Dear Dr. Bermant:
This is -, a patient of yours from a few years ago (or so). In my consultation/examination with you, your recommendation to me was to work on losing weight before moving forward with a gynecomastia procedure. I wasn't successful early on in losing the weight but now am losing weight and approach a weight that I want to stay at for doing the procedure.
I recently discovered online that you are now retired. Many congratulations on your retirement and thank you for all of your outstanding contributions over the years.
My question concerns the next best option for me in consideration of your retirement. If I am correct in my reading your online responses to requests for your recommendation for other gynecomastia surgeons, you have indicated that no other surgeon does your dynamic technique and that no other surgeon is currently training to learn how to do it. I also have carefully read your recommendations about picking a gynecomastia surgeon, and when following those, I have not been able to locate another surgeon that would live up to the standards (e.g., the pictures on their websites are for one angle only or I don't see any examples of movement after the procedure, etc.). Therefore, I was wondering if the best option for me is to wait and hope that someone eventually will be trained to follow your dynamic technique or try to find a surgeon other than you. If you think that I should not wait in this way, is there any specific surgeon that you would recommend as a next best option to contact at this point? Location is not an issue at all as what is most important to me is finding the best available surgeon.
Thank you in advance for your consideration of my question and my best wishes.
St. Louis, Missouri
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.
Thank you for your kind words. Yes, I really did like what my Dynamic Technique
offered especially when looking at results in life, not just a limited one or two views of the chest that can hide how the tissues look while in motion.
When I was still in practice, Weight Loss Before Gynecomastia Surgery
was the best sculpture I was able to offer.
This has been the basis behind many discussions here on this forum too:Fat - Gynecomastia Forum - Options For Surgery, Weight Loss, & Your RetirementGynecomastia & Fat Forum - Obese, Don't Care About Belly Can Surgery Fix Breast?
I still feel strongly that Weight Loss Forum - Gynecomastia Surgery not alternative to Losing Weight
This discussion is about someone's frustration with their contour and wanting a surgery fix: Gynecomastia & Weight Forum - Frustrated With Weight Loss Breasts Not Going Away
, I quote from then:
I have been working hard on getting my weight down. I have lost 40 kilograms but want to lose another 18. I still have breasts and all of the loose skin is driving me nuts.
Rate me makes little sense in gynecomastia or female like breasts in men. It is like trying to rate a female breast.
Congratulations on your weight loss! Does it not feel much better with that weight off? 40kg or 88 pounds is a significant amount of weight loss! But 18 additional kg or 40 pounds is not trivial.
Weight Loss Can help with the fat of gynecomastia, but not the gland. Remaining fat, gland, and sometimes the skin can be residual contour concerns.
Standard Pictures to Show Gynecomastia and Loose Skin Issues After Weight Loss can help others understand your concerns. Some are able to lose weight and not have a loose skin component. This is not a black and white defined issue, but one of grays and subtleties.
Weight loss before surgery is usually much better than weight loss after surgery. Weight loss is a coarse tool, Plastic Surgery is better reserved for refinement. This is especially true when tissue sagging is a factor. Why lift sagging tissue, lose more weight, and see that tissue sag again from further deflation?
Weight loss and surgical sculpture is a series of compromises. What suites any one individual will vary. Ideal sequence that I recommend my patients:
- Get to a weight you are comfortable living with.
- Let the skin adjust as much as it will. It can take from 6 to 18 months for skin equilibration after a gastric bypass and major weight loss.
- After Massive Weight Loss, Consider Tightening Lower Tissues First. There is little sense to lift the chest and then have a tummy tuck, lower the chest result, requiring a revision chest lift.
- Then Address the Chest.
- Use No Surgery Body Shaping Garments as emotional support not to rush the process.
Bouncing redundant flesh also can be a major emotional factor stressing any patient trying to lose weight. That is why I posted Videos of Compression Garments dealing with gynecomastia and stabilization.
The remaining fat and sagging can be stressful for a work in progress, being patient, finishing off the weight loss first is a better option.
When it comes time to look into surgery, male chest sculpture with loose skin is an art form needing special skills. Check for examples of the surgeon's work in this variation before risking a surgical gamble. Bad surgery with this problem can sometimes be impossible to fix.
I had many requests for help for those who tried surgery instead of weight loss to contour the body such as: Revision Gynecomastia Forum - Unhappy After Surgery Considering Revising
The issue is that Compromise Gynecomastia Surgery
is just that: a Major Compromise.
The forum is also designed to be a place for mutual support for those wanting tools to track what they are dong about their weight, losing weight, body building, and other sculpting needs than surgery.
I really like the advances in Body Fat Analysis Tools
beyond the simple one we used in our office to demonstrate the process. The Wi Fi scales can now become a component in the motivational method and in conjunction with our Standard Gynecomastia and Loose Skin Pictures
used to track problems, what has been achieved, and if a compromise is now an acceptable option.
This forum section was created to permit that issue to be discussed, proven, and improved. Just what is compromise, what does it get you and what does it not. Or, is there a better way?
Since retirement, I no longer offer specific medical advice but still share my knowledge about general issues and have been evolving tools like How to Pick Your Gynecomastia Surgeon
. These critical tools of problem and solution analysis are what I used to evolve my technique over the years. My methods kept changing as I found better ways. These tools can also be applied to better understanding options like claims of compromise gynecomastia surgery effectiveness (if muscle building, loose skin issues and other factors are also documented.)
Another option is to use what I have planted seed for here. I created this forum as a place for others to continue that process and show how they have gone the next step to a better solution. It is designed for the public to post problems and questions. It is designed to let those who are passionate about a problem to share their solutions, reasoning, and links to resources they created for demonstration. The challenge to to look beyond advertising hype and hand waving.
I welcome others trying to do the same and move the art of surgery yet further. The options seem to look for what compromise is suitable at present, sit back and wait, or help cause it to change.
Hope this helps,
Michael Bermant, MDLearn More About Gynecomastia and Male Breast Reduction