Will it/ can it come back?

[kennyb]

I am taking Nizoral shampoo (not orally) which relieves dandruff and MPB.  One of its side effects is gyno.

Does this mean it can "come back"?  Or will all the potential breast cells be removed?  

Or perhaps if there are only a few they can start growing again like mad?

Leaving aside the Nizoral, if my overall hormones were not great (kind of low test, but not high estrogen) but this had been stable for years....does this mean the gyno can or will come back?

[Grandpa Bambu]

Dr. Bermant says is it very rare for the gland to return.

John.

[merle]

The research that I have seen says that it comes back in 30% of first surgeries and 20% of second surgeries. It came back in my case and I have talked to many others that it has as well. It is impossible to get all the cells that can grow into breast tissue.

Given the right conditions it can come back. Generally not as bad as before, there are less cells to grow.

Merle

[Hypo-is-here]

Merle is quite correct, which is why it is very important for all men with gynecomastia to visit an endocrinologist prior to any surgical procedure with a view to ascertaining the hormonal situation.  Doing so allows you to rule out any underlying causative conditions or medications which maybe involved.

In particular reproductive endocinologists are experts in Gynecomastia and its development, wheras plastic surgeons experienced in this area are experts in gynecomastia removal.

If you are looking at a procedure it should be reproductive endocrinologist first and experienced plastic surgeon second.  If you are not looking at surgery it is still very worthwhile seeing an endocrinologist to ensure all is well.

[DrBermant]

Dr. Bermant says is it very rare for the gland to return.

John.

Gynecomastia Surgery Does Not Prevent Regrowth


I caution each of my patients that surgery does not typically stop male breast growth.  If there is a problem with growing breasts, recurrence can happen.  Any of these medical problems and or these medications can cause gynecomastia. So, if you want to get worried about regrowth, you could get yourself evaluated for each of these conditions to see if they could be a factor.

Surgery also does not prevent weight gain in the chest.  Men tend to put weight on the belly and chest regions.  I educate each of my patients that this surgery will not prevent further breast growth.  It is like changing/fixing a tire with a nail.  Fixing/changing the tire will not prevent you from getting a new nail in that tire.

I take care of many patients with gynecomastia, as many as 8 in one day alone.  With all the gynecomastia surgery I have done, it is very rare to have regrowth for patients I have sculpted.  One patient (who had surgery on only side by another doctor) came to me with pro hormone induced gynecomastia that only came back on the side that had no surgery.  His growth was massive on the one side and none on the other.  His surgery by that other doctor had left a massive crater - the skin was adherent against the chest wall with normal fat surrounding the ugly deformity.  One side looked like the deformity seen here.  The other side was almost a B cup breast so tender that I could barely examine it.  As with each patient who presented to me with current breast growth, he was referred for an endocrinology evaluation and stabilization before considering surgery.  I do not know if such radical surgery was a factor or not.   Even if it did, removing all fat under the skin just gives an unnatural look.

I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.  Any surgery technique, even radical breast mastectomy for male breast cancer can leave gland behind.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest.

You can see what I mean by fingers of gland here.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and red flag before surgery evaluation system, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention of gynecomastia, when possible, is much better.

Secondary Surgery is often an option for those who had prior surgery.  Such issues are better discussed during a consultation with your surgeon or someone who can advise you about your options.  We help patients explore such issues during consultations or preliminary remote discussions.

The research that I have seen says that it comes back in 30% of first surgeries and 20% of second surgeries. It came back in my case and I have talked to many others that it has as well. It is impossible to get all the cells that can grow into breast tissue.

Given the right conditions it can come back. Generally not as bad as before, there are less cells to grow.

Merle

It depends on what a study calls regrowth.  If you include issues like old age gynecomastia after testosterone function lessens, the facts are probably 100% of men will have breast growth - with or without prior surgery.  If you include gaining alot of weight, all overweight men have breasts.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[kennyb]

Thanks.

I have low T levels, but still 'normal'.  Gyno is stable for a long time.  Maybe that is a good sign?

[DrBermant]

on Jul 10th, 2006, 7:02pm, Grandpa Bambu wrote:Dr. Bermant says is it very rare for the gland to return.

John.  


In response to your post below in the thread "will it/can it come back" I was curious if it is possible to come back as quick as 2 weeks following a surgery. I ask because my right side still appears like it did prior to gyne surgery and feels like it when I grab it. Yet it feels a little hollow and fluid filled. I rules out it was not fluid or blood when I saw my surgeon post op yesterday for him to try and drain it. Nothing came out. He says it could be an air pocket or swelling and that I need to be more patient and not feel for all these lumps and what not this soon. Says I will see a dramatic change in then next 4 weeks even still from what it looks like now. I know I don't know as much as my surgeon but I do know what my gyne looked like and felt like before surgery and it is very similar and only on one side. I just can't imagine it coming back that quickly though. Doesn't seem possible. I think I am paranoid cause I have high estrogen levels maybe still in my system since I last did a cycle. That is how I got my gyne to begin with. I am taking novaldex just in case starting today as it should prevent any estrogen from binding. Thanks for any feedback.

regards

2 weeks is too early for regrowth of gland or fat.  Tissue just does not grow that rapidly.  

A hematoma,or collection of blood, after gynecomastia surgery can cause swelling.  Sometimes they can be drained.  Other times the blood must first liquify before it can be drained.  Sometimes the blood is diffusely in the tissue and cannot be drained.

There are many other possible reasons for contour problems that early after surgery which are best explored with your doctor or someone familiar with what has been done and can examine you.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[flex1appeal]

Well, I really don't think it is regrowth but I now have a hard not under my nipple and it is painful. My entire left side is beyond swollen and no fluid drained this past tuesday. Then, having the surgeon stick that big ass syringe in me made it black and blue again ontop of adding the additional swelling no doubt. I had my compression vest off for 2 hours yesterday as I was trying to wash it (my doctor said that would be ok). In that time, my right side swelled greatly. It is very uncomfortable and feels/looks like a boob. But my nipples are not puffy. Rather, my entire chest is puffy. Really weird. I guess it has to go down sooner or later. My left side is a little swollen still and both sides my nipples are sensitive. If I knew how to post pictures I would. Then you could see what I was talking about.