Before surgery questions + after surgery experience

[EatingCake]

Hello -- Gynecomastia Community.

I have surgery in 5 days and after reading a bit of information on this website I'm starting to get a bit of doubts on my plastic surgeons opinion. I do not have any degree in medicine nor did I spend an extra couple of years specializing in reconstructive surgery. My PS contends I only need liposuction, when I came into his office he checked me out and felt the chest area and believes it is fat.

Additional details: 67kg, 177cm tall - 19 years old (in 3 weeks), I'm athletic and barely have any fat around my body except for my chest.

Now, I'm sure I will see him on the day of surgery before he operates on me to draw marking on my chest right?

I want to bring that issue across to him without sounding (rude or out of place). I'm aware that I'm paying for this so it shouldn't matter what he thinks but only my satisfaction of it all. But, I don't want to say "I read somewhere you could possibly be wrong", I want to say something which may open the option of excision on the day, rather pure liposuction.

Any feedback would be greatly appreciated.

[wantridofgyno17]

I'm not being funny mate, but don't be so held back about it! It's your body, and it's your money, if you've got gynecomastia lypo isn't going to fix it and you almost certainly wont be satisfied. Tell him how you want it done, and ask if he's done it before, if he's not familiar with the excision process - go elsewhere and find a surgeon who knows what they're doing..

At the endo f the day, he should be trying to keep you happy, not the other way round. Good luck bud!

[EatingCake]

My plastic surgeon has done about 6 gynecomastia surgeries in the last couple of months, so obviously he is familiar with the operation in itself but he believes I do not have a gland there and he assessed the area of a few minutes telling me to put my hands on my hips etc.

The PS I'm seeing is in a family business with a brother in the same office and a father who is chief of medicine at a hospital, this is in Australia by the way. Basically my question was, on the day I should say what to him? I want to know exactly what to say with me being satisfied and not to piss off the person who is about to put a knife to my body when I'm asleep.

My internet is capped at the moment but hopefully in a couple of days before I can put pictures of my chest so maybe other might be able to rule out gynecomastia or the fatty tissue. PS rated me at 3/10 for my chest enlgarment.

One last thing, if it is indeed just fatty tissue can that fat ever grow back? I'm an athletic man but if I suddenly want to have a break for a month pack on some kilos, will it store in my chest like before or is this a one off never again?

Thanks again.

[Wayne1985]

My surgeon said the same thing.  He's an experienced PS who's been practicing for over 25 years.  I am a minor case.  He said my gland component is minor and I'll need liposuction only, because the thinks fat is what's pushing it out.  You're not the only one who's had this diagnosis.

Here is what Dr. Jacobs had to say about it in another thread:
http://www.gynecomastia.org/smf/index.php?topic=19549.msg134695#msg134695

As much as we think we know from reading on here and on Google, we have to assume our surgeons know much, much more than we do.

[Wayne1985]

...I'm still thinking about this.

This "lipo only" vs. "excision and lipo" debate seems to be fairly common on here.  I think it deserves a sticky thread with some opinions from the doctors on here.  They're the ones cutting guys' chests open and fixing them; they know when lipo only is an appropriate fix.

[Dr. Elliot Jacobs]

I am still bewildered as to why my plastic surgery colleagues try to define (pre-operatively) what they are going to do in any one particular case.  Why not begin surgery with the hope and plan to do lipo only (benefit:  one tiny incision) but be prepared to do excision if one cannot get all the tissue out with lipo only?

I also do not understand why some of my colleagues will have different fees for lipo or lipo with excision.  To my mind, if a surgeon is performing a gyne procedure, he should be fully capable of doing anything necessary -- at the same operation -- to achieve the best result -- and he should charge just one fee for the procedure.

I have examined a huge number of male chests -- lots of experience here.  And to this date, I still cannot be 100% sure of what the operation will require (lipo or lipo with excision) until I am into the middle of the procedure.  Except in rare circumstances, it is not possible for a surgeon, much less a lay person, to examine a chest and tell, just by feel,  how much is fat and how much is gland -- and whether lipo alone or lipo plus excision will be required.

Dr Jacobs

[DrBermant]

Hello -- Gynecomastia Community.

I have surgery in 5 days and after reading a bit of information on this website I'm starting to get a bit of doubts on my plastic surgeons opinion. I do not have any degree in medicine nor did I spend an extra couple of years specializing in reconstructive surgery. My PS contends I only need liposuction, when I came into his office he checked me out and felt the chest area and believes it is fat.

Additional details: 67kg, 177cm tall - 19 years old (in 3 weeks), I'm athletic and barely have any fat around my body except for my chest.

Now, I'm sure I will see him on the day of surgery before he operates on me to draw marking on my chest right?

I want to bring that issue across to him without sounding (rude or out of place). I'm aware that I'm paying for this so it shouldn't matter what he thinks but only my satisfaction of it all. But, I don't want to say "I read somewhere you could possibly be wrong", I want to say something which may open the option of excision on the day, rather pure liposuction.

Any feedback would be greatly appreciated.

If you feel you need to guide or advise your surgeon about what needs to be done, you have picked the wrong surgeon. How to pick a gynecomastia surgeon:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

You need to evaluate a surgeon's skills by what they show you from their web site, photos in office, or other methods. If you do not trust in your evaluation, think twice about using that surgeon.


Liposuction Is Great for Sculpting Fat

Each surgeon uses the tools and techniques he / she prefers.

Gynecomastia Examination by feeling alone can be misleading. Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this Gynecomastia Anatomy drawing and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

Liposuction such as ultrasonic, VASER, Laser, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

Gynecomastia Examination by feeling alone can be misleading. Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this Gynecomastia Anatomy drawing and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

The edge of the areola is a great place to fool the eye in hiding a scar.  I can remove a large gland through a tiny incision at the edge of the areola / nipple.  My typical incision now is about 1.6cm (about 0.6 inch) for a typical gland.  Remote incisions make the work easier for the doctor with liposuction. It is much more difficult to perform the liposuction from the areola incision.  This location can take more skill and time.  Remote incisions offer a better vacuum for faster fat removal.  However, they also usually require a second incision at the edge of the areola to go after gland, can injure tissues between the remote site and what needs to be worked on, and have no place to hide on the chest or under the arm. I also feel that a single small scar hidden at the edge of the areola are almost always better than 2 or more scars that often are as big or larger.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesion, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

For a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used "special cannula to remove gland," that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia Male Breast Reduction

[EatingCake]

Thank you for your feed back but the truth is I'm lucky enough to even see a plastic surgeon, as I have no money and my dad has decided to pay, I don't think I will be advising my surgeon its just in the pre op consultation room he believes its fat more then gland. But he never said it's definitely not gland or definitely not anything he just had his own assumptions - this particular surgeon has been around for 20 years.

Obviously has had a lot of experience performing surgeries but apparently gynecomastia surgery isn't something he does too often. The PS tells me he has done a few in the last couple of months but said its not too common as most people tend to just live with it. For me he thinks liposuction will be best because I'm skinny, the PS told me in the pre op room he will do another surgery for free if I am not satisfied with how it looks after.

Now as good as that sounds I only want one surgery and not have to worry about this crap ever again, but I guess it's good that the offer is there. I will post some pre op and post op pics maybe a week after surgery or so and get feedback from you guys.

 Lastly, I do not want a perfect chest - I want a chest better then the one I have now, I do not have unrealistic expectations or obsessed about my appearance, but the way it is now is quite aggravating, because at the end of the day we are unique and different if everyone was the same life would be boring. So bearing that in mind I'll just pray for the best and hope Jesus himself cuts me open haha.

Thanks again.

[Wayne1985]

Eatingcake, I spoke with my surgeon both at the consult and right before surgery about this.  The way I handled it was, I explained my goal: I wanted my nipple to shrink down to normal size and be flat, giving a normal, masculine contour.  I asked my surgeon to whatever he needed to do to make this happen.  My surgeon told me he was confident he could get this result, and I went into surgery feeling good about it.

He felt around my chest, and explained that, while he does do gland excision for some cases, mine felt like fat was pushing out the nipple.

[EatingCake]

All right, well I will see him tomorrow as today will be really my last day of having this condition, feels so weird, I have not told anyone I know about this and I will just disappear and turn my phone off until I'm fully recovered. lol

[EatingCake]

Just got back from the hospital man, what a story to tell.

Well, turns out I required no liposuction, my plastic surgeon said it was all gland (thank god), and I didn't need any DRAINS  Grin.

I guess my recovery will be short lived because of this.

The pain is barely anything to worry about it is more being uncomfortable then anything - my left breast hurts more then my right apparently there was more in the left side.

The worst part of this surgery was the WAITING - Omg man, the anticipation is a harsh mistress. Always looking up at the door waiting for your name to be called was next to unbearable, I guess waking up after anesthetic wasn't much fun either, that oxygen mask leaves a after taste for hours, yucky.

I will not be able to show you guys any pictures until about a week, as that is when the pads are removed, nor will I be able to have a shower for a week  Embarrassed. I guess seeing as this will only be happening once in my life I rather like to treat it as a odd experience and enjoy the time I wear what feels to be like bullet proof armor and stink like a bushman. A taste of the SAS soldiers life, and the pain is from a gun shot hahah kidding, nah srsly the pain is nothing and I'll pop a few painkillers before I head off to sleep tonight. One thing the nurses told me was to sleep upright for the first 2 nights, as uncomfortable it sounds it will reduce swelling and obviously speed up recovery - so I am all for that.

Anyway my fellow gyno comrades, I hope this post may have answered or released some anxieties if you too are thinking about surgery, in the long run this is going to benefit you the most, short term yes it sucks - but really what doesn't in life, everything comes at a price.

[EatingCake]

Quick update:

Pain was a lot worse today seems that after the anesthetic my body seemed to be experiencing more pain. No matter, I was prescribed with opioids/paracetomol for the pain, so lucky its not going to ever be too uncomfortable. I'm trying to only take them when necessary as after I have them I'm drowsy and my eyes are like pins, I also look off color and havent been able to have a shower so my skin is really oily and I will probably have acne by the time this vest is off and I can shower again.

Anyhow hopefully after this I have some opioids left over so I can sell the rest for some cash and buy awesome shirts with it, lol joke. I would never do such a thing.

I'm sure the worst pain was today, 48 hours I hear is the main stage for healing so one more day of minimal pain should be alright.

[EatingCake]

Update: I don't want to jump the gun so to speak but the pain is minimal to none at this point in time, I have been taking about 4 Capadex a day which isn't that much seeing as it says I can have 2 every 4 hours.

The more I lay down and rest the less pain I am in walking around, yesterday I was downloading music on the computer and my chest started to hurt like 20 minutes later and only lying down helped the pain, maybe its the gravity or the hand movement required to be on the keyboard.

My pet hate is the way I have to sleep at the moment, I always wake up with pins and needles in my hands because I have been putting pressure on my elbows all night sleeping on my back. I usually slept on my stomach or sides.

I am counting down the days when I see my plastic surgeon again, cannot wait until I see the results or better yet, never have to wear this contraption ever again. Worst part about it is on the sides where the fat hangs out it has left big red marks and my skin is really painful there, left a deep red mark or burn from the pressure, I have had to put pads there and it has helped immensely.