Gynecomastia Support Forum

Gynecomastia Forum Doctors => Ask a Doctor => Topic started by: ducky on January 13, 2015, 10:14:39 PM

Title: How does one become a pro at gyno surgeries?
Post by: ducky on January 13, 2015, 10:14:39 PM
and what lead you to choose it as one of the focuses of your practice?

I'm a 2nd year med student, currently interested in General Surgery. I have high interest in appendectomies and gyno surgeries and would love to perform both someday, as well as other procedures.  

Gyno surgeries are best performed by Plastic surgeons of course, but I'm not as interested in going into plastics. I know general surgeons perform gyno surgeries too, but the general consensus is that they stink at it lol.

So...if I were to go into General Surgery, what is the best way to get good at gyno surgery?
Is there a way I could do a gyno surgery fellowship through a plastics residency or something along those lines to get good at it? I have no idea how it all works.



Any info/advice you want to toss my way I will appreciate. :)
Any flame you want to throw at me for suggesting general surgery over plastics, I'll understand  :D
Title: Re: How does one become a pro at gyno surgeries?
Post by: Dr. Elliot Jacobs on January 14, 2015, 04:30:42 PM
I have always been interested in gyne because I grew up with it myself!

When I was a general surgery resident many years ago, the best breast surgeon in the hospital did a gyne procedure.  It consisted of a lengthy incision in the infra-mammary fold, and then dissection and removal of all the breast tissue and fat in an attempt to achieve a smooth, flat and symmetric chest.  It was a bloody three hour operation which left very irregular contours, a large scar, required drains and a lengthy healing time.  Basically, it was a bilateral subcutaneous mastectomy on a guy -- similar to what they would have done for a female.  When I left that operating room, I said there should be a better way.

After I entered plastic surgery, gyne surgery was performed similarly, except that the incision was around the edge of the areola.  Still a lengthy, bloody operation with sub-optimal results.  I again said there should be a better way.

Along came liposuction in 1982 and things improved.  Plastic surgeons were able to get better results in a shorter time frame -- but there was still a requirement to excise gland through a peri-areolar incision.  Now I was intrigued.  I felt that improvements in the design of the lipo instrument (cannula) could enhance the results.  I tried several different cannulas but ultimately designed my own cannula, which has further enhanced the results of the operation.  This cannula can remove fat, of course, but it can also remove a certain amount of gland.  It is not perfect, though, and I often have to excise gland as well -- but there is a much smaller amount remaining and it can be easily removed through a small peri-areolar incision with minimal bleeding.

The net result is that I can perform a gyne operation quicker, better, with far less bleeding, rarely use a drain and with excellent results in 60-90 minutes.  But it has taken several thousand gyne operations for me to reach this point and I was all self-taught.

To answer your question, I very much doubt if any general surgeons will provide the results that a plastic surgeon trained in gyne could do.  Unfortunately, there are no "gyne surgery" seminars.  I have  even offered to teach gyne surgery at some plastics conferences and have been rebuffed -- they do not seem interested.

Those are the facts as they are today.

Good luck in your surgical career -- whichever direction you choose.

Dr Jacobs
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