AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2200 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Organizations belong to ASAPS (American Society for Aesthetic Plastic Surgery); ASPS (American Society of Plastic Surgeons); ACS (American College of Surgeons); Clinical Assistant Professor of Plastic Surgery at the Albert Einstein College of Medicine in New York
Expert: Alan M. Engler, MD, FACS Date: 6/6/2008 Subject: Gynecomastia - Referred to General Surgeon... Should Be Plastic Surgeon?
Question Dr. Engler,
I have a 16 yr. son who was diagnosed with "hypertrophy of the breast." It involves both breasts and has been present for over three years. My son is "not" overweight at all. We've both researched Gynecomastia at length.
My son's pediatrician initially referred him to a Plastic Surgeon. Unfortunately, the referral lapsed and, due to insurance demands, a new referral was submitted.
The second time around, his pediatrician referred him to a General Surgeon rather than a Plastic Surgeon. The Gen Surgeon stated that he's done many of these procedures, yet he takes no before & after pictures to document results.
Is it normal to be referred to a General Surgeon rather than a Plastic Surgeon for Gynecomastia procedures, and can I assume that "hypertrophy of the breast" is the same as Gynecomastia? Also, is it a little odd that no before/after photos have been taken of the Surgeon's past procedures?
I'm thinking about a cut & run over to a Plastic Surgeon instead, but that will be a significant out of pocket expense. So, I wanted to ask about the normality of Gen Surgeons doing the procedure.
Thanks for your help!
Answer Hi Jim,
There's more about gynecomastia at my site, www.bodysculpture.com.
There are three issues here:
1) As far as I know, hypertrophy of the breast in a young man is the same thing as gynecomastia
2) It's not necessarily a matter of which doctor will do the procedure, as which sort of procedure will be done. If the right thing is done, it doesn't matter who did it.
That being said, I suspect that the best treatment for your son is to undergo liposuction of the chest. That is almost always my first line of treatment (unless there is an enormous amount of excess skin, in which case the skin need to be removed surgically). Normally, lipo is
very effective and adequate treatment for this issue. That being said, a small percentage of patient who undergo lipo for gynecomastia will need, at some point following the healing (ie six months or more) a secondary (touch-up) lipo, which is pretty minor, or, rarely, removal of some excess skin (which is less minor). Either way, though, the first step is usually lipo.
And, in general, I would think that plastic surgeons are more familiar with lipo than general surgeons. So - of course - I would most likely agree with you that a plastic surgeon is a better choice than a general surgeon. If there's a general surgeon who can do these procedures, then that's a different story. The absence of before and after photos documenting what he or she has done before is somewhat worrisome for a procedure like this (many procedures, such as facial and those on more intimate areas, are so personal that patients do not want to come back for after photos, so it may be somewhat harder to get photos in that case).
3) It may be that you're being referred to a general surgeon for financial reasons; ie, your plan has an arrangement with a general surgeon that makes is more cost-effective for them than if they were to have to pay for a plastic surgeon. That, of course, is a completely practical issue but it may be putting the best interests of your son in conflict with those of the insurance company.
I would have your son seen by one or more plastic surgeons, even if you have to pay for the consultations (I realize how easy that is for me to say, and I apologize...). That way, you'll have a good idea of what some of the surgical options are. You can also ask details of how the general surgeon would perform the procedure. And you should, of course, read up about this at surgery.org, plasticsurgery.org and a few other plastic surgery sites.
At that point, you may want/need to start lobbying your insurance company to cover a procedure that they may not want to do. That, too, is easier said than done, and it's always easier just to pay for things on your own. When you visit the surgeons, explain the situation and ask about fees. You may find that it's not as difficult as it might seem to have one of them do the procedure.
Finally, each insurance company is unique, and some/many do not cover gynecomastia at all (considering it a cosmetic procedure), in case that helps if you have to pay for it on your own.
