PS said "Just lipo." I'm not buying it. Pics attached.

[Russian_blue]

I just got back from a consultation which only took 30 minutes. He explained to me everything I've already researched within the past six months, and felt my breasts.
He told me that he thinks ultrasonic liposuction would do the trick. I told him that I'd been researching gynecomastia for a long time now, and that I know to generally stay away from the "just lipo" option. He told me he believes that 80% of my gynecomastia is fat, so I guess psuedogynecomastia is what he believe I have. He kept saying he doesn't want to "over do it, or under do it."
But, I don't know.. I've felt my own chest.. My right one has a large rubbery object right under the nipple, but the left one doesn't as much. I have lost weight, and I have gained weight and these have stayed with me. Granted, when I was at my lowest weight, these were smaller, but nonetheless, they were there.
He showed me four before and after pictures, two of which an excision was made. The lipo pictures looked great, but in my case I'm still very unsure if that would do the trick.
Now I'm getting really pissed off. I figured he would have immediately known that I do in fact have gynecomastia, and that an excision would need to take place, and I'd be on my happy way. I'm getting towards the end of high school, Summer's coming up in 6 months, I'm applying for colleges. I can't keep making consultations, and possibly have to wait weeks to months to even get the damn surgery. I don't have all the time in the world.
So I attached photos. What do you think? Do I need lipo, or excision?

[Dr. Elliot Jacobs]

Except in rare circumstances, it is difficult to feel your chest and determine if you need excision or lipo or both.  Breast tissue can feel hard or soft and the same for fat.  Even an experienced surgeon's hands cannot tell all the time.

I feel the best way to go is to find a surgeon who is PREPARED to do whatever is necessary during the procedure to get the best possible result.  When I do gyne surgery, I start with lipo -- and indeed sometimes that is all that is necessary.  But in many cases, the lipo is not enough and then I proceed to perform an excision.  I think it is best not to pre-determine the course of surgery before you even start.  Other docs may have a different approach -- but all good gyne docs are ready and capable of doing anything during the procedure in order to get the best result.

My best advice:  get several opinions and discuss the above with each of the surgeons.

Dr JAcobs

[George Pope, M.D.]

I've talked a lot about ultrasonic liposuction on this site.  It's something that was very popular in the mid and late '90's, but it's sort of fallen out of favor.  I've personally seen a few patients have long term swelling after that procedure.  I think the same holds true for laser lipo procedures, where laser energy heats up and melts fat.  I was never able to remove all of the gland tissue with ultrasonic energy when I used that technique; I always had to open those patients and excise tissue directly as well.

In my opinion it's not the way to go anymore. 

Dr. Pope, MD