Preop imaging. Is it fat or gland? (Photo)

Question

Hello. Recently had a mammogram and an ultrasound done to see the cause of my apparent gynecomastia, the mammogram report says it's just adipose tissue but the ultrasound report says there's gland overgrow. I went to a surgeon and he assured me it's almost all fat and that liposuction will suffice. I would like a second opinion. As for my history, I was an overweight child, lost weight 22 pounds with puberty, never really lost the chest fat, it always looked a bit saggy.

Zoran Potparic, MD · Answer

Gynecomastia is usually a combination of fat and glandular tissue in your age group. Liposuction  can remove fat tissue but for glandular tissue surgical excision is needed. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

To make a gynecomastia assessment, we need to see quality pictures.
There are three tissue variables that determine someone’s candidacy for this procedure.
Each of these variables continue to chest appearance and understanding how much each is contributing helps determine the best treatment and what kind of results someone should expect.
The three tissue variables are glandular breast tissue, the extent of subcutaneous fat and lastly skin laxity, either due to weight loss or loss of skin elasticity from age. 
Individuals with excess glandular breast tissue needed open excision with direct excision of breast tissue.Subcutaneous fat can be removed with Liposuction but glandular tissue cannot.
Individuals who have skin laxity from weight loss or age do not have the potential of getting the same quality results that those with tight skin have.
Each of the three variables should be carefully assessed during any in person consultation.
Gynecomastia surgery is not always straightforward and results can be unpredictable if surgeons lack sufficient, skills and experience, especially the ability to differentiate each of the three different tissue components.
Understanding you’re on candid to see you and choosing the best provider are the two most important variables for quality outcomes with long-term and patient satisfaction. A patient who is an excellent candidate has the potential of getting excellent results if they find an excellent provider. A patient who is an excellent candidate can also have less than ideal outcomes if the provider is lacking in skill and experience.
An individual who is not an excellent candidate, cannot have excellent outcomes, regardless of who does the procedure.
This is why understanding your candidacy for the operation is so important in maintaining long-term postoperative satisfaction.
There isn’t all that much patients can do regarding their own candidacy. What patients do have control over its provider selection.
Even mild skin laxity can significantly reduce potential outcome. This variable is the one that is most commonly missed during consultations. For most men who have in part true gynecomastia direct excision of glandular tissue is almost always needed for a quality outcome.
The following are some general guidelines for finding the best provider. 
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Preop imaging. Is it fat or gland? (Photo)

Answers (2)

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