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Is a second surgery worth it?

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Is a second surgery worth it?
« on: February 12, 2010, 10:34:34 PM »
So I had Surgery for Gyno about seven eight months ago. A little background info: I had quarter-sized firm tissue/ glands under both nipples. symmetrical. I, like some people I've read about have low body fat which emphasizes the appearance of these masses. I always remember having puffy nipples but when I stated to work out in college I used pro hormones which caused the formation of a hard "lump" under each nipple. I later found out that they were glands growing as a result of the estrogen build up from my choice to take test pro hormones. I stopped using the supplements and the growing stopped as well. I was left with the awkward profile that is hard to live with, as many of us know.

I managed to find a doctor that convinced me he could eliminate the lumps using two techniques...I forget the terminology but one was to make tiny cuts to fit a tiny pipe that emits ultra sonic frequency? to basically dissolve the tissue build up(basically lipo in my understanding) and secondly cut under the nipple and extract any firm tissue that the first procedure didn't take care of.

After surgery I was happy with the results. Healing went well and I took every step to ensure successful healing. Today I sit writing this considering a second surgery simply because the left nipple has what feels like gland as it is firm but almost floating or suspended. I can pinch and move it around. It seems to be the size of a quarter oddly enough but its not behind the nipple as was the case prior to the first surgery. It is just above the nipple to the right. The doctor apparently missed a piece when extracting or something to that effect.

Obviously the surgeon did not extract all of the gland or missed something during the procedure because the right nipple is perfect and Just recently have i been able to notice the protrusion of a lump in the left nipple area. I guess my question for someone in the know about this is: Does this happen often and has anyone heard of doctors giving a repeat customer a discount for coming back again.

I have yet to talk to my doctor about this, so I'm basically sharing my story and wondering if anyone has had a similar experience. I mean I feel like this is a small issue to justify having a second surgery as I still have the profile I wanted in the first place. I guess I just have this nagging in my head that knows I'm not even in my chest. The lump still has a degree of sensitivity especially when i press on it so I know it is a piece of gland left over from the first surgery and that bothers me.

Why couldn't the doctor just get all of it the first time, ya know? how could he miss a quarter sized chunk>? My doctor is gonna get an ear full when I see him next. Hopefully I'll hear some feedback from some of you before then.

All comments are welcome

Regards,

JL


   

Linkback: https://www.gynecomastia.org/smf/index.php?topic=20048.0

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DrBermant

Re: Is a second surgery worth it?
« Reply #1 on: February 16, 2010, 11:13:05 PM »
So I had Surgery for Gyno about seven eight months ago. A little background info: I had quarter-sized firm tissue/ glands under both nipples. symmetrical. I, like some people I've read about have low body fat which emphasizes the appearance of these masses. I always remember having puffy nipples but when I stated to work out in college I used pro hormones which caused the formation of a hard "lump" under each nipple. I later found out that they were glands growing as a result of the estrogen build up from my choice to take test pro hormones. I stopped using the supplements and the growing stopped as well. I was left with the awkward profile that is hard to live with, as many of us know.

I managed to find a doctor that convinced me he could eliminate the lumps using two techniques...I forget the terminology but one was to make tiny cuts to fit a tiny pipe that emits ultra sonic frequency? to basically dissolve the tissue build up(basically lipo in my understanding) and secondly cut under the nipple and extract any firm tissue that the first procedure didn't take care of.

After surgery I was happy with the results. Healing went well and I took every step to ensure successful healing. Today I sit writing this considering a second surgery simply because the left nipple has what feels like gland as it is firm but almost floating or suspended. I can pinch and move it around. It seems to be the size of a quarter oddly enough but its not behind the nipple as was the case prior to the first surgery. It is just above the nipple to the right. The doctor apparently missed a piece when extracting or something to that effect.

Obviously the surgeon did not extract all of the gland or missed something during the procedure because the right nipple is perfect and Just recently have i been able to notice the protrusion of a lump in the left nipple area. I guess my question for someone in the know about this is: Does this happen often and has anyone heard of doctors giving a repeat customer a discount for coming back again.

I have yet to talk to my doctor about this, so I'm basically sharing my story and wondering if anyone has had a similar experience. I mean I feel like this is a small issue to justify having a second surgery as I still have the profile I wanted in the first place. I guess I just have this nagging in my head that knows I'm not even in my chest. The lump still has a degree of sensitivity especially when i press on it so I know it is a piece of gland left over from the first surgery and that bothers me.

Why couldn't the doctor just get all of it the first time, ya know? how could he miss a quarter sized chunk>? My doctor is gonna get an ear full when I see him next. Hopefully I'll hear some feedback from some of you before then.

All comments are welcome

Regards,

JL

The question is there a contour deformity or just firm tissue. Firm tissue that does not show up on animation, may be a reasonable result. Firm tissue that puffs out with relaxed skin areola muscles or with chest muscle flexing or activities might warrant revision. Posting Standard After Gynecomastia Surgery Pictures or Standard After Gynecomastia Movies can help others better understand your concerns.

Liposuction Is Great for Sculpting Fat

Various types of ultrasonic and power assisted liposuction (UAL and PAL) have been around for quite some time.  Each surgeon uses the tools and techniques he / she prefers.

There are studies claiming that ultrasonic liposuction does not break down gland cells, these were done to justify the safety in female liposuction breast reduction surgery.  Ultrasonic energy cannot be both ways, good for gland breakdown and safe not harming gland unless there is a difference between male and female breast gland tissue which has not been proven to my knowledge. 

Tumescent liposuction is a form of anesthesia where fluid is placed in the tissues to be sculpted.  You can see very graphic pictures of the tumecent technique here.

Liposuction such as ultrasonic, VASER, Laser, power assisted, and sharp cutting cannula preferentially remove fat over gland.  Gland tends to exist under the nipple areola region.  When fingers of fat extend between fingers of gland, breast reduction can come from removing the fat and leaving gland behind.  On animation such as flexing the pectoral muscles or putting the arms over head, gland does not compress or move like fat.

When gynecomastia is from fat, liposuction works very well for contouring the chest.  I have seen many patients from other doctors who tried to use liposuction alone techniques that left gland behind that the patients just did not like for Revision Gynecomastia Chest Sculpture.

Here is an example of Revision Surgery after Liposuction alone.   Here is another revision after liposuction alone.

The problem is picking the right method for what actually is that patient's problem.  That is why I prefer my Dynamic Technique that permits what I find during surgery to guide my sculpture.  The incision at the edge of the areola  opens up my entire spectrum of artist's pallet of tools for my sculpture.  A remote incision robs me of many options and just does not looks as nice.

I have also seen patients with channel problems between remote access sites and the areola / nipple.  Scars, adhesions, and depressions can look terrible.  Check out the lateral (side views) and posterior oblique (side from the back views with and without muscle flexion here to see what I mean.

Ultrasonic liposuction uses energy to help emulsify fat.  Power assisted liposuction uses mechanical vibrating devices to rapidly move the cannula back and forth.  Both PAL and Ultrasonic methods have been around for several years.  Many do not prefer what they do to the tissue.  Others like what they offer.  Both still preferentially remove fat over gland.  Both make the work of the surgeon easier.  Some feel ultrasonic liposuction can cause more swelling, bruising, and the increase the need for drains.

Laser Liposuction ("Smart Liposuction") is just another variation of trying to destroy fat cells while in the body using laser light energy.  There are no reliable studies that it will also destroy gland well.  If it did, it would also destroy connective tissue, fascia, and dermis all closely related to light absorption in the body.  I have seen disasters from patients who had been told that the method would help their gland.  Some had defects I could not help.

For a liposuction cannula to remove gland, it can also remove connective tissue and other structures which can lead to more bruising and scars.  I have seen so many patients who were unhappy from doctors that used "special cannula to remove gland," that I just prefer to go directly to the problem itself.  Primary surgery is usually better than needing a revision.  All male breasts have gland.  With access to the gland directly, I can peel it off the areola muscle, minimize bruising and bleeding with direct control of the tiny blood vessels, and then reconstruct the contour.

For me however, they also both remove the feel of the tissue sculpture.  I like the much better control I get with my cannula selection and personally I do not like either ultrasonic nor power assisted techniques.  None of the cases on my website used either PAL, Ultrasonic, nor sharp cutting cannula techniques. 

As any artist, I take my cannula selection very seriously and have evolved what permits me to achieve my results.  I have considered and evaluated many, many technologies.  The many different types of cannula I use have their own advantages and qualities.  I pick a subset of these cannula that varies for the many different types of gynecomastia male chest sculpture that I see.

Gland removal by any technique can still leave a depression when  a major part of the problem is from gland.  For gland removal, I prefer the greater precision of removal under direct visualization and feel.  This also give me access to many more elements for my artistic palette of my Dynamic Technique to sculpt the remaining tissues.

This approach permits me to maximize the removal of the firm gland and sculpt the remaining fat.  How tissues move is important.  The human body is beautiful in animation.  That is why I show pictures of the chest with arms up, down, and with muscles tight / relaxed in addition to the results from multiple views.  Such analysis of the results as well as how tissues evolve, the possible need for drains, comfort level after surgery, are important factors in picking your doctor.  It is like an artist selecting a paint brush.  The results are what matters, not with what tool they sculpt.

The next question should revolve around, even if the doctor offers a discount, should you trust that surgeon for revision?  It depends on what that doctor can show before / after surgery examples for revision surgery. As further mistakes are made, revision surgery can become more and more difficult (and more expensive) to sculpt.

Hope this helps,

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


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