my outpatient appointment with PS....

[Worrier]

Okay just a brief recap. I was given nhs funding for surgery on appeal after weight loss.

I had to see the PS today for a reassessment before the op due to the weight loss.She examined me and said due to the success from weight loss I now have a slight case of a puffy nip( she used a Different term but i can't remeber it) on one side.She now says she is very reluctant to do  the procedure due to the 'risks'involved.

When I disagreed she said if my psychiatrist agrees she will do it .Talk about passing the buck. >:(She said many men have worse cases AFTER surgery. Is that suppposed to make me feel better..Thing is my shrink will agree but this is going to take even more Months to sort out.

I can't afford to go private as I am on a low income and Iam already in debt. My parents will not help as they think it is a 'slight case' to .

I just feel Iam being messed about. I first of all get told to lose weight .Okay I lost the weight .Now apparently it is not bad enough...
And I think she is crap as well as she said I could not improve my chest at all through weight loss.Now apparently an act of God has occured Several people have also said it looks better. But I really hate this puffy nip.And she is not prepared to help.

It stinks to me the whole system. I think it is all about saving money to be honest.Basically I have performed lipo on myself and saved them cash.Maybe I shouldn't have tried so hard. And now they won't cut the gland out after I met them half way.I will just have to moan at my shrink but at this rate it won't be an issue because I will go bald first

[phantom]

Hello Worrier

Sorry to hear you are so upset.  You are right when you say that the NHS is thinking of money first.  It's a shame, but it's the way it has always been.  I am guessing that your surgeon is weighing up the risks against patient benefit.  Because of the vacuous nature of the NHS in monetary terms, it boils down to the most needy patients getting treatment first.

So, who goes under the knife first?  A female patient with size 'J' cup breasts that has caused years of back pain and also has a family history of breast cancer or a guy with slight puffiness behind one nipple who, as the surgeon says, has less of a problem with gynaecomastia than many 'severe' cases that are post op?  The surgeon has limited funds and limited time and has to make some hard decisions.

I am not saying the system is right and I am not suggesting that this issue has not had a real psychological impact on you.  I am 32 and have had 'c' cup breasts since the age of 8.  My breasts overhang and I am the envy of many women per say.

I had only dreamed of surgery but saved and saved like crazy over the years to go private.  The thing is I could have gone NHS, but I knew I wanted to make sure I was getting treated when I wanted to be treated by the surgeon I wanted to be treated by.

You have nothing to loose by pursuing this with the people that are helping you to deal with it.  My only suggestion is that because we can never take the NHS for granted alone, for something as important as this, all avenues need to be explored which includes saving for private treatment.

Good luck.

[Worrier]

I kind of agree with you phantom. Obviously a woman who has has a mastectomy and needs a PS or someone who has burns should come first.

What I am annoyed about is the local authority approved funding , I was all in the mindset to have the op and now suddenly it is all up in the air again. The gyne was caused by a drug my doctor prescrbed for anxiety amongst other things and this side effect happens to 1 in a 1000 people so I just feel unlucky.

And it really doesn't help when a PS tells you initally you are a surgical case,makes me feel a freak, paints a picture that surgery is the only route to resolve this, diet/exercise would not sort this out, and then all of a sudden changes direction at the last stage.And says actually you don't need it  and says she can hardly see anything.Something just seems a bit wrong to me here.

[phantom]

According to what you say, it looks like your expectations have not been managed at all well. Managing patient expectation or prognosis is the core of any treatment for any condition.  We don't have to go into the realms of the psychiatric impact gynaecomastia has on us - that's why we have this forum!

I would go back to your psychiatrist and reiterate how this condition has come about through no fault of your own, that despite initial promises you have now been told to 'deal with it' yourself.  Explain how this is affecting you psychologically and how it compromises your life such as having to wear specific clothing to hide this issue and now never allowing yourself to go topless in a public area  - from the beach to the gym; how it affects your sexual relationships - not wanting to go topless in from of your partner;  having to deal with 'off the cuff comments' by other people - family, friends and strangers!  It's the psychological impact where the real pathology lies.  The surgeon was right to refer you back to the psychiatrist.  A surgeon will have to respond to the clinical needs of a patient if it is a physical problem - the gynaecomastia is causing you real distress which is a psychological issue and needs the backing of the psychiatrist to present to the surgeon for validation.

If between the psychiatrist and the surgeon believe there is no pathological impact on you either physically or mentally, then there are no medical grounds in which to perform surgery.  But if there are either physiological or psychological or both present, then surgery may be indicated.  Go back to the psychiatrist.

There is no real short-cut to surgery for non-life threatening conditions on the NHS (god only knows some poor folk have to wait too long for the urgent stuff like heart by-pass surgery).  So be patient, pursue this avenue until there is no one left to pass the buck.  In the meantime, seriously think about how else you can get to where you want to be - just in case.

[ruggedtoast]

Im going through exactly the same thing it sounds like. To cut a long story short I have now got to see an NHS plastic surgeon who has decided I have put on too much weight since my first GP check for him to do the lipo I need, although 2 kilos ago my GP said I was underweight.

I need to lose fat and go back in 3 months when presumably he'll either attempt to start the process for funding which may or may not be approved or tell me I dont have a bad enough problem anymore.

I know the nhs has limited resources and I have no problem with waiting or just being told a simple yes or no.

Its all this being messed around without knowing if theres even an op in the future for me thats killing me.

[Worrier]

I think alot of this is due to ps's ( nhs PS's anyway) not really understanding gynecomastia. Not only the physical aspects of it, ie my ps saying that nipples do not puff with gyne and that diet /exercise will  not help and then backtracking on what she originally said but also the psychological aspects of it.

One man may not be bothered by his gyne and another man may want surgery..Just saying it is not bad enough I feel is a bit ignorant. Just because SOME men may not be bothered by it just not mean it is not affecting me.

seems like  we are seeing the same PS rugged ... or one who went to the same school...