John’s Story – Part 1 – Initial Consultation

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Video Transcript

Dr. Delgado: I produced this video on gynecomastia because I wanted to show a man going through the procedure over about a six or seven month period of time. For the men that are apprehensive or nervous about making that call or looking for information, this video will help. It will take a guy that is a normal person with normal intentions, living with the same thing that a lot of men live through: embarrassment, not wanting to take off their shirt, and how they cope with it over time. This video takes you through the whole process to the point where he’s very comfortable taking off his shirt. and it certainly has changed his life.

Dr. Delgado: John thanks for coming in. I understand your here about your chest.

John: Yeah.

Dr. Delgado: Tell me about that. How long have you had it, and when did you first notice it, would you say?

John: Probably when I was, like, 15. I started. And I thought it was gonna go away. With my dad  it did, but with me I wasn’t so lucky.  so I’ve just been kind of insecure about it. And come to you.

Dr. Delgado: Yeah any has it fluctuated with weight gain or weight loss or has it more or less been the same?

John: It’s always been the same, you know, pretty much always been the same.

Dr. Delgado: Regardless of your weight?

John: Right.

Dr. Delgado: And do you take off your shirt and stuff and hang out?

John: Uh yeah, I do a little bit of pinching beforehand to make them look normal.

Dr. Delgado: Has it helped a lot?

John: The pinching? Well in my in my mind it does, but I probably look like a weirdo pinching myself. When I’m at the gym or whatever.

Dr. Delgado: Yeah, that’s common. Very common, guys say that. Do you wear tight clothing or things like that?

John: Um, sometimes. I try to avoid it. I try to avoid it sometimes. I’ll try to wear a shirt or an undershirt to keep them, you know, like a tank top or something. Under, under under shirts. A couple shirts sometimes.

Dr. Delgado: Mm-hmm. Does it bother you with your girlfriend or anything? Is there ever that kind of issue?

John: No, yeah, no not with the lady, no.

Dr. Delgado: Um, your father you said had it.

John: Yeah he had it but it went away for him. I also had a friend who had it in one one side and that went away as well for him.

Dr. Delgado: Have have you had any lab testing? Hormone testing or anything like that?

John: I thought about it but haven’t.

Dr. Delgado: Okay, what’s your goal? How would, you know, what do you want out of this thing?

John: I would like them, I would like to not be able to see my my my nipples through my shirt.

Dr. Delgado: Got you, yeah. In a t-shirt like that.

John: Like this, and I would like them to look look even. Symmetrical.

Dr. Delgado: Okay, well the technique I use is a gland excision which I think is a critical point in gynecomastia surgery because gynecomastia certainly includes a gland. If its pseudo gynecomastia then it’s fat. But true gynecomastia is a gland. And the gland is like this hard spongy material that you can’t suck out really, and it’s too hard, so you have to actually go in there and cut it out. And then if you do that you should have a very good outcome. About a third of my cases are re-dos from other places and the primary cause is liposuction. Guys try to do liposuction alone and what it does, the cannulas take out the fat around but leaves the gland there, sometimes it can actually look worse. So gland excision is critical and then liposuction helps blend things at the end. That’s my usual technique.

I usually always put it in a drain. My reasoning is that there’s a large dead space inside. Becomes fairly aggressive even though the tissue is is here, I’m undermining this whole area here. Because it’s got a, it’s got to redrape itself okay, and you have to blend it in. So what happens is you end up having this big dead space there that can collect blood or fluid. A drain, you know, has suction on. It closes, it collapses down that pocket and it allows it to scar down. Okay, and the flow comes out so I found that to be very very helpful. The complaint I used to have is the drain sight hole, I used to have it down low and men will complain of that more than the actual incision of the surgery itself. So over the years I’ve inched up and now I’m all the way up in the  the armpit so even though it’s a little bit uncomfortable for a few days, the scar is in the hairline up there. It’s not a problem, so I consider it kind of a win-win situation actually, you know, I get my drain to help produce complications and you have a well-hidden scar.

Usually the drain comes out in three days. You can usually drive a car within a week. You can usually go to work within a week, unless it’s  manual labor. You have to wear a garment for six weeks and you can’t work out for about four to six weeks. So though, that’s the rough timeline the problem that I see is bleeding and it’s just after surgery, you bleed. I mean there’s no way to predict it. We do a lot of precautions to prevent it, you know blood tests, and making sure your clotting studies are normal but in spite of that, you know, once you wake up after anesthesia your blood pressure goes up, something can open up and start bleeding. And you just take them back clean it up not a problem. And so that’s why I have men stay close by for the first night in case that happens.

John: Okay.

Dr. Delgado: Okay this is a picture of a patient that had gynecomastia. This is part of the gland that was taken out and you can notice there’s a large white component that’s the actual gland. Its breast gland. Yeah that’s what it is. So there’s fat around it which is the yellow stuff which is what liposuction attempts to take out. But as you can just imagine you can’t really get a cannula through that because it’s so thick and its so dense, so if someone has this and you do liposuction only you’re set up for a problem, you know. It’s just not going to flatten out nicely so you have to go in, you know, and cut this out. And you can’t just take out the whole thing you have to take it out in pieces to take it out slowly. So, you know, over reducing, you don’t want to have it, you know, concave or a crater deformity and you can easily do that with something that’s intense. So you have to go slow you have to kind of kind of, you know, taper it out slowly so it takes a while.

You know, there’s all kinds of guys that have this done, there’s guys like this, there’s guys like this, there this, is a man that had it done and this is a year after. You can see how is his pec now looks a lot nicer. He has some liposuction to nice and trim. You don’t need any of that. This is a teenager and this is a good example of the power of skin contraction. He’s had no skin taken out whatsoever here and look at how that’s kind of contracted back. It’s pretty incredible, he’s got a little bit left from this side and we can do a periareolar lift and take that little bit out but the kid, you know, was 12 years old, is ecstatic for obvious reasons. So these are just various examples of guys. All the incisions are around the areola. Let’s show you right here. There. This is where taking out my drains used to be. Okay now they are way up there.

John: So why were people, why were they complaining about the lower part?

Dr. Delgado: They could just see it. It stood out. And it stood out for a long, you know, takes a year. So now you know I’ve got it hidden completely so it’s never issue anyway. That just gives you some idea. Well let’s go examine you, I’d like to see how how you look okay?

John: Okay.

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