Author Topic: Should a plastic surgeon be responsible to tell you to go to endo first?  (Read 2441 times)

Offline MyName

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Hello all-

Without going into too much detail, I had gyno surgery and within two years it started to come back. Now it is back to the way it was before the surgery AND I have a void where the plastic surgeon said that I needed lipo. Dont feel confident enough in Dr to go back to him. I try not to get depressed over it but after living it for 30 years and finally getting the courage AND the money to do something about it and now this?!
My question to all that have had the surgery or have been for a consultation is did your Dr advise you to visit an endo prior to surgery? Is there anyone that had same results and what did you do about it?

Thanks...

Linkback: https://www.gynecomastia.org/forum/index.php?topic=21042.0

Offline gynedowner

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I am going in for surgery and have the same concerns. I was not advised to visit an endo before surgery. I can't imagine having the surgery and having it come back. If you don't mind me asking, did you gain any weight or do you suspect the growth to be entirely glandular tissue?

DrBermant

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Hello all-

Without going into too much detail, I had gyno surgery and within two years it started to come back. Now it is back to the way it was before the surgery AND I have a void where the plastic surgeon said that I needed lipo. Dont feel confident enough in Dr to go back to him. I try not to get depressed over it but after living it for 30 years and finally getting the courage AND the money to do something about it and now this?!
My question to all that have had the surgery or have been for a consultation is did your Dr advise you to visit an endo prior to surgery? Is there anyone that had same results and what did you do about it?

Thanks...

Not all patients need an endocrinology evaluation. Those with unstable issues do. With the help of endocrinologists over the years, I have evolved a Red Flag system of Gynecomastia Symptoms.  This method was received well during my invited Gynecomastia lecture at the American Association Of Clinical Endocrinologists 2008 national meeting.

I caution each of my patients that surgery does not typically stop male breast growth.  If there is a problem with growing breasts, recurrence can happen.  Any of these medical problems and or these medications can cause gynecomastia. So, if you want to get worried about regrowth, you could get yourself evaluated for each of these conditions to see if they could be a factor. 

If you are using something that can stimulate breast regrowth, shreds of gland remain behind with any surgical technique.  It is just not practical to remove all elements of gland.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest. Take a look at the Anatomy of Gynecomastia to see what I mean.  Even with a radical mastectomy (a disfiguring technique used for some male breast cancer problems), some gland can remain.  Surgery also does not prevent weight gain in the chest.  Men tend to put weight on the belly and chest regions.  I educate each of my patients that this surgery will not prevent further breast growth.  It is like changing/fixing a tire with a nail.  Fixing/changing the tire will not prevent you from getting a new nail in that tire.

Regrowth of gland from stimulation can occur where shreds of gland remain behind. This can be behind the areola, along the deeper edges or margins of a zone of excision. 

I take care of many patients with gynecomastia, as many as 8 in one day alone.  With all the gynecomastia surgery I have done, it is very rare to have regrowth for patients I have sculpted.  One patient (who had surgery on only side by another doctor) came to me with pro hormone induced gynecomastia that only came back on the side that had no surgery.  His growth was massive on the one side and none on the other.  His surgery by that other doctor had left a massive crater - the skin was adherent against the chest wall with normal fat surrounding the ugly deformity.  One side looked like the deformity seen here.  The other side was almost a B cup breast so tender that I could barely examine it.  As with each patient who presented to me with current breast growth, he was referred for an endocrinology evaluation and stabilization before considering surgery.  I do not know if such radical surgery was a factor or not.   Even if it did, removing all fat under the skin just gives an unnatural look.

Here is another example of Gynecomastia Breast Regrowth on my site.  Caution this is a graphic picture of the massive gland regrowth removed on the operating table.

This patient is rather unusual. He was a misdiagnosed genetic female who has lived his entire life as a male.  His birth certificate says male as does his driver's license. Yes, a terrible mistake labeling him male made from birth and early on not recognizing his Congenital Adrenal Hyperplasia.  His body has been exposed to high levels of androgens and estrogen since within his mother's womb. This results in an a condition better called Intersex than the older phrase Hermaphroditism.

I prefer to target the gland first with my Dynamic Technique. This permits me to remove most of the gland and then sculpt the remaining tissue to minimize contour problems.

By concentrating on the gland first I am able to minimize the chance of breast regrowth.  It is very rare for my patients to have recurrence.  With my techniques and my Red Flag Evaluation System before surgery, I have only a few patients over the many years I have been doing surgery that I know have regrown.  However, gynecomastia surgery does not stop breast regrowth.  For patients having breast growth, I have advised for many years that they should get their problem under control before surgery.  There are exceptions, such as young men with massive breasts that have not stopped growing.  That is why each case needs to be individually evaluated. 

Prevention and stabilizing the problem(s) causing gynecomastia, when possible, is much better. We help patients explore such issues during consultations or preliminary remote discussions.

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

Offline Paa_Paw

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My belief is that the patient should do a lot of homework before they consider surgery. This would include some investigation into the cause(s) of their Gynecomastia by a medical professional. Usually these investigations fail to find a cause and the condition is termed idiopathic. Because these are expensive and frequently fail to produce any results a lot of people think they are a waste of money and time. Conversely, if a problem is found, it can be dealt with prior to surgery.

Often a person who has not seen a Dr. in years will consult a cosmetic surgeon directly and have surgery without a second opinion. They put their faith in the surgeon completely (which is good) while accepting no responsibility for the outcome themselves (which is a mistake).



Do your homework, The result is in your own hands more than you know.
Grandpa Dan

Offline MyName

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I am going in for surgery and have the same concerns. I was not advised to visit an endo before surgery. I can't imagine having the surgery and having it come back. If you don't mind me asking, did you gain any weight or do you suspect the growth to be entirely glandular tissue?
I am thin/athletic. Although because of the fact that I have been somewhat depressed since it started to come back I have been going to the gym less and have developed a little gut :) The growth is glandular

Offline Dr. Elliot Jacobs

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The vast majority of gyne patients develop their gyne during puberty.  And if it is stable for years, then there is usually no need for an endo evaluation.

On the other hand, if you develop gyne later in your adult life, and if you have been on medications, taken body building steroids, etc, then it is worth a thorough investigation by an endo to find out the cause.  There are many other potential causes for gyne -- too numerous to mention here -- but the key is recent onset of gyne, tenderness/sensitivity of the breast or nipples, fluid discharge from the nipples, one-sided gyne, etc.  In these circumstances, it is worthwhile to have an endo evaluation prior to any surgery.

Remember, if surgery is performed on actively growing gyne, it may recur if the cause of the gyne is not treated ahead of the surgery.

Dr Jacobs

Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

Offline Grandpa Bambu

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To answer the question...

IMO, no... the PS should not be 'responsible' to advise you to get tested by an Endocrinologist. If the prospective patient is in their early to mid teens, it would be 'wise' of the PS to 'suggest' an Endo visit, but not be held morally or legally responsible to do so.

Just my .02...  ;)

GB...

Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline rds54

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Just for clarification, when you're determining if the gyne is stable or not, do you mean if it has been here for awhile? I first noticed my puffy nipples in about 7th or 8th grade and they have remained basically the same since I was about 16 (I'm now 22). I am about to graduate college, and since this has limited me so much, I want this surgery - sort of as a present. I'm so confused on what doctor I should consult first..

Offline Dr. Elliot Jacobs

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Yes, if your condition has been unchanged from 16 to age 22, with no additional growth, tingling, etc, then I might consider it to be stable.

Dr Jacobs

DrBermant

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Not all patients need an endocrinology evaluation. Those with unstable issues do.

Just for clarification, when you're determining if the gyne is stable or not, do you mean if it has been here for awhile? I first noticed my puffy nipples in about 7th or 8th grade and they have remained basically the same since I was about 16 (I'm now 22). I am about to graduate college, and since this has limited me so much, I want this surgery - sort of as a present. I'm so confused on what doctor I should consult first..

By stable I mean the gynecomastia is not changing nor tender nor producing milk. Gynecomastia can be there for many years and yet be enlarging. Gynecomastia can be stable for years but a new hormone stimulus can cause new growth. If there is a stimulation factor going on, that should be evaluated and managed first. Gland recently swollen from stimulation can shrink. Such issues are best explore in more detail during a consultation after an evaluation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction


 

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