To date, I have conferred with about 500 patients over the phone, through the regular mail and email and completed surgery — all without a hitch.

To expedite the process, my patient coordinator Jennifer (Jennifer@drelliotjacobs.com) will send you a form detailing the type of information and photos I need from you before we can speak on the phone.

I will then proceed to a presumptive diagnosis and suggested surgical treatment plan. You will need to have some medical tests prior to surgery – the results should be faxed to us two weeks before surgery.

But it’s not all phoned in! We will meet in my office the day before surgery and go over everything in detail, including the gynecomastia surgery cost; I will answer all of your questions at that point.

Here is what I would like to see in some digital photos of you (in jpeg. format).

To take the most informative pictures:

• Choose a background with one color. An ordinary wall works well
• Make sure it is well lighted with no shadows
• Have another person take the pictures
• Use a camera that will focus but not one with a wide angle lens; that warps the image too much
• If you’re interested in gynecomastia surgery, fill the viewfinder frame  from the shoulder bones to the belly button.
• Take a series of pictures without a shirt and with your thumbs gently linked together behind your back – one from the front, then a ¾ view from each side and one of the chest in both right and left profile.
• Then take one from the front with your arms straight out
• Don’t suck in your stomach; just be pictured as you naturally hold yourself

Some states – but not New York — now require cosmetic plastic surgery patients to have a physical before the rejuvenation surgery.

Here is my own policy about physicals before surgery:

• For teens and healthy patients up to about age 30: usually no physical required; I only need urine and blood tests.

• For guys over 40, a physical exam, cardiogram and the two tests mentioned above.

• Over 60, I require a physical, cardiogram and stress tests along with urine and blood tests.

We will also help with arrangements for your travel and NYC lodging.

Paperwork!

I think you’ll agree it’s a scattershot approach.

Here’s one from Harvard Pilgrim Health Care

Company policy:

• Covers those 16 and over
• Must have a gynecomastia diagnosis after a physical
• Signs and symptoms have persisted for at least 12 months despite

treatment of any underlying cause.

• Must be followed by an MD for at least 12 months

Documentation required:

• Medical records of the presence, extent and duration of gynecomastia
• Pre-operative photos
• Medical history including pharmacy records, chromosome analysis and drug screens.
• Proof of specialist care by a surgeon or endocrinologist to i.d. and treat any underlying condition.

(A chromosome test reveals if the patient has any genetic illness that causes gynecomastia. Hence, the need for an endocrinologist who also tests the patient to see if hormones are responsible.)

Reasons to go ahead with the gynecomastia plastic surgery:

• A dominant breast mass
• Gynecomastia on both sides
• Non-reversible gynecomastia due to medications prescribed to treat a medical condition or illness.
• Klinefelter’s Syndrome
• Grade III or IV gynecomastia for at least a year.

Exclusions:

• Under age 16
• Drug screen evidence of substance abuse
• BMI greater than 30, indicating obesity

The primary reason for granting coverage for surgery is psychological distress.

Nonetheless, most health plans contain a Catch-22 clause that specifically excludes any cosmetic treatments (like male breast reduction) that:

• Improves appearance
• Is performed for psycho-social reasons

Next: Many experts have put their heads together and recommended a common sense checklist for granting gynecomastia surgery.

That suggested checklist also screens for other reasons – like street drugs –  that a may cause gynecomastia.

It also considers the psychological and physical damage that happens  over time to a guy with man boobs.

Joys of smoking

Many times, when looking at the list of the things patients must do before plastic surgery, some smokers are dismayed to find they must give up the habit at least three to four weeks before the procedure and continuing on through some weeks after the procedure.

Plastic surgeons are not being politically correct. Our concern is about the substances in tobacco that conflict with good medical practice and plastic surgery outcomes.

For starters, nicotine injures the blood vessels and makes them constrict. That means less blood can flow to points in the body where it’s needed.

And one instance when a free flow of blood is most needed is right after surgery that requires longer incisions. Blood is very necessary for proper healing because blood carries vital nutrients and oxygen to the wound site.

Why? If the blood flow is limited, healing can be so delayed the tissue on both sides of an incision can actually die – this leads to very poor scars. Smokers are also at a much higher risk under anesthesia.

Other undesirable side effects include:

• Increased risk of infection
• Longer-lasting bruises
• Raised, red scars

On the other hand, I realize how addicting smoking is and that you may be in some discomfort. You can’t use Nicorette because it also contains nicotine but you can get a prescription for Chantix or Wellbutrin.

That’s why I applaud efforts of plastic surgeons around the nation who actually use carrots, and fewer sticks, to provide additional motivation to giving up the habit, at least long enough to allow for a good outcome to your surgery.

For instance, one board-certified New England plastic surgeon offers fee discounts for patients who give up smoking permanently and lose weight. And it’s all on the record – patients there must submit urine samples before surgery!

A California plastic surgeon, Darshan Shaw, M.D. was featured in our local newspaper, The New York Times, when he started offering non-smoking prescriptions to patients who could only have their surgery after permanently giving up the habit for good.

That creates more healthy patients and a better-than-average-shot at an excellent outcome to rejuvenation surgery.

It dawned on me later that Dr. Adams filmed me and one of my teen patients back in October of 2007.

I mention it because it’s one of the few filmed pieces I’ve seen that actually shows the breast, or glandular, tissue seen in gynecomastia.

The video follows a 15-year-old who loves sports but at 12 or 13 developed a serious case of gynecomastia, with very pronounced, female-like breasts that were hard to hide, even under heavy T-shirts.

Most days, he wore a compression garment as a T-shirt to conceal his pubescent-like breasts.

The problem? Sports were out of the question. As was taking off his shirt in public.

One of the charms of Plastic Surgery: Before and After was that, unlike most television shows about plastic surgery, Dr. Adams intended his programs  for adults and showed unfiltered, close-up segments of actual plastic surgery.

But most other programs blur or blank out surgical scenes as if they were X-rated sexual content.

The concept was not to make viewers lose their lunch by filming endless gore, but to show just enough to put across a teaching moment.

When Dr. Adams and crew filmed me operating on the teen, they showed how much work it was to liposuction out the fatty tissue from his breasts.

When it came to removing the actual glandular breast tissue, they zoomed in close and captured the look of the bone-white breast tissue as it was excised from the lad’s chest.

Glandular tissue is far too thick for liposuction.

The rest of the operation went well, the youngster healed and returned home where he could once again indulge in all the sports he wanted while taking no care at all about hiding his chest.

In fact, I think Dr. Adams’ film crew gave other gynecomastia sufferers a moment of supreme elation for the many youngsters who live in that world.

They filmed my patient gladly and willingly doffing his shirt to play basketball.

Why is that noteworthy, you ask?

For gynecomastia-stricken teens, hearing the command “Shirt and skins!” from a phys ed teacher is a moment of sheer terror!

“Skins” must peel off their shirts and then jump up and down, playing basketball. And that puts all eyes on their jiggling breasts.

Here’s the video:

We’ve already discussed how gynecomastia causes extreme embarrassment, social withdrawal and can ruin a person’s self-image, making him feel worthless.

Truth be told, there is plenty of pain to go around!

On one website supporting a petition asking insurance companies to cover gynecomastia surgery, you can see lives being held back.

For instance, Bruce blogged:

“I opted out of a promising military career because I would not disrobe…I suffer from depression and often isolate myself. (Health) insurance will pay for tummy tuck and breast reduction in women but not for gynecomastia. Would somebody explain why?”

Mark B. wrote:

“The emotional impact can lead to feelings of hopelessness, depression and thoughts of suicide…there is pain and tenderness when jogging..gynecomastia plastic surgery has nothing to do with cosmetics. All we want to do is live normal and productive lives.”

Giovanni V. added:

“It is not normal to have breast tissue if you are a man!”

Louis P shared:

“Having gynecomastia as a teen, I put on a lot of weight because I thought I could hide it…I’m now 40 and trying to lose the 100 pounds I put on…An adolescent boy should not have to suffer through what I did!”

Porta S. wrote:

“At age 15, my son’s breasts are larger than mine; he can easily fill a size B bra. This otherwise healthy, athletic boy has to deal with kids gasping in horror when changing clothes in gym.”

Chase, 18, blogged:

“I have not led a full life due to my gynecomastia and it kills me! I try not being depressed but I can’t help it. Insurance coverage would give me the second chance I so desperately need.”

Jim, 48 said:

“In high school, my girl friend said ‘What the hell is this?’ while we were swimming. To this day, I won’t take my shirt off in public.”

Dedan L. wrote:

“I developed gynecomastia at 13. Whether I was 135 or 235, it made no difference. Even at my largest and leanest, 215 and 8 percent body fat, I still wore a rash guard (a spandex athletic shirt) to the beach.”

Karen added:

“My 13-year-old son has gynecomastia; it’s heartbreaking to see him worry so much about how much breast shows through his shirt.”

56-year-old Paul blogged:

“I have considered taking razor blades and performing surgery on my man boobs. My entire life has been affected by gynecomastia.”