Three months post-op after revision surgery.(photos and ultrasound test)

[Jesk]

Hi, I’ve had gynecomastia since puberty, i have never taken steroids or something like that. Two years ago, with 26 years old, I decided to go to endocrinologist and talk about my problem. My first hormones check was OK except estrones and estradiol that were a very little above the normal range. My second hormones check shows a prolactin level very very little above the normal range but estrones and estradiol were OK and he prescribed me a Nuclear magnetic resonance of Pituitary (all was OK), then he prescribed me Dostinex. A few month laters taking Dostinex prolactin was almost 0.0 but gynecomastia keep there (estradiol keeps a bit raised). Then I decided to talk with a surgeon.

With 27 years old and taking dostinex, all hormones check were OK. After the operation when I saw my chest after the surgeon took off the sutures (2 weeks after the op) the chest was completely flat. After a month I stop to wear the compression garment and swelling begun. After four months I stopped took Dostinex cause endocrinologist said me that probably it wouldn’t be necessary cause probably it was caused by gynecomastia. After five months from the surgery (all was happening normal and my chest was become flatter across the months.) then it stops and I noticed when I touched that under my nipple there was nothing (it was empty) but flaccid. Then the surgeon said that he removed almost all gland under the nipple, if he removed more there would be a crate. Then he recommended massage the zone cause maybe it was scar tissue or more swelling.

Ok after one month massaging the zone I noticed that it becomes to hurt and I went to endocrinologist again to do a check and a ecography (ultrasound scan), I had my prolactins level higher than normal and my gynecomastia was regrowth like the beginning even a bit worse!!

I was very frustrated then I decided to stop massaging. I begun to take Dostinex again and asked for a date to a revision surgery but first I went to another hospital and another endocrinologist.

This endocrinologist thought that Dostinex it wasn’t necessary cause my problem with the operation was bad luck. And he think I have no hormone problems than induced by gynecomastia (massaging the zone after post op too, that can raise prolactin levels, he said).

Then I stopped to took dostinex and I did a hormones check a month and half after in that Hospital. All hormones were OK, included prolactin levels. Then he wrote a document saying that I can have a revision surgery cause my hormones problem was solved.

It was very frustrating but I decide to get surgery again. Then 3 months ago (03 march) I had a revision surgery with the same surgeon and he took off all gland and some fat that had appear again. After to weeks I had my chest even better the last surgery. All was ok after I stopped to wear the compress garment a month post op. Swelling appears and the nipples become to a bit puffy and empty (I can’t touch lumps or something like that when I press my chest, it just seems empty or with some fluid. The only scar tissue is behind the nipple that it’s a bit hard.)

I was worried about the same could occur then I decided to go the endocrinologist and check my hormones levels and had a ecography.
Two weeks ago I received the results. All my hormones levels were very good, Prolactin was 13,63 μg/L (the normal levels for a man in that hospital are under 14,7 μg/L, but cause prolactin raises with the stress, after 20 minutes with the pinprick it lows to 12,69 μg/L).
 
The ecography says:
 “We perform ultrasound of both breasts, we use high frequency transducer. We observed a small triareal hypoechoic retroareolar image with some anechoic tubular structure through it, impressing correspond to the remains of fibroglandular tissue. The maximum thickness from the subcutaneous level to the muscular wall of 11 mm on the right side and 9 mm on the left side. These findings are indicative of probable gynecomastia. It would be advisable to compare with previous studies, advising control and follow-up given the surgical history that the patient refers to. No other ultrasonographically visible findings.”
Then I Thought WTF gynecomastia again in two months post-op?!!? with the hormone levels OK? Then the endocrinologist said that all was ok, probably that tissue was scar or something like that. That I should stop worrying about it and give it time.

I think its normal that I was a bit obsessed cause it’s the second surgery and if it regrowth again I don’t know what the darn is going wrong with me.

Has been passed three months since operation and I don’t see the surgeon until the beginning of the next month. Until the date comes I want to ask your opinion.

PD: There are days that my chest is flatter in the morning and more flaccid or swollen across the day (why?).

PD2: I haven’t photos from the 2 weeks post-op cause I didn’t think I would keep obsessed three months after :S. Those photos are almost 3 months post-op.

Thank you.

[charlie1821]

My endocrinologist made it clear I would likely have to take dostinex for the forever basically. 
Since there don't appear to be any negative side effects at the low dose required for maintenance I don't plan on stopping. I just had my surgery 5 days ago, and don't want to risk regrowth so I will stay on dostinex. 

[Jesk]

Thank you for reply.
My last endocrinologist said recommended me to take Dostinex forverer, but he didnt know the cause. My actual endocrigologist (recommended by my surgeon) (both are good endocrinologists, but i wanted a second opinion) thinks that there is no reason to take Dostinex cause my prolactin levels are in normal ranges for a man. He thinks that cause massaging the nipple last time made regrowth some rest or gland tissue cause if u stimulate ur nipple it could cause an increase in prolactin levels.
As i said I check my hormone levels before and after the surgery and they were OK. It suppose that there is no reason for a high prolactin in a healthy man (I did a pituitary MRI and there wasnt tumors).
Then I want to think that just was bad luck. Right now there is nothing hard between my nipple and my chest (muscle) except some tiny lumpies and hard tissue behind the scision. My libido is good and my testosterone (levels checked) good too. Then I think there is no reason to thinks that this is going bad..... I hope that.
I have at the beginning of the next month the date with my surgeon. I will put here if there what he says to me or if I get some improvement. Meanwhile im glad for your answers.

[Jesk]

I forgot to ask you: What is the reason why your endicrinologist recommended you to take Dostinex forever?

[res.Cogitans]

All gyno surgeons (and physicians) suggest massaging the area (if you have lumps), its the first time i read that massaging will cause gyno back or prolactin high level.. It dont make any sense to me..
You should try to wear your garmet every day or every night. Compression is very helpful and prevents any swollen area at the healing period.. Also minimize scar tissue.. Healing period is many months, and not ony 1-2-3 months.
From the pics you provide i see that you have some more weight than normal.. Why dont you start a mild excercise with diet? Having more weight than normal, makes it hard for the best/flat chest.. All surgeons recommend normal weight to achieve the best possible result.. A surgery along cant make it perfect, you need to do some things.. As long as your tests and hormones are generally ok, but the type of your body is overweighted, you should try more and harder than others, but surely you should try.. Eitherway, it might come back (it wont be tissue, but fat) but it will look like gyno..

After surgery we must do 3 things that surgery cant help us if we dont make the decision to do them:
compression, excercise, diet.. 
Try eat clean.. Do a mild excercise to clean your body from toxins and fat.. and wear your compression for some more weeks for 8 hours a day or day by day..
Good luck mate

[Jesk]

Thanks for your reply.
Its true that i'm a bit overweighted and I have to lose at least 5kg of fat :/
About the compression garment. My surgeon said to me that i had to wear it until the first month. I've reading the forum and noone says that you will wear it more than 6 weeks.
Why I should wear it now (after three months)?

[Jesk]

Hi again,
I've just visited my surgeon at 6 months post op. He says that there is nothing below the nipple, that my chest is OK. He thinks that the flaccid chest as you can see in the photo and the excess of skin maybe occurs due to fat accumulation or phisiognomy. When I touch it there is nothing just behind the nipple but i have lumps in the sides (he says that is fat, gland cant be in the sides of the chest in a male, and he didnt touch the sides in the surgery, just pulled out the gland behind the nippple and left a little bit just for the contour)
What do you think about that after seeing the photos? Just 1 month after my surgery my chest were more flat and rounded, now my nipples arent puffy but my chest is flaccid.