Reasons for Gynecomastia Revision Surgery, Men who have made the decision to have male breast reduction surgery have found it can be a life changing event. They no longer have to try to hide their chest in loose fitting clothing or hunch their shoulders together. Social events are broadened to include all types of beach, pool and sports activities that may require a man to remove his shirt.
This new lease on life can be dashed if the surgical outcome is not what was expected. Some post-operative results are so disappointing that they will require a revision or “redo” surgery. Needing a revision can be complicated as now there is scar tissue the surgeon must contend with, and the elasticity of the skin may be somewhat compromised. Additionally, the patient will be faced with more surgical fees and another recovery period.
The most common cause of gynecomastia revision surgery is the repeated error of surgeons attempting to reduce the male breast with liposuction alone. True gynecomastia is a combination of fat and breast tissue, removing only the fat by liposuction will leave the breast tissue looking, even more, pronounced. There are many fancy names for “new” liposuction machines, but breast tissue is just too dense to be effectively removed through the cannula of the liposuction machine.
My gynecomastia practice is now at 40% revision surgery, most of the cases are where liposuction alone was done. Some fat must be left to be a buffer to allow the skin to move over the muscle, if too much fat and tissue are removed, it will lead to the second cause of gynecomastia revision surgery, the crater deformity.
The crater deformity is where there is a depression (or crater) under the nipple/areola complex from over resection of the fat and gland. To correct the crater deformity, the surgeon needs to do a fat transfer or a fat flap.
Other revisions include asymmetry, scar revisions, etc., to avoid the necessity of male breast reduction revision surgery choose your gynecomastia surgeon very carefully, do your homework! It takes a skilled gynecomastia specialist to shape and contour the male breast for a pleasing result. Make sure your surgeon is Board Certified in Plastic Surgery and specializes in gynecomastia. Ask to see before and after pictures of the surgeon’s patients.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
Michele Garber, the host of the Nip/Tuck radio show recently interviewed San Francisco Board Certified Plastic Surgeon, Miguel Delgado, M.D. The interview addressed many aspects of gynecomastia. Dr. Delgado has been a gynecomastia specialist since 1989 and was able to answer all of her questions regarding the embarrassing condition of man boobs.
Michele obviously did her homework in researching gynecomastia as was evidenced by her thought provoking questions. She was interested in knowing what causes gynecomastia and what surgical options are available for men.
Some significant topics covered were:
If a man has surgery, can the male breasts come back?
What age is best for surgery?
Are there other options besides surgery?
Are there risks associated with the use of steroids?
Is liposuction by itself effective?
Is it necessary to be evaluated by an endocrinologist?
Additionally, Miguel Delgado, M.D. states that for some young men their male breasts remain well after puberty making surgery the only option for removal. However, he says that young men have the best outcome as their skin is still quite elastic. Further in the interview it is revealed that older men tend to develop breasts due to age factors or gaining weight. Dr. Delgado also warns men that various drugs, legal or illegal, have been known to cause gynecomastia.
A condition little talked about but widely apparent is gynecomastia, the overdevelopment of the male breast. A reaction to too much estrogen or too little testosterone, gynecomastia can occur in newborns, teenagers, and adult men.
In babies, preteen, teenage boys, and young adult men gynecomastia is a reaction to estrogen from the mother or changes in hormones caused by puberty. It usually resolves within 18 months and is not a cause for concern. In older adult males, however, gynecomastia is usually caused by the natural decline in testosterone production or being overweight provides more fat cells which convert testosterone to estrogen. Of course, screening for much less common conditions such as liver or lung cancer, thyroid or hormone problems, or drug use can cause gynecomastia as well as certain medicines:
Steroids
Medicines used to treat ulcers or epilepsy
Digitalis and other heart medicines
Chemotherapy drugs, especially alkylating agents
Antiandrogen drugs (such as flutamide, cyproterone, and spironolactone)
Antianxiety and antidepressant medicines
Products containing tea tree oil or lavender oil
Luckily, gynecomastia is not harmful and easily treated. If caused by hormonal imbalances, it will usually go away on its own. If caused by a medicine or disease, discontinuation of the medicine or treatment of the disease will usually cure gynecomastia. If you find a one-sided breast lump, it is extremely important to consult a physician, particularly if you have any close relatives who have had breast cancer. A doctor can check the lump with a biopsy or surgery.
In extreme cases, surgery may be necessary. This surgery is similar to breast reduction. The average cost of gynecomastia surgery is $3,100, not including anesthesia or other related. After surgery, patients usually notice some discomfort and pain which can be alleviated with prescribed medication. Typically a week recovery period is recommended. The patient will wear a compression vest beneath clothes for two to three weeks to control swelling and help shrink the skin. Patients should refrain from physical activity for two weeks. They may notice some slight scarring, but results will be visible within the first two weeks after swelling goes down, with continued improvements for six months.
Gynecomastia can cause some men to feel insecure. If you notice an enlargement of your breasts, and diet, exercise, and discontinuation of medicines have failed to produce results, male breast reduction surgery can give you a flatter, firmer, and more masculine chest and profile.
The University of British Columbia, Vancouver, Canada did a study of over 400,000 men from ages 15 to 25. The study was regarding the side effects for current users of the anti-psychotic drug, Risperdal or the generic equivalent, risperidone. The results of the study showed men were 5 times more likely to develop gynecomastia than those who did not take the drug. Additionally, a study was done on one million older men who took Risperdal, and the results showed they had 69% higher chance of developing male breasts.
In 2005, The FDA required a “black-box warning” on the packaging of Risperdal. A “black-box warning” is the most stringent warning required by the FDA, a warning reserved for serious or life-threatening drug side effects. To date, the warning is only concerning the substantial risk for elderly dementia patients who are at increased risk of death by taking the anti-psychotic drug.
It is hoped that in the future there will be additional warnings such as the increase of prolactin levels that may cause gynecomastia. In the meantime, even with lawsuits continuing to be filed, Risperdal has not been recalled by the FDA or Johnson and Johnson. Risperdal is still being prescribed by doctors to treat mental health issues in children and adults.
Risperdal is an antipsychotic drug manufactured by Janssen Pharmaceuticals Inc., a subsidiary of Johnson and Johnson. Of all medications on the market, Risperdal has one of the longest histories of legal disputes due to the side effects, mainly gynecomastia, that the drug causes. At one point, it was the most prescribed antipsychotic in the United States. What a travesty for boys and men suffering from mental illness to have the addition of developing male breasts.
The first case to go to trial regarding the consequences of the drug was in September of 2012. The trial ended in a settlement on the first day for an undisclosed amount. For more information on Risperdal and it side effects, see the blog for August 14, 2015.
Since the first court case, five more were settled in 2012, and Johnson and Johnson is now facing hundreds more lawsuits. It is believed that the drug raises prolactin levels and blocks dopamine, resulting in the possible development of gynecomastia.
If you Google Risperdal lawsuits, you will see multiple offers from different law firms offering to represent men who have had gynecomastia develop due to Risperdal. Some law firms claim there is a settlement in progress that may pay out large amounts per claimant.
Back in May of 2014, meetings were started to petition for Risperdal Multidistrict Litigation (MDL). An MDL is not a class action suit but is for individual claims.
In a class action suit, one lump sum would be awarded if a settlement is agreed upon. Then the award would be divided equally between all plaintiffs no matter what their degree of injury.
For multidistrict litigation (MDL) all of the pending claims are represented in one courtroom and heard by one judge. Then each plaintiff would be fighting his own claim and can negotiate an individual settlement with their Risperdal attorney.
Johnson and Johnson has already paid 2.2 billion dollars to the Department of Justice when, Janssen a subsidiary of J&J, pleaded guilty to misbranding the antipsychotic drug.
To date, there are more than 1300 cases pending in the Philadelphia Court of Common Pleas. So far there have been three bellwether trials. The purpose of bellwether trials is to help gauge how juries may respond to testimony that may influence future negotiations and settlements.
In February, the first bellwether case was all over the news as it settled for 2.5 million dollars. The plaintiff was a 20 year old man who started taking the drug when he was 8 years old for treatment of autism. The second case went in favor of the defendant as there was insufficient evidence that the plaintiff’s gynecomastia was caused by Risperdal. The third case just recently settled in favor of the plaintiff for an undisclosed amount.
The statute of limitations varies greatly from state to state. If you believe you have been a victim of this drug, it may be in your best interest to see a Board Certified Plastic Surgeon who specializes in gynecomastia, and perhaps a Risperdal attorney.
