Severe Gyne. Pre-op to Post-op (Continuous updates).

[ninjamit]

I saw my doctor today and scheduled my surgery for this Friday, 11/5/2010.  I'm 25 years old, 5 feet 7 inches tall, and weigh 211 lbs.  I used to be at roughly 236-240 lbs about 2 years ago and have since managed to shed some weight.  In the last few months I've quit smoking cigs, began a much heathier diet, and have began exercising much more.  I understand that losing more weight is ideal in this surgery, the truth is I diet and exercise more frequently now but weight loss has always been a slow process for me and I don't want to miss out on the rest of my youth while I wait to get this surgery done, this was the main contributing factor to me scheduling it even though I still am overweight.

My doctor says he's going to make a very small incision through the lower half of the areola (which he says should leave an almost invisible scar), he will then remove the glandular tissue and also perform lipo to remove the excess fat on the portion under the armpits just behind the breast area.  Once completed he says I will have 2 drains (one on each side) which won't remain in place for more than 3-4 days I believe, and I will also be using a compression vest for a longer period of time.  I already have 2 post-op appointments scheduled with him for Tuesday & Thursday next week which he wanted to do to remove the drains then do another checkup.  He did also mention that there could be some skin sagging which could potentially require another surgery if it remains after 6months - 1year, but he believes I have good skin which should tighten well - though he did make it clear that this really depends on the patient and he can not guarantee it.  The reason he did not recommend tightening the skin during this surgery to prevent sagging is because this will require larger incisions which can leave noticeable scars and because of my Indian heritage (I am a very light skinned Indian man) and he says I run the risk of the scars coming back in a darker color which will be very noticeable and he believes it is smarter for me to go through this procedure first then wait the 6-12 months to see how the results are before going for the more abrasive surgery.

I respect the doctors here very much and would really appreciate their input on my case.  I've included pictures below (these are very recent - taken within the last 8 hours).

Note: My back was slouched when I first took the pictures, so I took new copies with my back as straight as possible and used the flash to provide better clarity.  I included all the pictures in the album.  I'll put up post-op pictures next week or the week after most likely.

[ninjamit]

Still looking for some input on this, surgery is coming up soon (2 days).  Just some words would help.  Does my doctors plan seem right? Does it appear from the pictures that my skin should tighten well? Should I expect sagging?

[Dr. Elliot Jacobs]

Yours is a severe case -- worsened by having been overweight.  And even though you are young and therefore benefit from good skin elasticity, I doubt very much that your skin will tighten sufficiently for you to be pleased after the surgery that has been proposed.

Would strongly suggest you obtain the opinion of at least two other experienced plastic surgeons.

Dr Jacobs

[ninjamit]

Dr Jacobs,

Thank you very much for your response.  At this time I simply can not back out with having made all the payments and having the surgery scheduled for the day after tomorrow, the financial loss would be too high for me.  I am going to go ahead with the surgery but will definitely keep in mind that I could end up with sagging as my skin may not tighten as well as I hope.  I appreciate your input very much, and now have a much more realistic exception of the results (though, as always, I will be hoping for the best).  If I need to do a revision surgery at some point after 6-12 months I will go ahead and do that to correct any issues I may have.  If this happens, I will make sure to post pictures on here and do more consultations prior to finalizing and scheduling.  Thanks again for responding, I really appreciate it.

[DrBermant]

I saw my doctor today and scheduled my surgery for this Friday, 11/5/2010.  I'm 25 years old, 5 feet 7 inches tall, and weigh 211 lbs.  I used to be at roughly 236-240 lbs about 2 years ago and have since managed to shed some weight.  In the last few months I've quit smoking cigs, began a much heathier diet, and have began exercising much more.  I understand that losing more weight is ideal in this surgery, the truth is I diet and exercise more frequently now but weight loss has always been a slow process for me and I don't want to miss out on the rest of my youth while I wait to get this surgery done, this was the main contributing factor to me scheduling it even though I still am overweight.

My doctor says he's going to make a very small incision through the lower half of the areola (which he says should leave an almost invisible scar), he will then remove the glandular tissue and also perform lipo to remove the excess fat on the portion under the armpits just behind the breast area.  Once completed he says I will have 2 drains (one on each side) which won't remain in place for more than 3-4 days I believe, and I will also be using a compression vest for a longer period of time.  I already have 2 post-op appointments scheduled with him for Tuesday & Thursday next week which he wanted to do to remove the drains then do another checkup.  He did also mention that there could be some skin sagging which could potentially require another surgery if it remains after 6months - 1year, but he believes I have good skin which should tighten well - though he did make it clear that this really depends on the patient and he can not guarantee it.  The reason he did not recommend tightening the skin during this surgery to prevent sagging is because this will require larger incisions which can leave noticeable scars and because of my Indian heritage (I am a very light skinned Indian man) and he says I run the risk of the scars coming back in a darker color which will be very noticeable and he believes it is smarter for me to go through this procedure first then wait the 6-12 months to see how the results are before going for the more abrasive surgery.

I respect the doctors here very much and would really appreciate their input on my case.  I've included pictures below (these are very recent - taken within the last 8 hours).

Note: My back was slouched when I first took the pictures, so I took new copies with my back as straight as possible and used the flash to provide better clarity.  I included all the pictures in the album.  I'll put up post-op pictures next week or the week after most likely.

Congratulations on the weight loss so far.

Have you checked your Body Mass Index with a BMI Calculator?  By definition you are in the upper range of obese.

BMI does not differentiate between fat, muscle, and bone.  Body Fat Calculators can help with the fat percentage and are better at helping define the fat component.

Plastic Surgery is not an alternative to losing weight.  With surgery, an overweight person will still look like a overweight person, just one with smaller breasts.

The problem is that Male Fat Pattern extends around the chest, under the arms, and around the back.  Plastic Surgery is not a good tool for a global fat problem.

I advise my patients to get to a weight / body fat percentage they are comfortable with before considering surgery. 
 
Weight Loss Before Gynecomastia Surgery can help with the fat, but not the gland.  However, you cannot pick where your fat comes from. Plastic Surgery is also not a good jump start tool for weight loss.  I have seen disasters from patients from other doctors with deformities from significant weight loss after their surgery.  Men tend to put fat on first in the belly and chest bands.  We tend to take of those areas last.  Early surgery and depending on weight loss to predictably change the body is a nasty gamble.  No Surgery Body Shaping Garments are a better temporizing choice.

The male chest can be distorted by gland and fat of Gynecomastia Male Breast Enlargement. After weight loss, loose skin can also be a factor to different degrees. Drooping or Ptosis is a frequent problem after massive weight loss or deflation of massive muscles.   

Posting Standard Pictures to Show Male Chest Drooping after weight loss can help others better understand if the loose skin component is a factor.

Low Nipples Look Strange on the male chest and comes in many different degrees.  The lower edge of the areola should be at or above the lowest part of the pectoral muscle when upright. When sagging is significant, surgery can combine both the residual contours of gynecomastia and loose hanging tissues in a single sculpture.  Male Mastopexy Chest Lift for Drooping Chest or Ptosis can consist of many different Surgical Options for Excess Skin of the Male Chest.  A Short Scar Skin Reduction Chest Lift hides the scars under the pectoral muscles and around the areola.  However, for more subtle problems, the compromise of leaving the loose skin alone can be a better option.

Finishing weight loss before surgery is usually much better than further weight loss after surgery. Weight loss is a coarse tool, Plastic Surgery is better reserved for refinement. This is especially true when tissue sagging is a factor.  Why lift sagging tissue, lose more weight, and see that tissue sag again from further deflation?

Consider asking the surgeon to reschedule after the weight loss.

Hope this helps,

Michael Bermant, MD
Learn More About Male Mastopexy Chest Lift for Drooping and Ptosis

[ninjamit]

Thanks for the input, I appreciate it very much.  At this point I am fully prepared for the surgery and I have been waiting for a very long time to do this.  I have a lot of faith in my surgeon and really do feel he will do a great job.  In all honesty the pictures I posted seem to look a lot worse than the condition in person, I tried getting the best pictures possible, but I think taking them myself at such a close proximity is what made it look worse than it is.  

I will most likely ask questions regarding my post-op recovery tomorrow when I return home and over the next few days.  I will also put up post-op pictures when the time is right to do so.

Thanks again for to both Dr. Jacobs, and Dr. Bermant.  I really appreciate you both taking the time to give me your input on my case in such a short time frame before my surgery.

[ninjamit]

My surgery finished at about 11.30am this morning.  Currently I have two drains attached, one on either side.  The drains are not very painful at all, honestly I'm barely feeling any pain, just some discomfort.  I was given a good amount of pain killers during recovery and because of this I'm going to eat some food and take a Vicodin, just in case the others wear off and I am in more pain than expected.  Most likely I will switch over to Tylenol tomorrow since I'm not really a fan of narcotic medications of any kind unless absolutely necessary.

I am also wearing a compression vest which I am not supposed to remove at all, until tomorrow night for a short time to shower and get cleaned up.  I can tell by looking under the vest that both sides crater down a little bit and have some definite sagging skin (which I was completely ready for because of the fast and exellent input from doctors Jacbos and Bermant).  My doctor also told me that I will see a significant improvement from how my condition was before and I shouldn't keep stressing myself out by looking at my chest and should try to just forget about it and let it heal as much as possible as the final results won't be noticeable for a longer period of time.

Right now, I'm ready to wait as long as I need to, I'm keeping my head up that everything will heal up just fine and after a few weeks / few months passes the sagging will be reduced to very low amount.  I think for me and for anyone else who has a case as severe as mine that it's very important to have a good expection of the results so you don't stress yourself out and to give yourself a long time to heal.  Once I've healed up and have the drains removed, I'll wait for some time for the skin to tighten and plateau before I post any post-op pictures.

To Administrators: I'll continue updating this post with as much information as possible so others in my condition will have a lot of information.  I was thinking maybe the post should be moved to the "Post Surgery" section as I can create a different post if I have any other questions specifically for doctors.

Thanks to everyone for your support, and a big thanks to gynecomastia.org!

[ninjamit]

Currently I'm only one day post-op.  I've been feeling a lot of soreness where the drains come out and around my entire chest area.  Currently there is a lot of swelling on my chest and the skin is definitely sagging down a bit (though it's a huge improvement since I had a very severe case).  I know it's way too early to expect these results to be final but I really think that once the swelling goes down and the skin tightens up a bit I'll be very happy with the outcome.  Right now I just have to hold out another 3 days until I can have the drains removed, since they are really the most uncomfortable part.  I feel slight pain when I stand up and sit down, mainly because that moves the area where the drains are.  I've been sticking with the stronger painkillers when I need them, but the pain is really not too severe, more or less just very uncomfortable. 

[zado611]

is it just me or can anybody get the pics anymore? the first time i saw the post i could but now i don't see your pics anywhere

[zado611]

and one more question Ninjamit.. are the drains noticible through your clothes

[ninjamit]

hey, i actually removed the pics b/c the website i had them hosted on kept removing them so i figured screw it.. i'll post before and after pics once I've healed up enough and i have more final results. right now it looks way better than the pictures looked, the skin does sag and is pretty swollen (but otherwise my chest is fairly flat).  i'm wearing a compression vest most of the time (except for a few hours every couple of days when i throw it in the washer / dryer).  so far i'm very happy with the results, my only hope is that the skin tightens up a lot more as time passes and doesn't continue sagging.  i don't regret getting the surgery one bit, but i admit that i rushed into scheduling and could have done a lot more homework.  to anyone reading this, take the recommendations of what our doctors posted on this thread.

1. Get the opinions of multiple plastic surgeons before scheduling surgery
2. Lose as much as weight as you can before surgery
- These are two things that everyone should take VERY seriously.  They both can only end with you getting much better results.

to answer your question, the drains tubes aren't really noticeable through your clothes but at the bottom of each tube is a container which basically is the same size and shape of a grenade (the nurse at the hospital actually said that's the nickname they all use for them: "grenades"), those containers are where the fluids drain into and those are what you have to empty every 4 hours or so.  so normally i would have those tucked into my shorts or sweatpants on the sides. if you can't imagine it, picture tubes on either side of your body coming down from under your armpit area to your waist line and being connected to a small water balloon (one on each side), and you need a place to hold the balloons or "grenades" at all times (which is why i tucked them into my shorts / pants). 

the drains are really the most uncomfortable part of the whole thing, until you have them removed you feel soreness and tightness when you move around and when you stretch your arms, my shoulders and arms felt pretty sore / stiff since i didn't really move them much.  the pain and discomfort was really the worst the first two days post-op (for those days i stayed on the strong painkillers- they helped me sleep and eased the pain), on the 3rd post-op day i felt a lot less sore and much less pain, but still a lot of discomfort from the drains.  right now i'm 5 days post-op, the drains were removed yesterday, and since having them removed i feel 100x better.  it was slightly painful when the drains were removed, but it lasted for less then 5 seconds on each side so it's not really too bad, they just remove the suture that holds them in place which can pinch then you'll feel an odd discomfort when they are removed from your body, I was way more nervous about it then i needed to be.  the wounds the drains leave (where they are connected to your body) heal up pretty fast, my doctor put antibiotic cream on both of them and covered it with a piece of gauze and taped the gauze to me.  he said they should be fully healed in a matter of days and i should change the gauze and put additional antibiotic cream if i need to. i'm seeing him again on Thursday morning for another check-up.

some things to note:
- my first two days post-op i needed help from my dad to empty the drains and to remove / put on the vest
- it was painful to move my arms too much so the help was very necessary
- when using the bathroom i had to tuck the grenades into the compression vest so they were held in place and my arms were free
- my first night the drain on the left hand side leaked onto my vest instead of into the tube and into the grenade.  this scared me when i woke up because i felt the moisture when i touched the vest and obviously the fluid is combined with some blood so the color is red (scary moment, but we cleaned it up and after thinking about it i realized that it technically still drained... but just didn't go through the tube, so that really shouldn't be a problem - it wasn't a problem and once the vest was washed / dried everything was back to normal).. we also put some antibiotic cream around the area where the drain tube was going into my side.  i emailed my doctor that night and he responded the next day saying that that's not a big deal and i did the right thing.
- if your doctor says it's okay to do this, you may want to remove the bandages around the drain tubes the day before or the morning of your appointment to have the drains removed, this is because it can be painful when your removing bandages because the medical tape holding them in place is very adhesive and your still pretty sore in the area where it's taped.  i just assumed taking my time to remove the bandages would be better than the doctor possibly doing it faster while i'm at the appointment.  your doctor will probably only let you do this if the tubes are sutured to you and he is confident that the drains wont be harmed by you removing the bandages. don't do this without asking your doctor first.
- after getting the drains removed, the wounds kinda pinched at times when i moved around, but this only lasted a few hours.
- for the first 3-5 hours after getting the drains removed, i felt a lot of itching around my chest and under my arms in the sore areas (but it itches on the inside - which is kind of strange), i didn't ask my doctor about this but i assume it's your body reacting to the drain tubes being removed and this is all part of the healing process.
- I've been taking multivitamins to boost my immune system and help my body's healing process, ive also been staying away from spicy food and red meat, and eating lots of vegetables.

Quick Summary:
- The first 2-3 days i felt the most pain (which shouldn't scare you - it's definitely not the best, but it's very very bearable and you'll need a lot of rest - i broke my finger as a teenager and that was so much more painful for a whole week)
- Days 3-5 the pain goes down a lot, i switched from the strong painkillers to Extra Strength Tylenol, and now i'm completely off both
- Once the drains are removed you'll feel much much better but you obviously still need to take it easy and get plenty of rest


Hope this information helps anyone reading.  I'll update this thread after another few days to a week.  Leave me any questions you have and I promise I'll answer them when I get a chance.  Take it easy everyone.

[Dr. Elliot Jacobs]

Excellent thread -- I think it is very helpful for you to describe your experience for others.

One thing, however.  It has been my experience that most of the skin tightens during surgery and only very slightly thereafter.  So, to be honest, you should prepare yourself for the very real possibility of having a flatter chest but with lax skin.  Should you end up this way, then would wait a minimum of six months to allow everything to heal satisfactorily, and then consult with your surgeon (if you wish) about further skin tightening.

Dr Jacobs

[ninjamit]

So it's been a little over a month since my last post.  At this time, I feel zero pain, still some very slight soreness in the underarm area where my doctor did a little bit of lipo to even things out (this is essentially the area where the drains were).  I do see some sagging as Dr. Jacobs has indicated above.  Currently I still am overweight but have managed to lose close to 10lbs since the surgery from a completely revised diet and exercise.  I am going to continue with my diet and exercise until i reach my desired weight (currently i am about 195 - and i'm looking to reach about 165).  Once i reach this goal my plan is to see how the chest looks; i am hoping the fat loss will tighten things up a little bit more.  If once I reach my desired weight I don't see any improvement on the sagging or I still want more of a resolution to the sagging problem, I may consider revision (this is also contingent upon the cost and the amount i save up), but at the moment I honestly think I may not need the revision surgery.

I am very happy with the results, the do not regret the surgery in the slightest.  Even though it sags I still feel a 100 times more confident in things as simple as wearing a tshirt.  I still wear the compression vest as much as possible as well as under armor (at all times i'm using one or the other - i don't use them both at the same time).  

I don't feel i'd be confident enough to go out to the beach or the pool yet, but that's not just because of my chest, i still need to lose more weight until i'd feel confident enough to do that.  Anyway, that's it for now unless any of you have questions for me.  If i get a direct message or reply on this thread it will be sent to my e-mail and i'll respond within 24hrs or less.  Otherwise I'll most likely post an update in another month or so.  Take care everyone, and Happy Holidays!

[zado611]

waiting for pics I know your excited for what life holds now that you feel a whole lot more freedom