Need Some Advice!!! Def have gynecomastia. Which procedure can be done?

[mpa2010]

I went for a consult this week to a accredited Plastic Surgeon in my area.  This surgeon was recommended to me by my primary care physician.  I have asymmetrical gynecomastia with the left side larger than the right.  The PS said could do a surgery but for good results would have to make my an incision where my breast crest at the bottom and pull the skin down to tighten.  Also would have to cut a new hole for my aerola.  With the aerola being detached and put in a new place it would lose coloring and may have to get it tattooed for coloring.  I am not too comfortable with that type of procedure and was wondering if there was another way to have the skin tighten back against the chest wall with out concaveing in and with minimal scarring.  Can it be done through a peri-aerola incision??  I am posting some pics and would welcome some feedback.

http://img820.imageshack.us/i/img0692d.jpg/
http://img412.imageshack.us/i/img0693gm.jpg/
http://img693.imageshack.us/i/img0694w.jpg/
http://img691.imageshack.us/i/img0695hg.jpg/

[Raider Fan]

Hello and welcome to gyne.org, mpa2010. 

Hmm....I'm not a doctor, but to me, your gyne looks fairly typical and I haven't heard of "typical" cases being as involved as what you described.  Hopefully, just the usual lipo and excision of the underneath gland will suffice.  Good luck to you.  

[DrBermant]

I for a consult this week to a certified Plastic Surgeon in my area.  This surgeon was recommended to me by my primary care physician.  I have asymmetrical gynecomastia with the left side larger than the right.  Said could do a surgery but for good results would have to my an incision where my breast crest at the bottom and pull the skin down to tighten.  Also would have to cut a new hole for my aerola.  With the aerola being detached and put in a new place it would lose coloring and may have to get it tattooed for coloring.  I am not too comfortable with that type of procedure and was wondering if there was another way to have the skin tighten back against the chest wall with out concaveing in and with minimal scarring.  Can it be done through a peri-aerola incision??  I am posting some pics and woudl welcome some feedback

Skin reduction is a good compromise for the patient with a great deal of sagging skin.  For a patient with normal skin elasticity, skin reduction is not normally needed during breast reduction surgery.  Elastic skin can really shrink quite well on its own and skin reduction scars then are normally not needed.

How well skin shrinks after removing mass behind it can vary greatly as shown by the two balloon examples on that link.  For my techniques, most of the change occurs in the operating room.  There can be some further shrinkage over time after surgery.  Building muscle mass can be one way of filling up a loose skin envelope.  However, it is very difficult to maintain such large muscles throughout our lives.

Excess Skin of the Male Chest with Gynecomastia comes in various degrees.  Here are my Standard Pictures for Evaluating Extra Skin on the Male Chest.

If there is a global fat component, surgery will not make someone who has a thicker layer of fat around the body look like they do not have that fat. Early surgery is a bad compromise. Breasts can be made smaller, but there will still be breasts. Skin reduction surgery is even more of a factor. Tighten the skin, lose weight, and the tissues will be loose again. That is why I suggest my patients first get to a weight that they are happy with. Weight loss is a coarse tool, surgery is better reserved for refinement.

Options are best explored during an evaluation with an experienced surgeon who can demonstrate their skills with this compromise issue of extra skin of the male chest sculpture.

Hope this helps,

Michael Bermant, MD
Learn More About Male Mastopexy Chest Lift for Sagging Tissues

[mpa2010]

Thanks Dr. Bermant for the information.  Awesome website that you have.  Extremely informative!  I forgot to mention that I won't be having the surgery till I drop down to a weight that I am comfortable with.  I started off at 280 lbs.  In the pictures I am 235 and my goal is to get down to 215 lb before I have another consult.  I was frighten by the type of procedure that was explained to me but I see a better judgment can be made on the procedure that would produce the results that I want once I at a comfortable weight.

[alphajc]

Losing additional weight prior to surgery would definitely be a plus, but I've seen pictures of persons with similar body builds who have had good results with excision and lipo.  By "accredited" plastic surgeon do you mean someone who is certified by the American Board of Plastic Surgery?  I would definitely seek out someone who is, like Dr. Bermant and others.  Some persons who are accredited or certified may be just certified in other fields such as general surgery or otolaryngology.

[mpa2010]

The surgeon is certified by The American Board of Plastic Surgery.  I am happy with the way the right side of my chest looks it is just the extra tissue that the left side has is what bothers me emotionally and physically.  Also the left chest area is sore and tender. I am going to wait and seek an experienced surgeon's advice that specializes in gynecomastia.

[alphajc]

That's a good idea.  If there isn't any renowned gynecomastia surgeon you are comfortable with in your area, don't be afraid or cost inhibited to travel to seek one like Dr. Delgado, Jacobs or Bermant just to name a few.

[Raider Fan]

Also the left chest area is sore and tender.

I also have pain only on the left side.  I have noticed that many who complain of pain and/or tenderness seem to have it primarily on the left side. Wonder why that is? 

It would be interesting to do a study to see which side pain is reported most frequently.  If the left side IS, in fact, more frequent, I'd like to hear some physicians speculate as to why that might be.

[DrBermant]

Thanks Dr. Bermant for the information.  Awesome website that you have.  Extremely informative!  I forgot to mention that I won't be having the surgery till I drop down to a weight that I am comfortable with.  I started off at 280 lbs.  In the pictures I am 235 and my goal is to get down to 215 lb before I have another consult.  I was frighten by the type of procedure that was explained to me but I see a better judgment can be made on the procedure that would produce the results that I want once I at a comfortable weight.

Thank you for your kind words. It has taken many, many hours over the past almost 14 years to bring it to this point. I am approaching 1600 pages and tens of thousands of before, during, and after surgery pictures and movies.

The surgeon is certified by The American Board of Plastic Surgery.  I am happy with the way the right side of my chest looks it is just the extra tissue that the left side has is what bothers me emotionally and physically.  Also the left chest area is sore and tender. I am going to wait and seek an experienced surgeon's advice that specializes in gynecomastia.

Waiting for a stable problem can have major benefit. Choice of surgeon is like picking an artist, checking the quality of their work is an essential factor.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia

[ddh]

I had my surgery 7 months ago. Although my plastic surgeon did a fine job, my skin did not retract as much as I would have liked.

One month after the surgery I looked great; everything had retracted nicely. I was really happy. But after a couple of months, my chest skin "relaxed" and I now have some sagging. Probably the only way to correct the sagging is the type of surgery your doctor recommended (some skin removal and repositioning of the nipple).

My skin didn't permanently retract completely because of my age (58). My skin has just lost some of its elasticity. However, my chest looked a lot like yours before my surgery.

Consult with one or two other surgeons and get their proposals. It is much better and cheaper to get the surgery done correctly the first time.

My 2 cents!

[mpa2010]

Thanks all to the advice given much appreciated.  I am currently down to 225 and plan to be down to 205 for the next consult that I have.  The pictures in the previous post were taken at 235 and these below are at 225.


http://yfrog.com/5uimg0762tj
http://yfrog.com/jtimg0761qj
http://yfrog.com/moimg0760pj
http://yfrog.com/06img0759hsj

[DrBermant]

Thanks all to the advice given much appreciated.  I am currently down to 225 and plan to be down to 205 for the next consult that I have.  The pictures in the previous post were taken at 235 and these below are at 225.


http://yfrog.com/5uimg0762tj
http://yfrog.com/jtimg0761qj
http://yfrog.com/moimg0760pj
http://yfrog.com/06img0759hsj

Congratulations on the weight loss so far. Another 20 pounds is not an insignificant amount. I advise my patients to get to a weight they are happy with, and then wait until the skin stops adjusting. For a massive weight loss patients, such as with Gastric Bypass, the skin can take from 6 to 18 months to adjust. Once at a weight they are happy with and a skin has gone as far as it will, then exploring the compromises of surgery can be better assessed. To help my patients better deal with the frustrations while stabilizing, I demonstrate Body Shaping Garments as an emotional band-aide.

Hope this helps,

Michael Bermant, MD
Learn More About Male Mastopexy Chest Lift for Sagging Tissues