Author Topic: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno  (Read 6740 times)

Offline DrBermant

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Hello Dr. Bermant,

I've registered to this (a different) forum because I've seen your posts and they've been very helpful and so I'd like to get your opinion on my case. I understand you've retired but I'd be really grateful if you could help me with my case, as I just don't trust a regular GP doctor, especially in the UK.

For me, my case is very mild I would say. I haven't gotten into bodybuilding, and have quite a small frame. I wish to develop my chest more, and was wondering if this would worsen the effect of the gyno, or it could help the contour appear more manly, because as of yet I have never trained my chest and I'd imagine without the gyno I'd be extremely flat-chested. The main area of gland feels as if it is under the nipple, and the skin around it is obviously larger to account for the gland. It is quite rounded, not particularly pointy, and it's a lot better with erect nipples.

I can provide pictures if needed, according to the rules of the pictures of your website.

Any help would be much appreciated,
Thank you!

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Since I am retired, I no longer offer medical advice nor my private opinion to messages or emails. I do respond to general issues as I have done on this forum.

I have worked with many Bodybuilders with Gyno over the years. They consistently had told me that as they built their muscles, what sat on top of the muscles got pushed out further.

It does not take much to ruin the cut look of the male chest. Subtle Puffy Nipple Gynecomastia is one such example of a small amount of breast tissue interfering with a male contour.

You are welcome to join to use our resources and learn. Posting Standard Gynecomastia Pictures here is one way to start. The Standard Gynecomastia Video is even more critical for contours and how they move.

Hope this helps,

Michael Bermant, MD
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Offline semicharmed

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #1 on: January 09, 2013, 02:26:25 PM »
Hi Dr. Bermant,

I'm the original poster of the query.

Situations unchanged - still haven't bitten the bullet and commited to a gym routine out of fear that it'll make the gland appear more pronounced. Visited a GP (Family Doctor) who told me it was a normal chest shape and he didn't feel anything out of the ordinary, but I can definitely feel the gland marble beneath my nipples. What else would explain the shape of my chest?

Would working out make them look worse - I mean my lower chest in particular is non-existant so might help create a more rounded appearance.

Is it definitely gynecomastia? If so, what surgery would it require - an incision to remove gland or liposuction.

Any help you can offer would be so helpful, I'm at my wit's end and just want to do something proactive about it.

Here are the pictures as required:

Front
newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2326_zps343b4b1a.jpg.html?sort=3&o=9 [nonactive]

Front, arms raised
newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2330_zps69e658f6.jpg.html?sort=3&o=8 [nonactive]

Sides
newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2336_zpsdaf9fbf9.jpg.html?sort=3&o=6 [nonactive]

newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2334_zps24c61caf.jpg.html?sort=3&o=7 [nonactive]

Sides Angles

newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2341_zps54c7a04b.jpg.html?sort=3&o=2 [nonactive]

newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2340_zps462b69e0.jpg.html?sort=3&o=3 [nonactive]

Hands on Hips

newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2342_zps50e9ff41.jpg.html?sort=3&o=1 [nonactive]

Hands on Hips, Muscles Tensed

newbielink:http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2343_zpsedae92ac.jpg.html?sort=3&o=0 [nonactive]


Offline DrBermant

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #2 on: January 09, 2013, 04:01:42 PM »
Hi Dr. Bermant,

I'm the original poster of the query.

Situations unchanged - still haven't bitten the bullet and commited to a gym routine out of fear that it'll make the gland appear more pronounced. Visited a GP (Family Doctor) who told me it was a normal chest shape and he didn't feel anything out of the ordinary, but I can definitely feel the gland marble beneath my nipples. What else would explain the shape of my chest?

Would working out make them look worse - I mean my lower chest in particular is non-existant so might help create a more rounded appearance.

Is it definitely gynecomastia? If so, what surgery would it require - an incision to remove gland or liposuction.

Any help you can offer would be so helpful, I'm at my wit's end and just want to do something proactive about it.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Welcome to our forum. Thank you for posting your images.

The most critical views for evaluating subtle Puffy Nipple Gynecomastia would be the obliques and muscles tensed:

Quote
Sides Angles

http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2341_zps54c7a04b.jpg.html?sort=3&o=2

http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2340_zps462b69e0.jpg.html?sort=3&o=3

Hands on Hips, Muscles Tensed

http://s1283.beta.photobucket.com/user/semicharmed211/media/IMG_2343_zpsedae92ac.jpg.html?sort=3&o=0

Puffy nipples comes in various degrees from nothing at all to quite large. In every male the Puffy Nipple Anatomy will be the same, even someone with a flat chest. There will be gland, fat, and skin. Gland will compress differently than will fat. As one looks through a Puffy Nipple Gynecomastia Picture Gallery to see other cases, just how one's chest fits in gets a perspective of what is out there.

Some want the curve over the male chest contour to be flat, not pointed over the nipple areola region. Others feel it is a normal anatomic variation. Others need that contour to be flat for activities such as Bodybuilders with Gynecomastia. Then building more muscle tends to push what gland is there out further or contours become more of a problem flexing muscles that then also push the gland out. For such individuals I would ask then to provide additional relaxed and then flexed muscles arms on hips oblique views as seen in the more advanced Revision Gynecomastia Standard Pictures.

If someone had scarring issues then options for a subtle gynecomastia surgery possible intervention would outweigh potential advantages. I have recommended against surgery for individual with such scar issues and similar contour issues. I have operated on other cases, but a real evaluation of if someone is suitable for surgery required so much more information before I would consider offering surgery in my practice to get the results you see.

Bodybuilding can be rewarding in its own. It does not manage gynecomastia, but does help shape the muscle. If gland then becomes a contour issue, then surgery becomes an option. For those not interested in the muscle shaping with exercise but want to see what a rounded shape is like on their chest, there are the No Surgery Body Shaping Garments that flatten the shape. I posted a series of example of various contours. Look in the mirror and compare to typical cases that I was demonstrating the garment working. The effectiveness is less the more subtle the contour issue to begin with. So if you go that route, posting "before and after" how the garment helps or does not help, can be of benefit to others.

In our office the option was easy. We had the garments there for our patients to try on. Most like the shape and bought them not wanting to take them off. That option to try on is no longer there, but the Second Stage Gynecomastia Garments are still available online.

Jumping into surgery is not always the best option. Subtle gynecomastia options depend on so many factors beyond what I have discussed as the wrong surgeon or wrong approach can result in a disaster. A surgeon really needs the skill to pull off this type of problem and simple front side view photos just do not tell the entire story of what is going on with how the tissue moves, flexes, and interacts with tissues above or under it.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Gynecomastia and Male Breast Reduction
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Offline semicharmed

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #3 on: January 11, 2013, 05:41:47 AM »
Hi Dr Bermant,

Thanks for your reply.

I understand what you're trying to say - are you suggesting that my case is perhaps too mild that potential issues with the surgery may outweigh the benefits of a flatter chest?

Would I not know for sure how the gland would appear if I lost fat and gained muscle? I'm trying to understand the anatomy so that I can gauge how to work out to provide a shape that I'm happy with. But it's hard to tell how much of my chest is fat, and how much is gland - and whether losing fat or building muscle would make it better or worse appearing. Is there a way to determine the size of the gland - I can feel it underneath the nipple, but it's difficult to ascertain its size.

Thanks again.

Offline DrBermant

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #4 on: January 11, 2013, 01:48:45 PM »
Hi Dr Bermant,

Thanks for your reply.

I understand what you're trying to say - are you suggesting that my case is perhaps too mild that potential issues with the surgery may outweigh the benefits of a flatter chest?

Would I not know for sure how the gland would appear if I lost fat and gained muscle? I'm trying to understand the anatomy so that I can gauge how to work out to provide a shape that I'm happy with. But it's hard to tell how much of my chest is fat, and how much is gland - and whether losing fat or building muscle would make it better or worse appearing. Is there a way to determine the size of the gland - I can feel it underneath the nipple, but it's difficult to ascertain its size.

Thanks again.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Exam of the Male Chest is insufficient to define gland vs. fat. I tried to estimate my patients' gland component, the inner black drawing on the markings before surgery. The outer black line was my estimate for the excess fat. You can see just how accurate these estimates were by starting out on the

Gynecomastia Gland Gallery which has pictures of the gland removed from the chest. Each then has links to the more complete patient before after photos with those marking estimates. For those who feel they have to know, Male Mammograms could be ordered. But, in my opinion, that is a wasted test and unnecessary radiation unless there were clinical indications.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Gynecomastia and Male Breast Reduction
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Offline semicharmed

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #5 on: January 11, 2013, 03:49:05 PM »
Hi Dr Bermant

Thank you once again for your reply.

So from your responses and the literature across the Internet I've absorbed - it seems that it's somewhat difficult to predict what is gland and what is fat even with a hands on analysis. In the case of fat dispersed with gland, is  it possible to lose that fat through normal weight loss activities or is it stubborn that would require liposuction?

I'm at this point now - I'm halfway between deciding to build my chest muscles and lose overall body fat to see if it improves the appearance of my chest, even though I know it will not remove the gland itself. Or I am tempted to see an approved consultant and have surgery performed in Poland, Belgium or somewhere similar as it is a lot cheaper than privately in the UK. I keep hearing stories of people who have exercised and it has made the gland appear more prominent- in my case I have very little chest muscle so building that may improve the contour. I am not an anatomy expert however so I don't know. When I flex muscles, I do think my chest appears a little better as it is more rounded and male-like. Would further oblique photos help to assess this situation?

Thank you Dr Bermant, I think it's fantastic that you're still responding to people's queries about gynecomastia after retirement and your resources has informed me a great deal. I think the wider world of plastic surgery needs to take note!

Kind regards

Offline DrBermant

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Re: Gynecomastia Forum - From UK, Want Dr. Bermant's Opinion on Gyno
« Reply #6 on: January 11, 2013, 05:05:59 PM »
Hi Dr Bermant

Thank you once again for your reply.

So from your responses and the literature across the Internet I've absorbed - it seems that it's somewhat difficult to predict what is gland and what is fat even with a hands on analysis. In the case of fat dispersed with gland, is  it possible to lose that fat through normal weight loss activities or is it stubborn that would require liposuction?

I'm at this point now - I'm halfway between deciding to build my chest muscles and lose overall body fat to see if it improves the appearance of my chest, even though I know it will not remove the gland itself. Or I am tempted to see an approved consultant and have surgery performed in Poland, Belgium or somewhere similar as it is a lot cheaper than privately in the UK. I keep hearing stories of people who have exercised and it has made the gland appear more prominent- in my case I have very little chest muscle so building that may improve the contour. I am not an anatomy expert however so I don't know. When I flex muscles, I do think my chest appears a little better as it is more rounded and male-like. Would further oblique photos help to assess this situation?

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Sorry, again as a retired doctor, I no longer offer specific medical advice and have already answered the questions about specific views used for subtle cases. However, I will not be offering my opinion about what that means. I already have posted on my site cases more subtle and more profound that I have sculpted. However, Not All Artists Have the Same Skills.

I have see so many unhappy patients who tried to use Cost of Gynecomastia Surgery to determine surgeon choice. That is a great formula for disaster when dealing with more difficult cases that demand more skills. The problem with most such sites is that I have rarely seen the specific cases by the surgeon. This is not surgery that just one goes and anyone can produce a great result. It is an individual sculpture skill which should be evaluated by looking at that individual doctor's work.

Before such risky gambles and adventures we have resources like How to Evaluate Before After Photographs to learn about why one needs more than just a few views to show real results. Beyond that, checking specifically how that individual manages subtle and difficult cases of gynecomastia is no guarantee, but better than hope alone when learning How to Pick Your Gynecomastia Surgeon.

Quote
Thank you Dr Bermant, I think it's fantastic that you're still responding to people's queries about gynecomastia after retirement and your resources has informed me a great deal. I think the wider world of plastic surgery needs to take note!

Kind regards

Thank you for your kind words.

Continuing to contribute about your progress pays it back to the forum and others reading about experiences and what happened with choices made. For some it will be surgery, others bodybuilding, yet others, leaving something alone. If you like what is offered here, use the social tools to spread the word and help others understand their options. We also appreciate links posted elsewhere to this forum and our resource pages I have written and continue to evolve. Beyond that, if there is a page that can be improved, this forum gives those who have ideas a place to share them.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Gynecomastia and Male Breast Reduction
Michael Bermant, MD
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