picture and advice for severe gyne

[wasatchm]

hi,

I'm 5"9' 195 lbs.  had gyne for 20+ years.  I have lost over 40 lbs in the last couple years (and managed to gain half of it back).  gyne is much worse on one side than the other (as you can see in the pic).  the worst of the 2 sides sticks out from my ribcage area about 1 3/4 inches.  the other side (mild case)  sticks out about 1/2 inch.  

so far I have seen 2 PS's and one has said I will most likely have excess skin on one side, the other surgeon did not think so.  any opinions?   the nipple on my larger breast hangs down farther than the other nipple (about 1/2 inch to be exact).  once I have gyne surgery on both breasts, will the 1/2 increase, stay the same, decrease?  I hope it doesn't get worse to like 3/4  or 1 inch.   one PS told me I may at a later time (after gyne surgery) have excess skin removed above the arola of the larger breast (in order to elevate it to the same height as the other arola.   also, is there anyone out there with before and after pics similiar to mine (I'd actually be surprised)?   I really want to get some idea of how I may look after surgery.   for some reason I have a hard to believing I will every look normal in the chest area (normal enough that I can walk past people at a beach (shirtless) and not be starred at.  I've never had my shirt off in public in a long long time.  

thanks

http://home.att.net/~blyth_austin/frontviewpic4.jpg
BA  

[wasatchm]

SORRY ABOUT THE URL,  here is the right link

http://www.geocities.com/bray19702004/frontviewpic4

[disarm]

well I'll be honest, i think you have a complex case and well one important thing to know is to not expect a perfect male model chest. on the other hand u don't wanna look like frankenstein either lol. seriously though, ummm i think you probably have a larger amount of gland on ur right breast and thats why its bigger. as far as the weight loss well when u lose weight sometimes skin doesn't shrink back as tightly as we'd like it to so i'm thinking you may need a breast lift on ur right side to move the nipple to a more natural position. if it is done externally that would require some sort of skin excision which may leave u with more scarring on that side. i don't know how acceptable that would be. its a trade off u may have to make. do your research and make sure they show you pics on the exact procedure & technique to be done to you so you can more or less get an idea. i also lost some weight and will having a (mastopexy) breast lift in two weeks with dr. bermant in VA. He has a website with lots of patient photos worth checking out www.plasticsurgery4u.com.  

[wasatchm]

wow, thanks for the extreme gyno link!  that's definetly encouraging.  I see no scars though.  I would of thought excess skin would for sure need to be romoved in that case.  

[DrBermant]

hi,

I'm 5"9' 195 lbs.  had gyne for 20+ years.  I have lost over 40 lbs in the last couple years (and managed to gain half of it back).  gyne is much worse on one side than the other (as you can see in the pic).  the worst of the 2 sides sticks out from my ribcage area about 1 3/4 inches.  the other side (mild case)  sticks out about 1/2 inch.  

so far I have seen 2 PS's and one has said I will most likely have excess skin on one side, the other surgeon did not think so.  any opinions?   the nipple on my larger breast hangs down farther than the other nipple (about 1/2 inch to be exact).  once I have gyne surgery on both breasts, will the 1/2 increase, stay the same, decrease?  I hope it doesn't get worse to like 3/4  or 1 inch.   one PS told me I may at a later time (after gyne surgery) have excess skin removed above the arola of the larger breast (in order to elevate it to the same height as the other arola.   also, is there anyone out there with before and after pics similiar to mine (I'd actually be surprised)?   I really want to get some idea of how I may look after surgery.   for some reason I have a hard to believing I will every look normal in the chest area (normal enough that I can walk past people at a beach (shirtless) and not be starred at.  I've never had my shirt off in public in a long long time.  

thanks

http://home.att.net/~blyth_austin/frontviewpic4.jpg
BA  

Uneven and unilateral (one sided gynecomastia) can be difficult sculptures.  The need for skin reduction and what techniques might be useful depends on many factors better discussed with someone who can examine the problem. Skin reduction scars can be an issue which is why I have been evolving my Internal Male Mastopexy Breast Lift technique to minimize the surface scars.  Your resutls will depend on many factors such as the problem(s) to be treated, techniques used, skill of the surgeon, how you heal, and other factors.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[jc71]

Yeah, you got it pretty bad. Don't despair, a good PS can make it look much better.  You're right, you "may" never feel comfortable walking on a beach, but at least they can get it to a point where you can feel confident walking with a t-shirt on.

You've gotta have realistic expectations.  That's a vital component to gyne surgery.

How do you hide those things? I use a super tight t-shirt with a loose button-up shirt over top.

Good job on the weight loss.


Dr. Bermant - Are there yearly conferences that plastic surgeons attend where they talk about and teach the latest techniques for gyne removal?

I ask because it seems that you're well schooled in a variety of "techniques." (Internal Male Mastopexy Breast Lift Technique and many others).  Or have you created these techniques from your personal experience over the years?

[wasatchm]

I just wear plenty big shirt (button ups).  never wear t-shirts unless I am playing basketball.   I always wear and undershirt also.  I don' t worry to much about people noticing now (as long as I have a shirt on).  although high school was another story.

so if I have surgery and get flatted out (so to speak), is there a big risk at having excess skin or wrinkles on the extreme side.  would it be smart to have part of the breast tissue (on the severe side) left in through the surgery to wait and see how much my skin tightens?  cause if I have pretty much all of the breast tissue removed then I increase the chances of having excess skin don't I?  in that case I will have to have the excess skin removed (and have a scar forever) or leave the excess skin there instead of having a scar.  neither plastic surgeon I have visited with has mentioned excess skin being an issue.  is it really something not to worry about?  I've never head of PS's removing part of the breast tissue and then waiting for the skin to tighten some and then remove the rest.  that would be great if it wasn't cause excess skin has been my main concern.

I would hope I can eventually walk at a beach without a shirt or go swimming.  I'm not expecting to have one of the better looking bodies there.  I just don't want to have attention easily drawn to me (which is what would happen now).  if someone is standing next to me for a few minutes and notices one arola is much larger than the other or one nipple is an inch higher than the other that would be no big deal.   I could live with that any day.  I could probably even live with a scar (as long as it wasn't to big and was only on one side).  I just thank god I don't have a severe case on both sides.  I would hate to have a notice-able scar above BOTH arola's.  that would be 10 times worse than just having one scar (as far as I'm concerned).  if you have two scars above both arola's people would take notice pretty easily.

[DrBermant]

Dr. Bermant - Are there yearly conferences that plastic surgeons attend where they talk about and teach the latest techniques for gyne removal?

I ask because it seems that you're well schooled in a variety of "techniques." (Internal Male Mastopexy Breast Lift Technique and many others).  Or have you created these techniques from your personal experience over the years?

Yes there are a number of meetings held all over the world for doctors to exchange ideas, learn new techniques, and review details.  Some of the better medical societies actually have requirements for continuing education to remain active members.  

I attend a number of meetings each year both to learn and exchange ideas.  I have lectured, given courses, and had informal exchanges with my peers about details of plastic surgery.  I can ask someone in person about something in the literature or my own findings.  I also get approached about what I am doing, why, how, and other details.  This is how medicine advances, checks itself, and evolves.  

Specialties even cross educate each other.  I have recently been invited to present my Gynecomastia Male Chest Scupture for one of the major Endocrinology Society Meetings.

The internet is another way for doctors to exchange details of what they offer.  My Gynecomastis Male Chest Contouring section of my website has more details about gynecomastia and surgery of the male chest than any article or book I have ever seen published.  Many doctors will comment to me about what they saw / learned from this resource.

My Internal Male Mastopexy Breast Lift technique has been an evolution of my many sculptures for large gland gynecomastia, fat flaps, advances in short scar female breast surgery this past decade, and the SFS superficial fascial suspension system concepts.  My Dynamic Technique is an evoluation of an approach to the many forms of gynecomastia deformity I have seen over the years.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Spleen]

You've got the real deal.  Surgery could help improve the appearance of your chest, but keep your expectations realistic.  You might be dealing with scars and loose skin, etc. but if you can deal with that stuff in exchange for an *overall* improvement it could work out for you.  See a few docs, ask about their experience with cases like yours, ask to see pix.  If you haven't already, get your hormones checked or see an endocrinologist to rule out any kind of hormonal issue.  Best of luck.

[wasatchm]

I think I'd rather deal with excess skin than scars for now (except for the scar from the cut on each arola).  I'm told that scar isn't that notice-able since the arola is darker in color.  I saw a PS on my HMO plan 5 days ago.  I'm currently waiting to see if the insurance will cover the surgery (probably take 2 weeks).  he said I have a 50/50 chance of getting coverage.  I'm really hoping insurance will cover the initial breast reduction surgery.  since I think I made need to go under the knife more than once to make make my chest look the best it can (whatever that may be).   if I spend my own money, I'm gonna be more paranoid the surgeon will do a half-a**** job (leave a good portion of the breast tissue in).   unless I call on an expert surgeon (delgado or bermant) to do the surgery I'll be nervous.  

I'll have to ask my PS the next time I see him for before and after (of previous gyne patients).  he said he has done over 200 gyne surgerys in his career.  I told him I wanted my chest FLAT (which would mean removing a lot of breast tissue).  he said I don't want a flat chest.  he said I need to have some fulness in my breasts or else I will have a caved in look.  

[wasatchm]

Well, if insurance covers the surgery I will not have a lot of choices.  there are only 10 PS's under my current HMO plan.  pretty disappionting considering I pay $100 for insurance/month (for a single 34 yr old male in great health).    that's not to say one of the 10 plastic surgeons under my plan can't do a good job.  I'll need to see a lot of before and after photos from previous gyne patients before I will feel comfortable selecting any plastic sugeon.  

[wasatchm]

anybody know where I can find pictures of previous gyne patients that have gyne similiar to mine and have had excess skin removed?  I'd be curious to know exactly how big the scar is and where it would be located.  thanks

http://www.geocities.com/bray19702004/frontviewpic4

[DanMaine]

My Dr. said that I had massive gyn. Should have had the glad removed for my first operation.
Had it removed this year. He said that the scars would show, and they do. I still keep my shirt on in public, but feel so much better after the operation. Pictures at
http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=11;action=display;num=1065103222

[allbah]

I would advise you to get your hormones checked.

[wasatchm]

thanks for the info and pics danmaine.  it appears the scars and from large incisions below each breast.  where these incisions to remove excess skin or remove breast tissue?  my ps told me if he removed excess skin, it would only be just above the arola on the larger breast.  this would be to elevate that arola to the same height as my other arola.  I don't think it would be near the size of the incision that you had.   he said many people wouldn't  be concerned with the height of each arola not being the same (as they are now).  I probably feel the same.  right now one nipple is 1/2 inch higher than the other.  the PS said after the surgery the difference in height would probably be the same (1/2 inch).  I'd gladly live with that as long as my chest was flat (for once in my life).