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My scenario.

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Offline cube

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My scenario.
« on: November 12, 2009, 12:59:10 AM »
I had surgery last year in july. The Surgeon who operated cut around both nipples completely. Now I have the same gyno but with scars around both nipples. I have discussed a revision surgery with a DR and he advised that because the previous dr cut around the areola there is a larger chance of NECROSIS of the nipple! He said that alot of blood supply was cut off because of the previous doctors failure. But he then said he has never had a situation like that happen in his 30 yrs of performing surgery. Is this something I should be concerned about or is it still a very rare scenario?? I am now more stressed than ever because of this....

Linkback: https://www.gynecomastia.org/smf/index.php?topic=19389.0

Re: My scenario.
« Reply #1 on: November 12, 2009, 05:14:48 AM »
Hi Cube,

Did you see a Private Doc for the second op consultation?

If not that would be the next thing to do from reading on here karidis has a good reputation.

Go speak to some one that is a professional and can give you the anwsers you are looking for, most consultations are free.

Wannabemassive

TRAIN HARD LIVE LONG

Re: My scenario.
« Reply #2 on: November 12, 2009, 05:46:09 AM »
Cube

That surgeon was correct.  If indeed you had incisions made completely around both nipples, then the potential blood supply from the surrounding skin has been significantly damaged.  The only good remaining blood supply to your nipples now comes directly upward from below.

If you now were to have additional surgery in which tissues from beneath the nipple are removed, then that could theoretically damage the only remaining blood supply to the nipples -- and they could necrose.

This is a very tough situation.

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

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DrBermant

Re: My scenario.
« Reply #3 on: November 12, 2009, 08:09:24 AM »
I had surgery last year in july. The Surgeon who operated cut around both nipples completely. Now I have the same gyno but with scars around both nipples. I have discussed a revision surgery with a DR and he advised that because the previous dr cut around the areola there is a larger chance of NECROSIS of the nipple! He said that alot of blood supply was cut off because of the previous doctors failure. But he then said he has never had a situation like that happen in his 30 yrs of performing surgery. Is this something I should be concerned about or is it still a very rare scenario?? I am now more stressed than ever because of this....

Blood supply is an issue making this difficult sculpture.  Options depend on the original problem, what was done, complications, the skill of the revision surgeon, and many other factors best determined during an evaluation.  Here is an example of a patient who had a mess created by his incompetent first surgeon who cut all the way around the areola leaving a Large Areola Complication After Bad Gynecomastia Surgery that I was able to revise the areola and deal with the remaining gland component.  Check the linked pages to view the entire series of pictures before, after, and during surgery to see what I mean.

Hope this helps,

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


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Offline cube

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Re: My scenario.
« Reply #4 on: November 12, 2009, 10:16:49 PM »
Thank you Dr Jacobs and Dr Bermant for your quick response. And yes Wannabemassive I did speak to a very good Dr over the phone and sent him pictures, but I have not consulted with the Dr in person. He did advise me over the phone of the possibility of necrosis. What do you think the chances are of necrosis considering the situation? Are we looking at 50/50 chance? Or something less dramatic. I agree with Dr Jacobs this is a very tough situation. Is it possible that some blood supply has returned from the area that was cut around the nipple? The Dr also mentioned he has never had a nercrosis of the nipple occurr before, but i dont know if he has encountered a situation like this one.

I have seen the results of the procedure you performed Dr Bermant and the results are impressive! This demonstrates it is possible to remove the glandular tissue from beneath and leave the nipple with enough blood supply. Although as you say it depends on alot of factors... I'm terrified at this point and not sure what I should do. If it where the case that the nipple became necrose, would it have to be completely removed?? What are your recommendations how should I proceed in order to achieve the best result?? 

Re: My scenario.
« Reply #5 on: November 12, 2009, 10:49:42 PM »
Because of my servere case of gyne i had a choice of getting my nipples cut off i thought about and was just gon get a tatoo over it but i just went to save them.  It's not like you need them.  you aren't goin to be breast feeding or anything and you prolly already don't have feeling in them anymore. But i didn't do bc I just thought it would look weird as hell without nipples, which you prolly think the same damn thing.  But i hope everything works out for you man and im sorry you're goin through this. I know it must be hard man!! 

you say you still have gyne though?? 
My before and after surgery pics: Leave a comment if you look!! (HAD THE WRONG LINK UP! THIS IS THE ONE WITH ALL THE PICS)
http://www.gynecomastia.org/smf/index.php?topic=19342.0

Re: My scenario.
« Reply #6 on: November 13, 2009, 06:08:14 AM »
All is not lost.  I have had a few selected cases in which I was able to do aggressive lipo beneath the nipple and remove enough tissue to make the patient happy.  The alternative way to do this is to temporarily remove the nipple, do the chest contouring procedure (and remove any excess skin in the process) and then replace the nipple as a "free skin graft."  This is a more radical approach which I have done in a few selected cases.  You must understand that the nipple would then be more cosmetic and would have limited feeling.

Suggest you do a face to face consult with a very experienced gyne surgeon.

Dr Jacobs

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DrBermant

Re: My scenario.
« Reply #7 on: November 14, 2009, 10:29:49 PM »
I have seen the results of the procedure you performed Dr Bermant and the results are impressive! This demonstrates it is possible to remove the glandular tissue from beneath and leave the nipple with enough blood supply. Although as you say it depends on alot of factors... I'm terrified at this point and not sure what I should do. If it where the case that the nipple became necrose, would it have to be completely removed?? What are your recommendations how should I proceed in order to achieve the best result?? 

A dead nipple does not look good, reconstruction is a major compromise after such a loss.

Thank you for your kind words, not all doctors have the same skills nor offer the same techniques.  We are glad to help you explore your concerns and options during a consultation or a Preliminary Remote Discussion. After learning more specifics and detail of the original problem, what was done, and other factors, that is when I offer patient specific advice and discuss risks, benefits, and alternate methods of care.  If interested, 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 Revision Gynecomastia and Chest Surgery

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Offline cube

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Re: My scenario.
« Reply #8 on: November 15, 2009, 11:36:44 PM »
All is not lost.  I have had a few selected cases in which I was able to do aggressive lipo beneath the nipple and remove enough tissue to make the patient happy.  The alternative way to do this is to temporarily remove the nipple, do the chest contouring procedure (and remove any excess skin in the process) and then replace the nipple as a "free skin graft."  This is a more radical approach which I have done in a few selected cases.  You must understand that the nipple would then be more cosmetic and would have limited feeling.

Suggest you do a face to face consult with a very experienced gyne surgeon.

Dr Jacobs

Again I greatly appreciate your response and I am coming to terms with situation more as I consider the possibilities. If the scenario does occur where the nipple does necrose would it have to be completely removed? Or is there still the possibility of what you mentioned a "free skin graft?" Also I am travelling for the procedure and I would likely not be able to return due to work and school. Is this something local doctors are trained to deal with? I have to take all this into consideration because I am the primary money maker in my household. Any additional work leave would really strain my financial situation. I thank you again for your assistance. I am on a short time frame so my decision has to be very soon.

Re: My scenario.
« Reply #9 on: November 16, 2009, 07:00:50 AM »
If a nipple necroses, it is dead and it cannot be replaced as a free skin graft.

Sometimes decisions have to be made during an operation.  This might be one of them.  If the surgeon examines the nipple during surgery and feels it can live, then fine.  If he examines the nipple and has doubts about its blood supply, then he might elect to remove it, tighten the skin and then replace it as a skin graft.

This gets to be very complicated and that is why I suggested you consult with an experienced gyne surgeon to discuss all the possibilities.

Dr Jacobs


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