Dr. Delgado: So, David our plan now is to really examine you. I like to really go over in detail what we’re planning to do and why we have to do it. So if you can stand up and take off the gown. You know as we see the major issue is that you have very loose skin. You know that’s the primary, you know problem with your particular gynecomastia case. It’s the most extreme case which is a grade four. This means the nipples are pointing straight down and there are the black feet of skin. so the only technique that is viable for you is to actually cut both skins and breast tissue off and fat off and then reposition your nipple. The other techniques will not work in which we actually make small incisions we go in and do a subcutaneous clean-out of tissue and the skin shrinks. You’re past that now you know maybe if you had done it years ago things may have been different but you know as you age the skin loses its elasticity and its contractility and that’s what we see here. In general, I mean you’ve got a great body a great physique a great you know chest you know great PEC and you know our goal here is to try and contour you back again. So that you can wear your tight shirts and just feel more comfortable. The incisions is going to be at the natural crease down here and I could see probably with the overhanging of skin you get rashes and uncomfort in that area. Um, a couple of good things one you do have hair, and the hair will grow out heavily. I see you’ve shaved down here and the here will really camouflage the incisions and things of that nature. The incision will start about here and it will come all the way over to about here and we will you know cut out skin breast fat and pull the skin down tightly. So our goal here is to get a tight chest with no overhang. But that means however is that you will have that scar that will be ever-present but I think in your case there’s no other option it’s going to give you an immediate great outcome. And we’ve talked already about where the nipple would go and you show me some pictures which I certainly agree with that in a male chest the nipple should be you know low in lateral it shouldn’t be high and medial you know you know airing out laterally and lower is better than anyplace else. And we stitch you up and try to get them as as as matched as we possibly can. Now looking at your chest you’re more full on this side here and I do feel a lot of not gelarety you know inside and a lot of that is just you know steroid usage and breast gland that we won’t be really doing you know a lot in that regard. Because if we start cutting a lot up here won’t be smooth and then look irregular, etc. So as I say you will feel nodule already there now it’s rare that breast cancer occurs and it typically will occur in men over sixty years old but you know it’s rare I’m not that concerned at all about that in your case. But we will send your tissue to pathology and they do hook it over okay. Now in terms of marking out your chest, the first thing I do is try and get our incisions as metrical as we can so if you can put your arms up high. And this is the natural fold is where we try to go in at which is going to be right here. And this is this thinner point here and the incision will come all the way over now in your particular case it looks very symmetric oh and some men once felt higher or lower you’re just pretty even. And as I said we may have to come out here to kind of taper at this skin off unfortunately will deform your tattoo. Oh okay, and probably the amount of tissue we’re gonna take off. And what I’ll do is I’ll tailor it you know I’ll tighten it up and take out more or less but I’m just getting a starting point so this again he’ll be pulled down very tightly we’re gonna try and get out these folks here as much as we can you know that can be challenging if we don’t want to put our scars up here we want to keep em low. So we’ll try to work on this area as much as we can. I also try and get this incision about the same on both sides as well as a good starting point. And as I said our goal is this going to be tight so that when you wear your t-shirt it’s snug. So we will take the nipple off completely and it’s going to be reattached as a graft. The graft takes you to know always it never really dies it just is cut out it’s basically sewn on there’s something both turret that’s put on top and it takes about a month to really take hold.
Dr. Delgado: So again you’re going to be more full here because that’s the way your Anatomy is are you right or left-handed. I’m breaking up okay and you’re larger on your left side the day that any questions that you have?
David: We talked about just a loose skin you know you know when I go down like this you see all that looseness you think we’ll lose some.
Dr. Delgado: Yeah unlike you do that again so it’s gonna be more like this so you will it will definitely improve some of this laxity I mean from this dimension is will be there but you’ll gain it this it’ll be in tight in this dimension not as tight in this dimension because the skin is not taking being taken out anywhere but it will be snug it will be tight. Okay yeah okay don’t you have a seat and we’ll get going here.
Nurse: This is the compression vest that you’re going to be going home with today it’s going to be on you when you’re waking up from surgery and you’ll keep it on you for the road until your post-op appointment when you come back, yeah. But the need for compression prevents hematomas that’s the most important thing so you get all this compression right here wants to remove all that tissue and this part is specially said when you’re at home with you feel like this is getting loose you can undo it and retighten it so it’ll go like this preventing hematomas okay okay all right.
Dr. Gaynor: David, hi! Dr. Gaynor, we spoke last night.
David: Yes, hi, Dr. Gaynor.
Dr. Gaynor: Being that a good night’s sleep last night I got a little bit of sleep, okay well we spoke and I know just to go over the information we spoke about the last couple of nights I know you have not had surgery before. All right give me a nice deep breath. They don’t put mantras on your you and blood pressure cuff EKG pads normal stuff, I used to follow you. And I’ll give you some medicine through the IV which will make you go to sleep. When you are asleep I’ll place a breathing tube in the back of your mouth you won’t know about it cause you’ll be asleep but after surgery sometimes people have a little bit of a sore throat counting everything. If you do it you’re going to New York you should belong last. All right well we’re here take good care of you you’ve been through it rid of the risks and complications listen whenever you consent you accept those extremely where you’re healthy you’re in fine shape. Leverage looks good very good control so I think everything goes very very well for you wonderful.