Dr. Delgado: Hi I’m Miguel Delgado, board-certified plastic surgeon, and today we’re going to do a double incision mastectomy with a free nipple graft on a male with severe gynecomastia. In his particular case it was due to steroid usage in his bodybuilding techniques but it can also be used for men who have had massive weight loss or men that have severe gynecomastia with excessive skin. Today we’re going to go over the preoperative period, the intra operative approach that I take showing it the entire technique, as well as the post-operative period in weeks to come. Thank you very much.
Dr. Delgado: David thank you for coming in very much. So you’re here about your gynecomastia.
Dr. Delgado: Um, can you sort of give me your story you when your first noticed it, what you think contributed to it, and basically dealing with it?
David: All right well, I’m a personal trainer and I, you know, I’m constantly working on perfecting my body, growing my muscles, and so I started to supplement my workouts with some steroid usage and I didn’t notice any gyno, you know, things of submitting itself for a long time and…
Dr. Delgado: How long would you say?
David: Um, I dabbled in it for a few years and I didn’t really notice that it was having effect.
Dr. Delgado: Were you taking any anti estrogen things?
David: No, I really wasn’t I really was, you know, very new to it, didn’t have a good mentor to show me what to do and when and just kind of feeling my way through it. And uh so I made mistakes along the way. And it really wasn’t until I had kind of weaned off of it and lost a little bit of weight that it really manifested itself. I really started to notice it and it became more and more pronounced. And I was really unhappy with it, the way it looked.
Dr. Delgado: You know it’s very common that some men could take steroids and have no effects, others can take a little bit and it really effects into a large extent. So, I mean your story you know is very typical. how did your chest change over that timeframe when you started noticing it?
David: Well I’ve always had an easy time building my chest, my pectoral muscles, so in a way it kind of hid what was going on and only when I did lose some weight and loose some muscle did I realized what was happening. And all of a sudden you know there was some you know is there’s a lot of droopage there and that wasn’t there before cuz this is all firm muscle. And then it just became even more and more pronounced.
Dr. Delgado: So you did not have any enlargement as a young boy?
David: Correct .
Dr. Delgado: Okay so this is purely steroid induced?
Dr. Delgado: Um, any pain, discomfort, any psychological effects from the steroids?
David: You know it’s more the the feeling, the ostracized you know feeling where you’re, you know you don’t want anyone to see your chest and as a professional athlete and trainer that’s the worst thing you could want to happen to you because your body is your billboard. You know you sell yourself by the way you look. So I suddenly lost that. So I, you know, your your confidence goes when that happens and I build my career on how confident I am and showing that I can help people because of the way I look myself.
Dr. Delgado: Absolutely. Do you take off your shirt now in public or do you…?
David: Now I’m wearing looser clothing, but normally I would be wearing it you know like lycra and it’s tight clothing at the gym. not only because it moves better with the body but the you know it shows it shows off the body better.
Dr. Delgado: Sure. So what would you say is your goal now in terms of surgery? What would you like to accomplish?
David: I just want to be able to put a tight shirt on again at work and have everything look like it’s supposed to look. Or how it used to look.
Dr. Delgado: Sure. Sure. Why didn’t you do it earlier? is there any reason why you waited?
David: You know, I wasn’t quite sure if weather maybe I had put on some weight and that caused it to happen.
Dr. Delgado: You didn’t know what it was.
David: Yeah, I thought well maybe if I lose some weight it’ll go away, but that’s not how it works. So going up and down in weight didn’t affect it, it stayed there.
Dr. Delgado: Sure. You know usually when you have true gynecomastia its breast gland so it doesn’t fluctuate with weight gain or weight loss but the fat around it can go up and down. so once you really develop it you really can’t get rid of it unless you have a surgical procedure. and this is a very great technique, curative technique. you can accomplish what you want to accomplish. now it really depends on the degree of gynecomastia there’s various types, various severity of it. some are extreme. I think you’re more of the extreme type in which you have to have a more aggressive technique done and we’ll kind of talk about that during the exam and sort of explain our technique. What we’re going to do and why we have to actually do it. The procedure is not a you know a cancer procedure. So the procedure is to make you look good, it’s not to go in and take out all the gland wherever it is. It’s to make you look aesthetically pleasing. So you may still feel some of that in there, okay? And sometimes if you still take steroids, as I think you’re planning to, that tissue can still be stimulated . You’ll never get to the point where you are now, but you can you know have some activity still going on in there so I just want you to know that, that there can be some reoccurrence, you know if you continue. Can you explain to me why you’d like to continue the steroids? What does it do for you overall?
David: Well, you know I’m in my 50s now, and you know, it’s much harder to maintain a big, muscular build once you age. You have to work a lot harder than I used to. I injure myself easier and this, you know, doing the steroids, does give that you know that extra boost that helps you maintain the muscle you already have. Helps you put on some of the muscle that you’ve lost for whatever reason. You know so I’d like to maintain it just a you know a more of a low-key basis just to keep what I have basically.
Dr. Delgado: Absolutely. Well I think that you’re going to do great. Thanks for sharing your story. I’d like to go on to our next step of really examining you and going through that process.