Author Topic: Gynecomastia Forum - Which Doctor Target Gland 1st, Bruising, Evaluate Results  (Read 3134 times)

Offline DrBermant

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My name is - , 17 years old from Israel.
I have gynecomastia since age 14-15 and i decided i want to have surgery.
I'm in good shape (1.80m, 85kg) and have mainly gland tissue with a bit of fat.
I was very impressed with your surgical approach (targeting gland first) and with the fact that your patients had minimal bruising and swelling.
I narrowed my search of a surgeon to two options: DR x and DR y.
I like DR x's approach of taking the gland first and do less liposuction (less bruising, better outcome, natural look) compare to DR y
that performs "aggressive" liposuction first ( thru a different hole- more scars) and then takes the gland out ( DR y patient have more bruising and swelling and  keep the vest on for much longer...I assume because of the "aggressive" liposuction)
Because I actually think you had the best results and approach i wanted to ask you who do you think is a better surgeon and who do you recommend me to use to fix my problem?
Thank you very much.

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

At your age, you will have to bring these issues to your parents first.  It may be difficult, but they need to hear what is bothering you.  If they agree, then together this answer may help.

It is so nice to see my approach now taken up by others. Many years ago I was frustrated with what I saw in the literature of gynecomastia that discussed liposuction followed by removal of gland. I was seeing unhappy patients done elsewhere with contours that just did not move well. The male chest contour is not just what is seen in still photo with arms at the side. Men like to play sports with their shirts off. The chest needs to look good flexing muscles and arms up overhead. That led me to first learn how to document the male chest:

Standard Pictures Male Chest for Gynecomastia which then evolved into standard sets for other issues like loose skin and scar deformity. Most critical of all were my Standard Male Chest Videos.

These tools permitted me to evolve my Dynamic Technique targeting gland first and then using liposuction through the same tiny incision to contour the remaining fat. I address my concerns about aggressive liposuction cannula here on this post: Gynecomastia Forum - Does Sharp Cutting Liposuction Remove Gland? I analyze the failings of Avoiding Areola Scars with Armpit Incisions? on that post.

The basis for the changes in what I was doing were on what I saw with the best critical evaluation system I could design. I found I could also document the path taken between the before and after showing Bruising and Swelling Picture Gallery from Gynecomastia Surgery. I think all doctors owe their prospective patients and extended view of what the path is typically like for their patients and how tissues move after surgery on parts of the body affected by muscle action. If something is better, then there should be a way to document that it is better.

In addition to the images, I also used my Male Nipple Exam, evaluation of the chest, and forms I developed to record the problem, what was done, Comfort After Gynecomastia Surgery, record the Gynecomastia Healing, and the result.

It is so nice to hear that others are now incorporating what I have been talking about for years into their practice. But are they, and to what degree? That is why I developed tools like How to Evaluate Gynecomastia Pictures for Problems and Results and resources like How to Pick a Gynecomastia Surgeon. Separating verbal hype and salesmanship from reality can be difficult. The tools that I measured my own progress and evolution, were my standard pictures & videos, how does the result look when flexing the muscles, arms up overhead are all more critically looking at the results achieved. When loose skin is involved, the bending over views show just how tight is the skin against the chest. There were other views added to better show scar issues seen when flexing muscles. If a surgeon only shows fewer views or no before after movies, then how does the result look when playing sports, swimming and living life? I even had some patients unhappy after surgery done elsewhere come to me for help telling me that their surgeon(s) would not take the pictures arms up overhead or flexing muscles. I do not understand the justification in not taking those photos. I wanted my work to look good not just in limited views. Here is one example of how bad a result can look in motion, hidden with fewer photographic still views: Extended Crater Deformity After Failed Revision Surgery.

With a more critical evaluation system, especially the before and after videos, I was able to evolve and refine my own methods over the years. That is why a more critical Standard System of Documentation was incorporated into the tools I build to help in the selection of surgeon. Seeing how their work moves and what path taken to get there: if not shown, is there a better technique?

Your parents with you are welcome to use our tools and resources in exploring among the many surgeons world wide.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Gynecomastia and Male Breast Reduction
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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