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User experiences

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User experiences
« on: January 17, 2009, 10:55:36 PM »
hey, just a quick question.. do most poeple who have a successful surgery forget about this site soon after? i mean it could be understandable to a point (people dont want to think about it anymore)

its kind of a tough question to ask because if its true, those people would be gone! haha

i'm just trying not to get discouraged seeing all these posts about reoccuring gyne, scar tissue, and second surgeries.. basically i dont know how successful surgery is when i dont see both the positive and negative feedback.

thanks

Linkback: https://www.gynecomastia.org/smf/index.php?topic=16651.0

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Offline Grandpa Bambu

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Re: User experiences
« Reply #1 on: January 17, 2009, 11:46:45 PM »
Most guys here who have surgery, usually disappear shortly thereafter. I assume, that their surgeries went well and have moved on with their lives...  ;)

'Reoccurring' gynecomastia is very rare...

'Scar tissue' dissipates with time...

'Revision surgery', IMO, is not all that common. Many guys, shortly after surgery are freaked out by swelling and such and are very quick to say that they need a revision. When probably in most cases, it's not necessary at all.


To the resident Docs...  How many gynecomastia revisions are done? Just a ball-park figure, percentage wise... thanks!

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

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Offline Jock

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Re: User experiences
« Reply #2 on: January 18, 2009, 01:22:28 AM »
When I recently visited Dr. Karidis in London, he said that revision was sometimes required in about 2% of his cases.
Took the plunge and had consultation with Dr. Karidis 7th January 2009.
Surgery 26th February 2009.
Just wish I'd been able to do this years ago.

http://www.gynecomastia.org/smf/index.php?topic=17004.0

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DrBermant

Re: User experiences
« Reply #3 on: January 18, 2009, 08:53:09 AM »
Most guys here who have surgery, usually disappear shortly thereafter. I assume, that their surgeries went well and have moved on with their lives...  ;)

'Reoccurring' gynecomastia is very rare...

'Scar tissue' dissipates with time...

'Revision surgery', IMO, is not all that common. Many guys, shortly after surgery are freaked out by swelling and such and are very quick to say that they need a revision. When probably in most cases, it's not necessary at all.


To the resident Docs...  How many gynecomastia revisions are done? Just a ball-park figure, percentage wise... thanks!

GB

I perform many revision gynecomastia operations.  Most are for patients who are unhappy with results from other doctors.  I have performed revisions on patients who had gynecomastia surgery by plastic surgeons, general surgeons, gynecologists, urologists, ER doctors, family practice doctors, radiologists, and those with no certification at all!  That is why it is so important to pick a doctor who has demonstrated good technique with this surgery.  I will probably need to expand that section of my website to show many more examples.  That is also why I put up a section on picking a surgeon for gynecomastia surgery here on this forum:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

However, there have been a significant number of those who had regrowth for problems not stabilized before surgery.  Recurring gynecomastia is not rare when the underlying problem is not addressed first.

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.

There were a couple of my patients who initially completed their paperwork stating that they had growing tender breasts.  When I then told them they needed an endocrinology evaluation before I would continue considering surgery, the stories changed.  Their breasts were not "really" growing, and they were not "really" tender.  Each turned out to have underlying endocrinology problems and had recurrence after surgery.

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.

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.

I have seen cases of gynecomastia recurrence from other doctors' surgery.  One example recent example was a male nurse who brought in pictures before surgery with large breasts, pictures of a flat chest after this other doctor's surgery, and new breasts bigger than what he started with.  I set this patient up for a better endocrinology evaluation and we found he had Adrenal Genital Syndrome, a defect in his adrenal glands management of cortisone creating massive levels of testosterone and estrogen since he was in his mother' womb.  His birth certificate said male, but his chromosomes, never checked before were XX.  He was not a he, but a misdiagnosed female who could have lived a normal life as a woman if his doctors had just taken the time to evaluate his problem and not jump the gun for surgery!  I will be adding this sad story to Plastic Surgery 4U soon.

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.  Any surgery technique, even radical breast mastectomy for male breast cancer can leave gland behind.  The problem is that there are fine fingers of gland that dissect between fingers of fat and can extend quite far into the chest.

You can see what I mean by fingers of gland here.

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.  This puts my recurrence rate at well under 1%.  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 of 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

Re: User experiences
« Reply #4 on: January 23, 2009, 11:24:44 AM »
Dr. Bermant,

I have a son who has bilateral glandular gyneco (prohormone induced). He wants to have the surgery now, but still reports growth on one side. He has been off the prohormone for about 9 months. Does he need to wait longer or get surgery now? Largest (still growing) is the size of a small bird egg.

Thanks!

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DrBermant

Re: User experiences
« Reply #5 on: January 23, 2009, 12:00:59 PM »
Dr. Bermant,

I have a son who has bilateral glandular gyneco (prohormone induced). He wants to have the surgery now, but still reports growth on one side. He has been off the prohormone for about 9 months. Does he need to wait longer or get surgery now? Largest (still growing) is the size of a small bird egg.

Thanks!
Gynecomastia surgery does not stop breast growth.  Getting a problem stabilized first is much better than facing a recurrence after surgery.  For my patients with growing breasts, I typically recommend an endocrinology evaluation.  These are issues I help patients explore during consultations or Preliminary Remote Discussions. Jane is my office manager and can explain the process.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.


Hope this helps,

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

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Offline Grandpa Bambu

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Re: User experiences
« Reply #6 on: January 23, 2009, 12:21:48 PM »
However, there have been a significant number of those who had regrowth for problems not stabilized before surgery. Recurring gynecomastia is not rare when the underlying problem is not addressed first.

What percentage of your patients that you have performed Gynecomastic Reduction Surgery on, have had a case of recurrence as a result of an underlaying problem?

Also, what percentage of your patients that you have sent for Endocrine evaluations, have actually had an 'Underlaying condition/problem'?

GB

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Offline Paa_Paw

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Re: User experiences
« Reply #7 on: January 23, 2009, 09:26:33 PM »
In response to the original question, Most Post-operatives soon lose interest in the site and simply move on. Grandpa Bambu is a valued exception, he has stayed on as a valuable resource.

Of the people who express dissatisfaction with their surgical outcome; some are recently post-operative and somewhat impatient for the swelling etc. to subside while many others first get here after having surgery performed by a less qualified surgeon.

In the long term, the overwhelming majority of the cases have results that are quite satisfactory when performed by a well qualified surgeon.

Thanks and Hats off to Dr bermant for his most enlightening responses above.
Grandpa Dan

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Offline Bman41

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Re: User experiences
« Reply #8 on: January 25, 2009, 12:53:31 AM »
They do?  I haven't heard either way honestly.


Re: User experiences
« Reply #9 on: January 25, 2009, 02:12:45 AM »
Here is my analysis of this fine question.   Personally, as I am starting to feel more confident in my result, I feel less inclined to be using this site. But, that being said, I will not leave this site because I feel I owe it to my gyne brethren to provide information on my heeling process (as soon as I get some time I will post my manifesto).

I think most younger men who have sucessful gyne surgery--make like a banana, and split--because they are out running to the beach and catching up with their new found youthfull social circles, activities and various other escapades.  Many older men (25 and above) who in my assumption have suffered longer with this mental and physical condition, I believe, stay active longer.  Why?  Their scars ran deeper, so they feel a moral obligation to provide support--Bambu and the like are fine examples.  Also, being older were are more stable in life (ie., not running off to college, the army, or new adventrues as often) so we have a little more time!

That is my theory.  There are many other reasons to support this argument but I am sick of typing.

PS:  If you have not had surgery and plan to, do not forget about this website!  I'm off to the beach!!!

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Offline Ryuuk

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Re: User experiences
« Reply #10 on: January 25, 2009, 06:06:01 AM »
I'm still mystified by the fact that women can get breast reductions and rarely experience regrowth yet according to Dr. Bermant regrowth is almost assured with a feminine hormonal balance.

The smallest amount of breast growth in a preop woman can mean an immense amount to a preop man.

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Offline Grandpa Bambu

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  • 31 Year Gynecomastia Victim...
Re: User experiences
« Reply #11 on: January 25, 2009, 08:39:12 AM »
I think most younger men who have sucessful gyne surgery--make like a banana, and split--because they are out running to the beach and catching up with their new found youthfull social circles, activities and various other escapades.  Many older men (25 and above) who in my assumption have suffered longer with this mental and physical condition, I believe, stay active longer.  Why?  Their scars ran deeper, so they feel a moral obligation to provide support--Bambu and the like are fine examples.  Also, being older were are more stable in life (ie., not running off to college, the army, or new adventrues as often) so we have a little more time!

That is my theory.  There are many other reasons to support this argument but I am sick of typing.

You hit the nail on the head dude!  ;)

GB

Re: User experiences
« Reply #12 on: January 25, 2009, 04:36:10 PM »
Here is my analysis of this fine question.   Personally, as I am starting to feel more confident in my result, I feel less inclined to be using this site. But, that being said, I will not leave this site because I feel I owe it to my gyne brethren to provide information on my heeling process (as soon as I get some time I will post my manifesto).

I think most younger men who have sucessful gyne surgery--make like a banana, and split--because they are out running to the beach and catching up with their new found youthfull social circles, activities and various other escapades.  Many older men (25 and above) who in my assumption have suffered longer with this mental and physical condition, I believe, stay active longer.  Why?  Their scars ran deeper, so they feel a moral obligation to provide support--Bambu and the like are fine examples.  Also, being older were are more stable in life (ie., not running off to college, the army, or new adventrues as often) so we have a little more time!

That is my theory.  There are many other reasons to support this argument but I am sick of typing.

PS:  If you have not had surgery and plan to, do not forget about this website!  I'm off to the beach!!!


AMEN to all that, brother! I plan on sticking around, too!

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DrBermant

Re: User experiences
« Reply #13 on: January 25, 2009, 08:31:19 PM »
I'm still mystified by the fact that women can get breast reductions and rarely experience regrowth yet according to Dr. Bermant regrowth is almost assured with a feminine hormonal balance.

The smallest amount of breast growth in a preop woman can mean an immense amount to a preop man.

Even if women do experience some small regrowth they certainly don't return to anywhere near their pre-op size or else the surgeries wouldn't be performed. And keep in mind these are women with natural hormone balances that would encourage breast growth AND they have a good amount of gland left behind.

The cases which Dr.Bermant talks about are more than just a little regrowth. I'm not saying Dr. Bermant is completely wrong, and if you're reading this Dr. Bermant please don't get angry with me because I'm just trying to initiate some scientific debate here.

Here's something to consider for EVERYONE reading this. More men here have hormonal imbalances than they know. Many hormonal conditions are never detected by endocrinologists even with blood tests. My sex drive plummeted and I developed gynecomastia yet my blood test show "normal" every time I've been tested. The scale of how they measure hormones is not accurate because hormonal balances are unique for each individual and the scale doesn't differentiate. 20 years from now the endocrinology of today will be looked back on as useless.

Gynecomastia does not just happen, it's triggered. Evaluation systems or not many guys with ongoing hormonal abnormalities are slipping under that radar I guarantee.

If regrowth was assured with a hormonal imbalance many more guys would experience it. I've been coming to this forum on a weekly basis since 2004 and I've only seen one guy post here who had real regrowth. He got gynecomastia from taking elavil and continued to take it after surgery. Most of the posts about regrowth are guys worried about it but who have not actually experienced it. And of course Dr. Bermant will reply with his usual response and that gets circulated around.

If Dr. Bermant is trying to educate people that's wonderful. The truth needs to be known regardless of how unpleasant it is, but there's a fine line between education and self-promotion. Gynecomastia causes a massive amount of mental anguish and people commit suicide over it, lets not be too negative here.

It is not male or female, it is being a mammal.  The gland in either men and women will regrow under the right hormones.  After Breast Reduction Surgery in Women the breasts will get bigger from the hormones triggered by pregnancy, prolactinoma, or the same conditions that cause gynecomastia male breast enlargement

The smallest amount of breast growth in a preop woman can mean an immense amount to a preop man.

That is correct, smaller breast growth shows up much more on a male chest.

The fact is that I have seen many such problems with my experience of thousands of gynecomastia patients for over 30 years.  Prevention of recurrence does not make a surgeon money.  Our win is in minimizing patients' total cost and reducing the need for more costly revision surgery.  The system has evolved over the years to help find those needing an evaluation and subsequent treatment.  It is a compromise to minimize unnecessary testing and having all patients evaluated with endocrinology first. 

My revision rate is less than 1%.  Check out typical literature on the subject:

http://www.ncbi.nlm.nih.gov/pubmed/18026791?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

revision rate 7%


http://www.ncbi.nlm.nih.gov/pubmed/11176630?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

recurrence rate 3/20 = 15%


http://www.ncbi.nlm.nih.gov/pubmed/15269574?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

revision rates 10.3 to 38.1%


http://www.ncbi.nlm.nih.gov/pubmed/18675546?ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

revision rate 35/65  = 54%


http://www.ncbi.nlm.nih.gov/pubmed/18026791?ordinalpos=44&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

revision 7%  100 patients over 10 years

http://www.ncbi.nlm.nih.gov/pubmed/11252087?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

revision 2/10 = 20%

That high a revision rate is just not acceptable if it can be lowered with better screening and techniques.

Hope this helps,

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

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DrBermant

Re: User experiences
« Reply #14 on: January 25, 2009, 08:37:19 PM »
In response to the original question, Most Post-operatives soon lose interest in the site and simply move on. Grandpa Bambu is a valued exception, he has stayed on as a valuable resource.

Of the people who express dissatisfaction with their surgical outcome; some are recently post-operative and somewhat impatient for the swelling etc. to subside while many others first get here after having surgery performed by a less qualified surgeon.

In the long term, the overwhelming majority of the cases have results that are quite satisfactory when performed by a well qualified surgeon.

Thanks and Hats off to Dr bermant for his most enlightening responses above.

You are quite welcome  :D

Michael Bermant, MD


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