QUESTION: Dr. Blau, I always wondered what you do to the gynecomastia gland after you've excised them out? I know this may sound gross but does some of your patients keep them as some sort of momento to show people? Can they keep them?
ANSWER: The specimen has to go to the lab. It's a New York State law that anything removed from the breast must be sent and checked for malignancy. While it's extremely unlikely that a malignancy would exist in a typical case of gynecomastia, the laws are clear that anything removed from the body must be analyzed for irregularities.
QUESTION: Dr. Blau, have you ever performed areola "donut pexy" or do you not like this practice...if you do perform it, is the scarring always permanent or can it heal?
ANSWER: With regard to gynecomastia surgery, I try to avoid "donut pexy" procedures because the scarring can be permanent and usually very pronounced. Whenever that much "cutting" is involved, the results may not look as natural as the patient would like. In the majority of cases, standard glandular removal will produce the desired results the patient is looking for.
QUESTION: I had my gynecomastia removed about a year ago and the doctor told me that he had to leave a small amount of tissue under the nipple or else the nipple would collapse. Now it seems as though my gyno has come back. I have noticeable lumps under my nipples. What should I do? Was the surgeon wrong to leave that small amount of tissue in?
ANSWER: Without knowing your exact history or examining you it's impossible for me to make an accurate assessment of the situation. I also have no knowledge of how much gynecomastia tissue was actually removed from your chest. I cannot speak for other physicians. In my practice we have not had a recurrence in the last twenty years. Especially with regard to bodybuilders, the key is to ensure that you remove all the glands the first time around so that a second surgery is never required.
QUESTION: How long should a typical gynecomastia surgery take. I went for a consult with a physician in New Jersey and he told me it takes 2 to 2.5 hours. He also told me I must be put out with general anesthesia. How long does your typical surgery take? Can it be done with a local or must I be asleep?
ANSWER: The typical gynecomastia surgery takes me between 60 and 90 minutes. I don't use general anesthesia in the majority of patients. In fact, I use local anesthesia in 50% of my patients. This greatly reduces the cost of requiring an anesthesiologist and it reduces the discomfort following surgery (from the side effects of the general anesthetic). In fact, most of my patients feel so "good" following surgery that I have to remind them to take it easy and not move around too much in days following surgery to prevent bleeding.
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