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Possible 3rd time with surgery.....

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Possible 3rd time with surgery.....
« on: January 26, 2010, 10:18:52 PM »
The first time that I had surgery to remove it, I was about 17 yrs old.  Then again when I was 27.  The first time it was about the size of two golf balls.  Second time was a little smaller.  Now it has become tender again and everytime it is on the same side of my chest.  I am not an alcoholic, body builder, drug abuser or overweight.  I am about 5'10" tall and 175 lbs.  I have never been asked to have any blood work done.  I have had a mammogram done the second time around.  Could fertility drugs that my mother took to have children be a cause?  Are there any other questions that I should ask about besides liver, thyroid or genetics that could be the cause of Gynecomastia?  I can't keep going back and having a surgery every couple of years to get rid of it.  Any suggestions or comments would be appreciated.  Thanks.

Linkback: https://www.gynecomastia.org/smf/index.php?topic=19925.0

Urgent -Need Answers! Gyne back 3rd time
« Reply #1 on: January 27, 2010, 08:08:27 PM »
I had gynecomastia when I was 17 but let it go until it was extremely painful and had my first surgery.  The surgeon took out about the size of 2 golf balls.  The second time it I had surgery I was 27 and they also took out lymph nodes.  Now, I am 31 and it is back again...  I am not over-weight, an alcoholic, a drug-abuser or a body builder.  My doctors have only ever done a mammogram (the second time around) but no blood tests.  My mom had taken fertility drugs in order to have children.  Is it possible that this could be a reason that it continues to come back?  Are there blood tests that should be done like liver, thyroid or genetic testing?  Is there some other possible reason this continues to return.  I am seeing my family doctor tomorrow afternoon and could use some guidance and answers.  I don't want to keep having to have surgery every 5-10yrs because it comes back and it is painful.  Not to mention having to argue with insurance companies.

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DrBermant

Re: Possible 3rd time with surgery.....
« Reply #2 on: January 27, 2010, 08:48:01 PM »
The first time that I had surgery to remove it, I was about 17 yrs old.  Then again when I was 27.  The first time it was about the size of two golf balls.  Second time was a little smaller.  Now it has become tender again and everytime it is on the same side of my chest.  I am not an alcoholic, body builder, drug abuser or overweight.  I am about 5'10" tall and 175 lbs.  I have never been asked to have any blood work done.  I have had a mammogram done the second time around.  Could fertility drugs that my mother took to have children be a cause?  Are there any other questions that I should ask about besides liver, thyroid or genetics that could be the cause of Gynecomastia?  I can't keep going back and having a surgery every couple of years to get rid of it.  Any suggestions or comments would be appreciated.  Thanks.

Tenderness and breast growth are typical Symptoms of Gynecomastia .  Problems that are not stable can come back. It can be a challenge to discover some causes of the gynecomastia. An experienced endocrinologist who really  cares about investigating these difficult problems can often be key.

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 Gynecomastia and Male Breast Reduction

Re: Possible 3rd time with surgery.....
« Reply #3 on: January 28, 2010, 03:56:17 PM »
Thank you so much!  This was very informative and helpful to me.  I will discuss with my family doctor about finding an endocrinologist.

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DrBermant

Re: Possible 3rd time with surgery.....
« Reply #4 on: February 17, 2011, 09:51:33 AM »
Thank you so much!  This was very informative and helpful to me.  I will discuss with my family doctor about finding an endocrinologist.

You are quite welcome!

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737


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