Dear Dr Bermant I am a Plastic Surgeon based in the UK and like your online videos on Youtube. I wanted some advice on how to deal with patients of severe Grade III gynaecomastia particularly those following bariatric surgery. Any advice would be gratefully received. Warm regards
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.
I have been puzzled how to address and answer this email question from a surgeon. The problem of Gynecomastia With Excess Skin
comes in different degrees after major weight loss like after gastric bypass or other variations of Bariatric Surgery. These all tend to be quite complex sculptures especially when trying to minimize the extent of the skin scars that extend around the entire body. A surgeon has to be comfortable enough with the compromise issues of a Skin Reduction Chest Lift
vs. extending the scar all the way around the back.
Beyond that there are the many other problems seen with the After Weight Loss Patient
extending throughout the entire body. Experience builds judgment needed to decide what other compromises are to be made, order of surgery, timing (waiting for the skin to equilibrate) and so many other factors, that make an email or post woefully inadequate. Actually a single course, book, or video would probably not be sufficient for all of the variations. The YouTube video is a meager introduction to the resources I posted online on the subject. But that too is only the beginning before tacking such a complex problem.
I think back on my own training, the learning about judgement, limitations of what to tackle until one develops the skills and experience are part of the making of the surgeon. Male chest contouring for Gynecomastia
(Female Breast in Men) with Excess Skin is an variation of the Female Mastopexy Breast Lift.
. But instead of a female breast, one is looking for a flat male chest. I learned that sculpture taking course after course beyond my years of formal medical training and residencies. I read as many books (there are not much there, mostly on breast reduction or chapters in more encyclopedic Plastic Surgery texts. I searched for articles in journals and online. The Gynecomastia and Male Mastopexy literature was woefully inadequate. That is one of the reasons I developed my Encyclopedic Online Resources. The many hundreds of pages online are more extensive than any text I have found to date in the literature on the topic, especially on the critical documentation on how the tissues move and more than just the arms at the side few views that tend to hide significant problems seen on animation.
The process of learning any surgery starts in how to document the problem and results acheived which involves so much more than just my Standard Male Mastopexy Pictures
or more critical Standard Male Mastopexy Videos
. There was an entire ritual of history and exams which I evolved my own specific Male Chest History Forms and Male Chest Exam Forms to record the problem and outcome. I even evolved my own Male Nipple Exam
and chest exam based on what I learned over the years.
I modeled my work after John Tebbetts forms he published for Rhinoplasty, but mine went well beyond that adapting over the years. They were done with Desk Top Publishing which meant I could think about the work done that day, what went well, what could have been done better for the exams, consults, check ups, follow ups, and then take the sheets and improve them. We kept a limited number of the forms so that they could be tossed when the new version came out, driving my staff nuts with the number of revisions I did. It was fascinating seeing some patients years later and having to redo the paperwork as the methods improved, documentation changed, or photographic views augmented. Preserving and Developing Training Tools For Gynecomastia and Male Mastopexy
The web form was written for the public. It would be a powerful tool for someone to help me fund or volunteer to adapt the content for surgeon education. I have hundreds of hours of digital video, many thousands of before and after photos yet to be used effectively. To take what is in my head, the experience and preserve it for other surgeons to review, scrutinize, and incorporate, into their practices as I did the video tapes, texts I used during my training. Retired, I do not have the resources to complete this project on my own. Sorry, not going to pay someone to do this nor will I be giving it away. But I was just transforming 6 hours of a Tumescent Tummy Tuck wonderful demonstration of anatomy in the near bloodless field into a slide show with its own drawings realizing the power I had in the documentation collected over the years. The public version changed for surgeon's use would be awesome. The same goes for the tiny video I put up on my site: Gynecomastia Surgery Video
, is only a small version of the whole operation and does not include the male mastopexy elements. Transforming those raw resources into teaching tools, would be a service for those who want to learn why I evolved my Dynamic Technique
to see if have I really come up with something better?
But perhaps what might become a surgeon's resource is only a thought at this time. Perhaps I will be able to do it on my own. Perhaps there will be those who want to see this happen and will make it so. But for now, the web is what I have done, almost 16 years in the making. But is that enough? When should we do cases ourselves or refer them to a more experienced surgeon is an answer that is not simple. I saw many UK Patients for Gynecomastia
who preferred my techniques when I was in practice. For my own taking on of cases, it was a matter of critically looking at the quality of my own skills and knowing the limitations of what I was capable of. If someone's simple cases are not at sufficient level, then waiting to learn more before tacking difficult cases is what I was taught. It is also about studying and restudying the resources over and over again was part of what I used for evolving my methods. My complete resources posted on the website are a start, but not enough on their own without the missing details for surgeons. Perhaps some day that will change.
Surgeons are welcome to join and discuss cases here. However, I am not offering any courses or training sessions. I can share my general experiences here, but will not be offering specific advice for solving cases.
Hope this helps,
Michael Bermant, MD
Retired Plastic SurgeonLearn More About Gynecomastia of Male Chest Ptosis - Sagging and Male Mastopexy Chest Lift Sculpture