It looks like I have excess skin in the axila and chest. Notice in the before pics when my arms were down, I still didn't have the excess bagginess in the axila area. I had been on several consultations with plastic surgeons, and some thought I needed additional liposuction and gland removal, and some were right in that I needed a chest lift or skin excision. I feel a lot better knowing that the area can not possibly be fat. My plastic surgeon would not of left residual gland or fat in my chest area. This explains why when my arms are up my chest appears flat and sculpted, but when my arms are down everything sags. My weight has not changed since the previous surgery.

[Dr. Elliot Jacobs]

Thanks for posting your "before" photos -- that is very helpful.  It would be important for us to know your age, your weight now and your maximum weight.  Also, as has been stated, you would do well to lose some weight -- and that need not be done thru weight -reduction surgery.  You might seek the help of a nutritionist who could guide you towards a better life-style, which would include a proper diet.

As for extra skin, I totally would not do any skin removal, which would leave permanent scars on your chest skin.  Rather, when you are at a better weight, consider a revision operation with an experienced gyne expert.  When enough tissue has been removed and appropriate extension of removal into surrounding areas has been done, you might be surprised as to how much spontaneous skin tightening will occur.  Then, six months after this aggressive surgery, you can sit down with your plastic surgeon and see if there is any objectionable excess skin.  My guess is that there won't be -- but if there is any excess skin, it could be removed in a much much smaller procedure since much of the excess skin would have self-tightened, thereby leaving only a small amount to excess skin to be treated.

Good luck!

Dr Jacobs

[gemidude]

Yes I know I need to lose weight. But how would losing weight help with the excess skin? It’s not fat in the axila area. The skin obviously has not tightened on its own after the surgery, because of the severity of my gynecomastia. I would think if anything losing weight would make the excess skin appear more saggy. As seen in the pre op pictures, I never had the sagginess in my axila area before the surgery. And I’m the same weight as before. Which leads me to conclude this can’t be fat related. I’m willing to sacrifice having a scar, for my chest to be aligned with my abdomen.

[gemidude]

I’m having a revision Monday. I will report back with results after that time. Skin excision, residual gland removal, and lipo is planned.

[gemidude]

I had my surgery. I woke up all bandaged up and in drains. But I did take a peek at my chest. I am very pleased. I can tell the original doctor left residual gland, because now I don’t feel that mass or lump behind my nipple. I’m positive now, it wasn’t scar tissue. I feel vindicated now. Because honestly, no amount of weight loss, dieting, or exercise would of solved this. I think plastic surgeons should be held more accountable for their work. I know when I had the original surgery back in 2012, some people on this board were telling me to be patient, but let me tell you, if you don’t see results on day one, you will not see any later. If something does not look right, most likely something is not right. And expensive is not always better. Because I paid my previous doctor 7 grand to do this, while the new doctor charged me a fraction of that for the revision. Still an American board certified plastic surgeon. I haven’t seen what my side lateral or axila chest looks like but I will find out Wednesday. I will post pics Wednesday when I get the bandages off.

[gemidude]

I finally decided to take some post op pics. If anyone is squeamish you might not want to look at them. I'm bruised pretty badly. And my right side is very swollen and filled with fluid. But love the results. I love that I can see my lats, with no excess skin overhang.