Gyno Reoccurance

[nms]

How can it reoccur? thanx

[Paa_Paw]

Yes.  But how often it happens is something you can control.

Some fat and glandular tissue remain even after surgery.  In fact, it has to be left there to maintain the body contour, otherwise the breasts would be concave.

If there is a hormone condition which favors feminization,  That tissue will be able to proliferate.

In the case of serious weight gain, the breast area is a natural place for fat to deposit.

The possibility of regrowth is greatly diminished simply by seeing an Endocrinologist first.  Your gynecomastia is most likely due to hormonal imbalances while you were in puberty but sometimes it is a symptom of other diseases.  The Endocrinologist can rule out or treat any glandular condition which might cause a problem.

Keeping your weight within normal bounds has many health benifits.

If you take the apropriate steps prior to surgery, the chance of regrowth can be greatly minimized.

[sophomore]

my gyno reocurred. I had my surgery done by silverman and not two weeks post op i could feel a little disc under my left nip growing back again, and as it stands now the lump is bigger than it was pre surgery, i didnt see an endocrinologist prior to surgery, if i did what kind of information could he have given me about my hormone balance, and is there anything he can do or give you that would stop the gyno from growing back after surgery? Ive also heard that if the PS disconnects the gland, not cut it out but just disconnects it, that it is impossible for gyno to grow back because the estrogen would have no way of attaching itself to the gland..dr bermant do you have any insight on this procedure?

[Allan7865]

my gyno reocurred. I had my surgery done by silverman and not two weeks post op i could feel a little disc under my left nip growing back again, and as it stands now the lump is bigger than it was pre surgery, i didnt see an endocrinologist prior to surgery, if i did what kind of information could he have given me about my hormone balance, and is there anything he can do or give you that would stop the gyno from growing back after surgery? Ive also heard that if the PS disconnects the gland, not cut it out but just disconnects it, that it is impossible for gyno to grow back because the estrogen would have no way of attaching itself to the gland..dr bermant do you have any insight on this procedure?

I wouldent be alarmed just yet.. it could be that its just scar tissue and that it may still go down. Go see your PS and see what he says.

[Hypo-is-here]

I was told that it can reappear but it is not commen when done by a surgeon that has experience.

Whoever said that is talking utter crap.

The only way to absolutely ensure that glandular tissue does not act via the influence of hormones is to perform a full masectomy- which removes all breast tissue.

[sophomore]

there is no way that this gigantic lump can be scar tissue, its been over 6 months since the op, and since when does scar tissue accumulate to such a big lump under the skin..and yes he probably did leave some tissue in there so it wouldnt look concaved but i doubt it would of looked concaved because i have pretty low body fat (10%)and a decent amount of muscle in my chest (300 lb bench)

[tsjas]

Sophomore, I had a similar case of gyno reoccurance. My gyno reoccured about 4 weeks after the surgery. I told the surgeon about it but he said "Oh this is just a swelling after the surgery and it will soon disappear." He told me to come back after 6 months. I went back to him after 6 months and he said "Oh it is not so bad, and that my chest looks normal". The problem is that my gyno is as bad as before the surgery. It is funny that my surgeon did not tell me that chest looks normal before I had surgery. He only told me that after he charged me $4000 for the surgery.

[Hypo-is-here]

Guys who have gynecomastia reccurance need to try and ascertain why.

This should involve endocrine testing and if this has been done in the past liver, kidney and thyroid function tests should be added to the original panel of tests.

[Testing_Andractim]

I have only heard of 1 case of gyne reoccuring after surgery, i don't know any of the details i just heard that it did.

[wolfpack24]

I am about 4 months post op now and I'm a little worried.  The lumps that I thought were scar tissue might be getting bigger.  I'm starting to think that its already coming back. I went to the endo before surgery and he said everything is fine with my hormones so its not that. I've worked out and ate relatively well since the surgery too. I just dont understand. I will go and see my PS as soon as possible but I just cant see how these two lumps are scar tissue.  I'll try and get pics up so you guys can see. Info??

[DrBermant]

my gyno reocurred. I had my surgery done by silverman and not two weeks post op i could feel a little disc under my left nip growing back again, and as it stands now the lump is bigger than it was pre surgery, i didnt see an endocrinologist prior to surgery, if i did what kind of information could he have given me about my hormone balance, and is there anything he can do or give you that would stop the gyno from growing back after surgery? Ive also heard that if the PS disconnects the gland, not cut it out but just disconnects it, that it is impossible for gyno to grow back because the estrogen would have no way of attaching itself to the gland..dr bermant do you have any insight on this procedure?

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.  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 remainng tissue to minimze 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.  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.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[frodo]

If the gyno was NOT caused by smoking cannabis, can it reccour after surgery if you smoke cannabis? The endocrinologist I asked said no. Any opinions?

[DrBermant]

I kind of noticed at about 4 or 5 weeks and it has slowly progressed over the last couple of months to about 40% regrowth. I'm really not sure what to think about it. I mean, he did the surgery and it looked good in the beginning. I know that he did lipo and direct excision -but I am still experiencing some regrowth. I'm pretty sure he did everything that he was suppose to do and it is my body that is having the issues. Probably need to go see one of those endo docs. I'm going for a 6 month post op eval with dr. wiener next month and I'll find out wtf is going on.

Good luck,
Ringo

That is why I evolved my red flag system!  As discussed above, patients with growing breasts are better stabilized before surgery.  If there is an underlying endocrine problem, address that first.  Surgery does not stop further breast growth.  Surgery does not stop weight gain.

Check out the expanded version of my response here:
http://www.gynecomastia.org/smf/index.php?topic=16651.msg115797;topicseen#msg115797

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[DrBermant]

I have posted another example of Gynecomastia Breast Regrowth on my site.  This patient is rather unusual. He was a misdiagnosed genetic female who has lived his entire life as a male.  Yes, a terrible mistake labeling him male made from birth and early on not recognizing his Congenital Adrenal Hyperplasia.  His body has been exposed to high levels of androgens and estrogen since within his mother's womb.

To learn more about his experiences start with this Video of his patient experiences with female to male chest surgery.

The point is that breast reduction or gynecomastia surgery does not stop breast growth.  Finding the problem and stabilizing it first gives a much better chance of lowering the chance of recurrence.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction