Below is a continuation of the last blog that addresses frequent asked questions to Dr. Delgado by his patients.

Question #6:  Is it painful?

Answer:  Gynecomastia reduction surgery is not particularly painful.  Most men find they need pain pills for only two or three days.  Drain removal can be a little uncomfortable, but recent, improved techniques have made it less so.

Question #7:  Will the nipple sensation be lost?

Answer:  With surgery, it is always possible to have a change in nipple sensation.  Some patients have reported changes in sensation, but most do not mention it.  Merle Yost of gynecomastia.org has surveyed men who had gynecomastia surgery and a change in nipple sensation is one of the subjects addressed in his survey.  If you sign onto the site, gynecomastia.org, you can read comments by post-surgical patients regarding the changes they have experienced with nipple sensation.

Of patients who underwent the combination of liposuction and surgical excision of gynecomastia, the approach most often used by Dr. Delgado, 21 reported no change in nipple sensation and 29 reported there was a change in nipple sensation.  Two of the patients who reported a change said that they had an improvement in nipple sensation. Twenty-seven patients reported a loss of sensation ranging from 0.5% to 100%, with the average loss being 37%.  

Remember, this is a survey and not a scientific controlled study.  It does, however, offer interesting information.

Question #8:  How much does it cost?

Dr. Gaynor, anesthesiologist

Answer:  Costs depends on the complexity of the surgery.  Gynecomastia reduction surgery at Marin Cosmetic Surgery Center is always done with a board-certified physician anesthesiologist, never under local anesthesia.  Our facility has national and state accreditation as an outpatient surgery center.  These are important facts to consider when comparing costs with various providers.  Cost usually falls between six and eight thousand dollars.

Question #9:  What could go wrong?

Answer:  This is real surgery and the risks associated with that cannot be overstated.  Bleeding under the skin is one of the most common complications.  It used to occur in about 8-9% of patients, but over the past three years we have been able to reduce that figure to approximately 5-6%.  We now require blood clotting tests and prescribe a regimen of Vitamin K to boost the body’s clotting mechanism.  We advise patients to stay at a local hotel if they live over an hour away. 

Complications do occur.  This is a fact in the practice of medicine.  It is how the complications are managed and handled that determines the outcome.  Dr. Delgado has vast experience with gynecomastia surgery and is very comfortable in treating any complications that might occur.

Over or under resection of tissue can occur.  Under resection can be handled with re-excision, but over resection requires fat injections to the involved area.

Question #10:  When can I go back to work?

Answer:  After gynecomastia surgery a person can drive a car within a few days and can return to school or work within a week.  (If a person’s work is physically demanding, two weeks of recovery will be needed.)  Formal exercise regimens should not be resumed until six weeks after surgery.  

Question #11:  What is the policy if I am not happy?

Answer:  Dr. Delgado’s goal is to have you be extremely satisfied with your results. If a revision is needed, and it can be performed in the office, he will do it at no charge.  If general anesthesia is required, Dr. Delgado does not charge the patient for his services, but there may be a fee for the surgery center and the anesthesiologist’s services.

On March 23, we had a blog on FAQ’s for the gynecomastia patient recovering from surgery. There are many questions patients ask Dr. Delgado prior to making the decision to move forward with surgery. Below are several questions he is frequently asked, and we will be posting a few more in our next blog.

Question #1:  Are there any nonsurgical treatments for gynecomastia?

Answer:  Although you can read about easy, non-surgical cures in the news and advertisements, and there is considerable ongoing research aimed at finding a way to reverse it without surgery, no effective medical treatment actually exists at this time.

Question #2:  Is liposuction adequate treatment?  I do not want a surgical procedure.

Answer:  Liposuction alone is not a good treatment for gynecomastia.  Only with cases of pseudogynecomastia is it an adequate technique.  Removing the fat around the gland only creates an unnatural bulb and patients are not satisfied with the aesthetic result from this technique.  Redo surgery from other establishments comprises 25-30% of Dr. Delgado’s gynecomastia practice and most of these cases have had liposuction alone.

Question #3:  Will the entire gland be removed during the surgery?

Answer:  Not necessarily.  Male breast reduction surgery for gynecomastia is a cosmetic procedure.  Therefore, enough is removed to create a good looking, flat, but contoured chest.  Sometimes the entire gland is removed and sometimes only 80% or 90% is removed.  After surgery, Dr. Delgado is happy to discuss this aspect of your procedure with you.

Question #4:  Will it come back after surgery?

Answer:  Rarely, but the tissue can be still stimulated and enlarged by steroids or other medication use.   Of course, weight gain can increase the fat content of the overall chest and body.  Gynecomastia seldom returns if enough of the gland is removed during the surgical procedure.

Question #5:  Will insurance pay for the gynecomastia surgery?  

Answer:  This is a very difficult question to answer even though Dr. Delgado has dealt with insurance companies on hundreds of occasions.  It is unusual that gynecomastia reduction surgery is covered, even in the most severe and unfortunate cases.  Most insurance companies consider it cosmetic surgery.  Dr. Delgado has occasionally received approval for cases in which a medical condition or syndrome has caused the gynecomastia.  Even symptoms of pain and tenderness usually fail to warrant coverage in the opinion of the insurance carrier.

Nevertheless, Dr. Delgado is always willing to write a letter and send photographs to the insurance carrier on behalf of the patient, with the hope that insurance coverage for the surgery might be granted.

Gynecomastia.org is the best website for information on gynecomastia, male breast reduction in the entire world.  I have followed and participated in the website ever since it’s inception in 1999, and admire Merle Yost for his dedication and efforts to educate the public regarding gynecomastia.  The website he has introduces the entire spectrum of issues regarding gynecomastia, nicknamed “moobs” from the psychological impact to the post-surgical results.  This website has an array of qualified physicians, a wonderful forum for men to discuss their condition, to get advice and share stories.  The website also offers valuable information regarding physicians around the country and the pros and cons of their practices from a patient’s perspective.

There is a “Find a Surgeon” section to help you locate a board certified plastic surgeon that specializes in gynecomastia surgery. There is a “FAQ” section, medical articles, treatment options, gynecomastia gallery with before and after pictures. Also, post surgery workout information and much more.

You need to sign up to participate in the forums, but there is no charge.

I highly recommend that men with gynecomastia use this website for its completeness and its in-depth coverage of this medical condition.

Miguel Delgado, M.D.    

We all know the world has gotten smaller with the incredible progresses of technology. We are able to do things unheard of even ten/twenty years ago. The popularity of Skype has opened doors and opportunities for all of us. Dr. Delgado now offers complimentary consultations via Skype for out of town patients which allow them the opportunity to have the next best thing to a personal consultation for male breast reduction. Gynecomastia surgery techniques can vary from patient to patient, depending on the severity of their case. With Skype,Dr. Delgado can evaluate a patient, and answer questions, saving the cost of travel for that initial consutation.

For those who have never experienced Skype, it is easier than you may think. Most computers come with built in web cams, but if your computer doesn’t have one, they are very inexpensive to purchase and will attach right to your computer.  Radio Shack has them for $20 and up.  Amazon.com has them for less than $10. Less than the cost of a consultation!

Registering for Skype takes only a few minutes, and it is free. So not only do you get to speak directly with Dr. Delgado you will be meeting him face to face, a great opportunity to get to know him. After your consultation, his patient coordinator will be able to email a quote to you. If you are interested in having a consultation this way with Dr. Delgado, please call the office and set up a time. (415) 898-4161.

According to the “American Society for Aesthetic Plastic Surgery” (ASAPS), cosmetic procedures dropped only 2% from 2008. Compared to all surgical procedures, which had a drop of 17%. Of all cosmetic procedures done, men make up a total of 9%, but for men there was actually an increase of 8%.

Dr. Miguel A.. Delgado, Jr. is a member of ASAPS which is the leading organization of plastic surgeons certified by the American Board of Plastic Surgeons, who specialize in cosmetic surgery. On March 9, 2010 the 13th Annual Cosmetic Surgery Statistics from the Aesthetic Society were published. You will note that gynecomastia surgery, male breast reduction, also known as Moobs, is in the top 5 procedures for men.

This can most likely be explained by the fact that many people realize the importance of feeling good about themself and how it projects into their lifestyle and work place. In these challenging times we are all facing, a good attitude and self image is of utmost importance.

1. Do I have to wear the vest day and night?  Yes.  Your compression vest must be worn day and night for exactly 6 weeks.  It may be off for showering but for no other activity.  Feel free to wear a cotton T-shirt under your vest for additional comfort.
2. Is there anything I should look for or be concerned about?  Watch for any excessive swelling, bleeding or bruising; from one side or both. 
3. How soon can I drive?  You may drive when you feel safe.  Do not drive if you have taken any prescription pain medicine.  Do not drive long distances within your first week of recovery if possible.
4. When can I shower?  Once your drains have been removed, please wait at least 8 hours or until the next morning to shower.  Do not soak in a bath tub or hot tub until your wounds have healed completely. *Prior to drain removal you may “sponge bathe” or use baby wipes to freshen up then reapply your pads and vest.  Do not get your drain wound/site wet.
5. When may I begin using something to prevent scarring?  Begin using Silicone gel pads about 10 days after your incisions or wounds are completely healed.  Most men can start using the pads between 3 and 5 weeks after the procedure.  Silicone should be used for 2-3 months.
6. How soon can I start working out or exercising?  Do not do any strenuous activities for 4-6 weeks.  Depending on your particular procedure and how you heal, sometimes Dr. Delgado will allow some exercise (walking, no weights!) a little earlier.  Refraining from any cardio or aerobic activity will help reduce your swelling and get your chest to your desired shape sooner than later.  Ask Dr. Delgado about this as each patient and procedure is different;  he will customize this aspect of your recovery.
7. Can I wash the vest?  Yes, you may wash your vest as needed.  Wash (in machine) on gentle cycle with cold water.  Line dry.  If you need it in a hurry, put it in the dryer with a few dry towels and set the dryer on cool air setting.  You should have two vests so be sure you are wearing one while laundering the other.
8. Do I have full range of motion with my arms?  Yes.  However, if extensive movements during your early recovery period cause pain, refrain from stretching for a week or two.
9. What ointment can be used to help the incision line and drain wounds heal?  Use Bacitracin ointment twice daily and cover with a clean gauze sponge. 
10. Do I need to finish my medicine, even if I feel fine?  Take your pain medicine only if needed.  Do finish your Keflex (cephalexin), the antibiotic and if you are taking Sinecch, finish it as well. 
11. Should I take any pain medicine before my appointment to have the drains removed?   Tylenol (acetaminophen) is usually helpful and may be taken if you are driving yourself.  If you have a driver, taking a stronger pain reliever may be more helpful.
12. When can I resume taking medication, supplements or foods that Dr. Delgado had me discontinue prior to surgery?   Please consult with Dr. Delgado at one of your post op appointments or call with this or any other question.
13. What number do I call if I have any concerns after office hours?  Call 415-898-4161.  The answering service will have Dr. Delgado call you back.  If your concern seems serious and you do not receive a prompt return call, phone 9-1-1 or have your caretaker take you to the emergency room.

Should you have any question not addressed here, please call the office at 415-898-4161 or email your question to info@dr-delgado.com.

Gynecomastia is no longer the mystery it used to be. With the advent of the World Wide Web, information on virtually any topic is now immediately available. Sometimes too much knowledge can be confusing, and you may find yourself in a situation where you are trying to diagnosis yourself.

In particular, these days, there are volumes of information available on male breasts, technically known as gynecomastia. There are many specific websites now with a lot of good information, such as http://www.gynecomastia.org and some plastic surgeons that specialize in this procedure have excellent information on their websites. Dr. Delgado has a website dedicated specifically to gynecomastia (male breast reduction).

Recently, in some chat rooms, the question of seeing an endocrinologist first or a plastic surgeon has come up. It is very important to select a plastic surgeon that specializes in gynecomastia, when selecting your surgeon, be sure to ask how many cases he/she averages a year. The surgeons who specialize in this procedure will know how to evaluate your particular case and determine if further testing and consultation is recommended.  With Dr. Delgado you will find at your initial consultation he will be spending a great deal of time taking your medical history and will do a physical exam. Prior to surgery you will be required to have a blood test that will help determine if you are a good candidate for surgery. In very few cases this test comes back out of range. Dr. Delgado usually has this test repeated to be sure of the results. If the results are still out of range, then a referral to an endocrinologist is in order.  After evaluation by both doctors it will be determined if you are able to proceed with surgery.

It is most disappointing to have found the surgeon that you feel most comfortable with only to realize that he is quite a distance away, which will add to the costs of the surgery. Dr. Delgado is most aware of the challenging economic times we are all facing. It is his wish to extend some relief to his patients. Therefore at this time he is offering a generous travel package for his out of town patients.This fantastic offer allows patients the choice to stay at The Novato Oaks Inn  or The Napa Garden Hilton.  Some gynecomastia patients may have a family member or friend traveling with them to help with their care, having such a beautiful place to stay in such incredible surroundings will make the trip more enjoyable for all.  Here are some of the details of the offer.

Dr. Delgado’s offer:

• 5 Days at Novato Oaks Inn
    Spacious guest rooms and suites
      Complimentary continental breakfast
      Room Service
      Free Shuttle to local shops, restaurants and theaters
      Free wireless internet access
      Special wedge pillows for support and comfort
      Only 30 minutes to San Francisco or Sonoma
• Travel Vouchers for SFO to Novato
      Complimentary vouchers to provide transportation from
      SFO to Novato and your return trip
• Free Shuttle from Hotel to Surgery Center
      Complimentary shuttle will take you to Marin Cosmetic Surgery Center
      and to Dr. Delgado’s Novato office as needed during your stay
• In-Room Post-Operative Visit by Dr. Delgado
     

CALL NOW 415-898-4161  http://www.gynecomastiaspecialist.com/
For Details and Your Complimentary Consultation

 
When going through the process of selecting your plastic surgeon for gynecomastia surgery, another important factor to consider is where is the procedure being done? Many surgeons use a local hospital or surgical facility with multiple operating rooms.  In many cases the outcome may be fine, but there are definite advantages when the surgeon has his/her own private surgery center.

 
First quality control; you have only one operating room. That means less traffic going in and out of the surgical facility, which reduces the risk of infection dramatically.  Infection is one of the greatest risks in surgery, the ability to control and reduce the probability is extremely important. 

Second, the surgeon would be in charge of ordering his own medical supplies and instruments, therefore monitoring quality and “state of the art” equipment at all times.
Third, the surgeon has command of the surgical staff, he is able to pick and choose the team with the best qualifications and skills available to him. The surgical team must be “in sync” with the surgeon in order to obtain the best possible outcome.

While picking the best surgeon is extremely important, the surgeon’s “team” can make or break him.  Having a team that the surgeon has trained himself allows him to focus on the patient and not be concerned with the skills of the staff he may have been assigned to for the day as can happen in a hospital setting. Gynecomastia is a surgical procedure that only a handful of plastic surgeons specialize in;  a surgeon that also has his own surgery center and trained team is  optimal.

And lastly, check the credentials of the surgery center. Marin Cosmetic Surgery Center, is a fully accredited surgery center, meeting Medicare Guidelines, and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc.(also known as Quad A) thus awarding it the distinction of being a “Surgery Center of Excellence”.

Drains are a surgeon’s choice based on his procedure.  There is no right or wrong answer.  Each surgeon must deal with the outcome and complications of “drain or not to drain”.

I drain!  The surgery that I perform for the average gynecomastia patient is an aggressive and wide exposure approach.  This creates a large area of “dead space” or open space.  This pocket has a large area of “raw space”, which loves to ooze fluid.  A drain will collapse the space, evacuate the fluid and create a negative pressure to the cavity, which encourages it to close down.  The addition of the compression garment creates a perfect environment for healing.

Early in my career, I used drains based on the complexity of the case.  Greater than 10% of the time, I had fluid accumulation inside the dead space area.  This is called a seroma, not an accumulation of blood, but of yellow body fluid.  This complication is easily corrected by needle aspiration every four to five days until the cavity is collapsed.  But, it is very inconvenient for patients.  Also, there can be prolonged healing.  In the end, all works out perfectly if the complication is dealt with properly.

I have learned from my experience over twenty years.  I drain all cases.  Allow me to explain further.

The drainage output allows me to see what is going on inside!  By the consistency of the fluid, thickness, and the speed at which it is coming out, it can alert me and my staff to:

• Let’s observe him longer in the recovery room.
• Let’s take off the garment to see if swelling is occurring due to a blood accumulation.
• The fluid is thin.  Great!  All looks good.

As a surgeon, this gives me valuable information.

I see many patients from out of town.  They need to heal uneventfully.

My seroma or fluid accumulation rate is near zero.  However, there is a price or tradeoff!  The small scar from the liposuction or drain site has been a point of concern for patients.  Sometimes, it is more obvious than the incision around the areolae for glandular excision.  My patients have educated me about this over the years and now I have an instrument to take the incision high up in the armpit and go towards the back.  Listening to your patient is the most valuable thing in a plastic surgery practice.  This is a win-win situation.  I get my drain and the patient’s have to search for their drain incision!
Miguel A. Delgado, M.D.