Should all glandular tissue be removed?

[G]

Hello folks,

I'm going in for my second surgery for gynecomastia in the middle of December and I've got a question- should all of the glandular tissue be removed?

My surgeon was way too conservative during the first surgery and my results were very underwhelming as a result. The biggest problem in his philosophy seems to rest on his insistance that not all of the glandular tissue be removed. He believes that removing all of it will cause my chest to look too flat. However, I really do want my chest to look FLAT! What gives with this guy? Isn't he supposed to remove all of the gland?

I really don't want a third surgery so I'd like this procedure to get done right this time.

[uk2000]

ive had the same problem, surgeons ive had never removed enough, no1 ive had 3 surgeries.
1 side is now flat, so no complaints,  the other sides seems still to have to much gland.
i say tell em to rip it all out, cos after time it will fill in.

[DrBermant]

Hello folks,

I'm going in for my second surgery for gynecomastia in the middle of December and I've got a question- should all of the glandular tissue be removed?

My surgeon was way too conservative during the first surgery and my results were very underwhelming as a result. The biggest problem in his philosophy seems to rest on his insistance that not all of the glandular tissue be removed. He believes that removing all of it will cause my chest to look too flat. However, I really do want my chest to look FLAT! What gives with this guy? Isn't he supposed to remove all of the gland?

I really don't want a third surgery so I'd like this procedure to get done right this time.

With my Dynamic Technique, I target gland first.  However, with any surgical technique, shreads of gland remain behind.  How fingers of gland pass through fingers of fat is the limiting factor. I perform alot of secondary surgery on other doctors' patients, and but rarely need to revise one of my own sculptures.

Revision Gynecomastia Surgery often can help with residual tissues.  However, it depends on the problem. Take a look at these patient's photographs: here and here.  Check out the movies on how the problem is not excess remaining gland, but extended areas of too much tissue removed and the skin adhering to the muscle.  

Each came to me asking to have more tissue removed even though there were massive crater deformities.

To better understand someone's concerns about their problem before, after surgery, or how good a result is after, Standardized Photographs say much more than words.  If something is supposed to be so bad or good, show the pictures or movies how the tissue moves.  That way others can get a better idea about the quality or degree of problem.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[tonysoprano]

so Dr. B,

What were the options for those 2 patients next?

where to for them , in terms of gaining any further improvement? do they have any options?

[S_Mack]

Dr B. -- Another Question,

What can be done immediately post-op if one has had a "conservative surgeon" that removed only minor amounts of gland?  I am 6 days post-op and fear that this could be my situation.  In terms of post-op healing in this case, what can be done to ensure the best results?

[DrBermant]

so Dr. B,

What were the options for those 2 patients next?

where to for them , in terms of gaining any further improvement? do they have any options?

It is easier to remove than replace.  For those two individuals, the defects were just too great.  

When there is enough local tissue, my Fat Flap Sculpture can move near fat into the defect.  Fat with a blood supply tends to stay alive.  Fat without a blood supply (graft) does not do as well and tends to become firm and not look good with animation.  

Dr B. -- Another Question,

What can be done immediately post-op if one has had a "conservative surgeon" that removed only minor amounts of gland?  I am 6 days post-op and fear that this could be my situation.  In terms of post-op healing in this case, what can be done to ensure the best results?

6 days if very early for some techniques.  It can take months to see final results.  Revision Gynecomastia Surgery may be an option.  However, tissues need to heal and soften before any possible secondary surgery.  Such issues are best explored with your surgeon or someone you see for a second opinion.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture