surgery then chances of it coming back

[rocknroll316]

If you have surgery, what are the chances of the gynecomastia to come back?? I have had my gynecomastia since about 13, and it hasn't gotten larger. Im just trying to shed out about 20 pounds then tell my parents about my gyne to get surgery. I don't want it to come back.

[DrBermant]

If you have surgery, what are the chances of the gynecomastia to come back?? I have had my gynecomastia since about 13, and it hasn't gotten larger. Im just trying to shed out about 20 pounds then tell my parents about my gyne to get surgery. I don't want it to come back.

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 have seen many patients from other doctors who have had so much tissue removed, that the skin was adherent to the muscle.  The vast majority still wanted more removed!  When I get the chance, I will try to post more examples of such defects.  It can be very difficult if not impossible to repair such deformities.  When someone gains a lot of fat elsewhere, the craters can get deeper as the surrounding fat walls grow.  Even with such radical excision, gland remains and a few patients had new gland growth.

Negative endocrinology evaluations do not prevent breast regrowth. I have seen one patient who had 3 prior operations by other doctors for gynecomastia.  The patient brought a nicely documented series of images showing breast regrowth after each surgery.  The amount of tissue removed on each operation was substantial, so I doubted it was a case of inadequate removal.  I sent that patient for an Endocrinologist evaluation which came back negative.  After talking with his endocrinologist, further endocrinologists were consulted and further testing was done.  These tests were negative.  There was quite a bit of money spent on these endocrinology evaluations, yet no cause was found.  Of the large number of gynecomastia patients I have sent for Endocrinology evaluations, only a few have ever come back with an actual condition that needed treatment before surgery. 

My plastic surgery practice brings me patients from around the world giving me a very nice exposure to a wide range of Endocrinologists.  My lectures about gynecomastia also gives me the opportunity to discuss this condition with many Endocrinologists specializing in the treatment of gynecomastia.  I have been speaking with Endocrinologists about gynecomastia for over 30 years.  Almost all have told me that good screening by history and physical examination is the standard of care for a gynecomastia patient considering surgery. I recently polled 10 Endocrinologists on this matter.  9 out of the 10 said that automatic endocrinology referrals for gynecomastia patients was not warranted.  A number of Endocrinologists specializing in the treatment of gynecomastia helped me set up a series of red flags for evaluation instead of automatically sending each gynecomastia patient for testing.  For some, an endocrinology evaluation helps set their mind at ease and is a great idea.  For others I mandate it before surgery because of my findings during my evaluation of the patient.

Yet, for all the many years that I have been treating gynecomastia, extremely few of my patients have actually had glandular regrowth that I know of.

Surgery is best on a stable problem - not one getting worse.  Surgery typically does not prevent regrowth.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[headheldhigh01]

that's a very useful post, almost a candidate for posting in a recurrent topics area or something.  but it is probably the exception rather than the rule.  and not to hijack the thread, please don't start on it, but the part about the 9/10 endocrinologists' comments about referrals looked like useful info too.