The photos associated with the blog say a lot. I saw these two patients the same week, and they share a similar story. Both had previous surgery and they both came from far away. On the day I examined them in the office before their scheduled procedure, I concluded that neither had any evidence of gynecomastia. I encouraged them to cancel their procedure and told them I would be happy to refund their hard-earned money.
Yet they persisted. We talked more. I examined them again. I invited all my staff in for their opinions and they all unanimously agreed their chests looked quite good (if not amazing) and that surgery wasn’t needed. The conversation even got to the psychological aspects of gynecomastia: maybe it’s the way you see yourself and maybe that isn’t an accurate reflection of physical reality.
Boy, I couldn’t have been more wrong with these two fine gentlemen. I finally agreed to open them up and look for something I didn’t think would be there. Lo and behold, they BOTH had quite a large amount of dense, stuck scar tissue shaped like pancakes. Their cases went from “I don’t think you have anything” to “OMG, this is a really difficult case!” To say that I was and am humbled is an overstatement.
What I learned from these cases is that I can examine a revision patient, and it grossly feels and looks normal. The “tip off” that something is going on is the patient’s insistence that something is there and that there is usually more fullness than there should be ideally. But it feels so soft and smooth. Typically, scar tissue is quite firm, localized, and obvious. Live and learn, my friends.
Revision gynecomastia can be like a box of chocolates: you never know what you’re going to get. I have said this many times before, but these two cases are very uncommon. Fit patients with relatively normal-looking chests may yet have advanced scar tissue with a normal appearance and normal examination. For the record, their cases likely involved the use of LASER SMARTLIPO treatment, which is a “hot” laser that can leave extensive scar tissue. These cases are often from the hands of underqualified medical providers who have an expensive machine in their offices, and they need to use it. It is not my recommended liposuction alternative simply because I have seen so many cases of deep scarring associated with LASER use.
How did I miss this? I consider myself very ethical and moral when it comes to my practice. I never want to do wrong by my patients. I never want to feel like I’m doing sham surgery (a surgical procedure that mimics the appearance of the real surgery but does not involve the actual therapeutic intervention or active component of the treatment). I learned that if a patient thinks they have something there, it’s likely there. Listen to the patient. I learned that the chest could look and feel normal when there is a very significant layer of underlying scar tissue (though not common). I reconfirmed that learning is lifelong.
For the record, these two patients are very happy with their treatment at the Austin Gynecomastia Center. I’m glad it worked out for them. The gynecomastia mind-body connection is very real and something that I have learned to respect. The ultimate goal of gynecomastia treatment is to make a normal appearing chest while liberating the patient from the mental burden. I appreciate each and every one of my patients.
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