Great Results with Dr. Jacobs (Sept., 2009)

[ramesh]

When Dr. Jacobs asked that I post about the experience I had with him, I heartily agreed.  I'm in my early 20s, and I had suffered from gynecomastia for nearly 10 years.  I had thought about surgery in the past, but I had never seriously pursued the idea until I came across a profile of Dr. Jacobs in the New York Times.  I didn't realize that doctors actually specialized in this surgery.  I immediately made an appointment for a consult with Dr. Jacobs.

That consult was in January of 2009, when I was visiting New York.  I waited for quite a while before I jumped into the surgery.  I looked into a few doctors in Chicago, closer to where I lived, but no one did the volume of surgeries that Dr. Jacobs did.  I also felt more comfortable with Dr. Jacobs because I could see the results of many patients on his website, while other doctors only posted 2 or 3 sets of pictures.  Dr. Jacobs was a bit more expensive than the other doctors, but I felt that his experience justified the costs.  I finally made an appointment for surgery with Dr. Jacobs in September of 2009.

My surgery experience with Dr. Jacobs was excellent.  The surgery went well with no complications.  In addition to liposuction, Dr. Jacobs made small cuts and excised glandular tissue from under the nipples.  The scars healed quickly and are nearly invisible today, which is great because I usually scar very easily.  I have gained a little weight since the surgery, but my chest remains flat.  I am extremely pleased with my experience and results.

The total cost for the surgery and anesthesia, pre-insurance, was $6950.  Dr. Jacobs's staff subsequently filed all the insurance paperwork, and my insurance reimbursed about $2000.  The surgery was on Tuesday, I was walking around on Wednesday, and by Saturday I was well enough to move boxes and furniture for a relative.  By far the most uncomfortable part of the whole process was wearing the compression garment.

I posted a few pictures online so that you can see the results.  I'd be happy to answer any questions you have.

Before
After

[303MattS4]

Who's your insurance co. and how did the staff go about getting part of the procedure reimbursed?

[ramesh]

Hi Matt,

At the time I had UMR through United Healthcare.  It was interesting to note that we didn't even provide advance notice of the procedure to the insurance company or get the names of recommended doctors from them, yet it was still partially covered.  Dr. Jacobs's office said that insurance reimbursement is much more likely if glandular excision is necessary rather than simple liposuction.

[ramesh]

I’ve been asked a few questions about my surgery with Dr. Jacobs by pm, and I wanted to put my answers together so that others could read them.

Q:  Do I have to have accompaniment to the surgery?

A: Dr. Jacobs requires that you have somebody accompany you on the day of the surgery—this person will make sure that you can get back home/to your hotel all right.  I had a relative accompany me (I also stayed at their place for the following three days), but Dr. Jacobs has a list of nurses that you can hire on a day-by-day basis (if you hire a nurse, you will need one until the morning after the surgery.  After that you can get around on your own). 

Q: How quickly will I recover?

A: After the surgery, you will feel okay for a few hours (leftover effects from anesthesia) but will be extremely sleepy. Overall, if you do the Thursday surgery, then take Friday off from work and recuperate over the weekend, you'll be good to go by Monday (a little sore, but nothing too bad).  I had the surgery on Tuesday, and by Friday I was riding the subways without a problem.

I would say that I was good enough to go to work by the fourth day after the surgery (I imagine some people can go to work on day 3, but I didn't have to so I didn't try).  After a week, the whole feeling of tiredness goes away.  After about two weeks, your stitches wash out in the shower.  After a month you can stop wearing the vest (but I would suggest you wear it at night for another month).  I stopped wearing the tight undershirts after 2 months.

Q: How is the pain?  How long does it take to wear off?

A: The doc prescribes pain meds, and I suggest you buy them (I only had to take a few tablets, though, not nearly everything that I was prescribed).  The first 12 hours or so after the anesthesia wears off is the only time that there is real pain.  The pain peaks in the middle of the first night.  Combined with the fact that you're constrained in a super-tight compression garment, the first night is pretty bad (not super painful, but just uncomfortable because you can't sleep).  I found that to minimize the pain, I couldn't stand straight until about three days after the surgery (bending forward helped relieve the pain).

Q: How bloody is the aftermath?

A: You will have to remove the garments and all the dressing for your first shower after the surgery (this will be two days afterwards).  You'll note that there seems to have been a lot of bleeding.  Don't worry—all that blood is just the remains of a saline solution that they use to wash out and disinfect the surgery site.  You won't actually have been bleeding--you'll just be leaking a little bit of the saline.  The saline will stop a few hours after surgery.

Q: Do you have advice for the compression garment/vest?

A: The vest is the worst part of the recovery.  You get used to it after a few days, but at first it's a damn nuisance.  During the day it's not so bad, but at night it makes sleeping a bit difficult.  You have to use safety pins to secure the vest (that's why you need to buy the elastic Underarmour undershirts).  I would suggest that you buy 4-5 undershirts (as small as possible--I usually wear size L clothes, but I bought size S undershirts.  Try to see if XS or children's sizes work better.  Also, make sure to get black--the white shirts aren't as compressive).  You should wear two undershirts at the same time--that way the safety pins have more to hold on to.  You will get used to the vest, so in the end this is not something you need to worry about.  The vest fits in well under your regular shirts (it's pretty tight, so no one will realize that you're wearing it).

The vest is not that bad.  When you go to Dr. Jacobs for your checkup on day 3 after the surgery, make sure you ask him to give you a lesson on how exactly to put the vest on.  Then, while he's still there, try to do it yourself and make sure that he tells you it's okay.  Putting the vest on is pretty quick (about 2-3 minutes every morning after your shower), and it's definitely doable alone.

Q: How about the day after?

A: The day after surgery, you aren't allowed to take a shower.  I don't think I actually changed my shirt that day, but it would be possible.  I walked around my relative's apartment a little and watched some tv, but otherwise I stayed in bed and slept.  I would not suggest trying to go outside on the day after.

Q: How is the scarring?

A: In my surgery, there were four incisions made.  One was made on each side of the chest for the regular liposuction.  Dr. Jacobs also cut under my nipple to remove the hard glandular tissue that was in each nipple.  The nipple incisions were made in the dark areola area, so there are no scars there.  The two other incisions were scar free for a while, but now there is a slight darkening where each incision was made.  This is not surprising for me because I scar very easily.  And the scars don't look obvious or out of place--they look like any other scar that I could get from a mosquito bite or something.  I don't think that everyone scars, but certainly some people do.  There is no pain, no limitation of movement, no adverse effect after the surgery.  I had minor shooting pains (maybe once every 3-4 days I would feel a pain in one of my nipples), but that went away after about 2 months.

Q: Can I fly with the compression garment/vest?  Will the TSA stop me?

A: Traveling with the vest is not a problem.
1) Make sure you get a medical note from Dr. Jacobs (on his letterhead, preferably).  This would state that you recently underwent an operation for which you need to wear a compressive vest, etc.  You should keep this letter on your person as you go to the airport.
2) When you go in to security, take a look at the machines that they are using.  If they just have the regular metal detectors, then you will be fine.  Just make sure that you take out all your safety pins before security (you can put the safety pins back in after security).
3) If they have the full body scanners (which are becoming more common now), then you should show this letter to the security person who checks your passport and tell him about your situation.  He'll understand and he'll probably suggest you get a patdown and a metal wand search.  The full body scanner would show that you’re wearing this suspicious garment.
4) In any case, you should plan to arrive 20 minutes earlier than you normally would, just to make up for any inconvenience at security.

In terms of being on an airplane, the vest is not a big problem.  It's always somewhat uncomfortable, but it doesn't interfere with travel.  By day four after surgery, you should be able to handle carrying your suitcase, but to lessen the hassle I would suggest that you take a taxi from your hotel to the airport.