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Gynecomastia or enlargement of the male breast may produce an unwanted feminizing appearance. This is typically caused by an increase in stromal (connective) and ductal tissue, however a serious underlying cause should always be considered. The incidence of occurrence in naval military exams is about 8 in 100,000. Gynecomastia is noted normally to some degree in pubescence with incidence as high as 65% in boys aged 14 to 15 years. By late teens this finding lessens to 7.7%. Cosmetic surgeons consider 3 grades:

I. a button of extra tissue under the areola (the pigmented area surrounding the nipple)

II. diffuse enlargement with indistinct peripheral margins.

III. further mass effect with excessive skin involvement.

To see before and after examples, visit our web-site and click on photographic examples

http://penisdoctor.com/gynecomastia.htm

A patient writes.  “In a word.  Excellent attention and care.  I was allowed to watch work in progress with a hand held mirror.  The first week afterwards, there was some swelling which subsided by the third week. Ultimate result, just the way it was explained to me.  Very neat incision line, no suture tracks, no puckering, no pin holes or ghost lines.  Pain free and I will be combat ready in 3 more weeks.   Whoopie!    N.A.C”

Who stands to lose.  Presented by Dr. Judy Choi.  Causians, older men, those with absence of partner, being heterosexual and relationship duration greater than a decade.

Harold M. Reed, M.D.

Drs. Perovic and Egydio reported at the AUA meeting.  Case study involves 25 patients who underwent simultaneous penile implant (prosthesis) insertion and opening of penis with Tutoplast.  An average of 1 1/2″ length gain was achieved with excellent preservation of sensation.

I also have had similar experience with Tutoplast.      Harold Reed, M.D.

Answer, per Dr. Andrade, yes it can.  Therefore another article confirming that ESWL is not indicated for Peyronie’s disease.

This May at the AUA, Drs. Choi and Mulhall report erectile dysfunction based upon plaque incision and grafting.  Almost half had some reduction in erectile function after surgery.  The recommendation: this operation by itself is not recommended for older men.  However, 50% of patients pre-operatively had arterial insufficiency and 21% venous leakage, not good vascular signs.

Did two yesterday and both patients are doing well.  Seem to enjoy being housed at the Baltic Hotel which is nearby and had a chance to visit both.  One an aspiring audio engineer for cinema with a bright future ahead.  Both had tight frenulums which required removal.  One had the raphe reconstructed as allowing it to heal by secondary intention would have taken 2 weeks.

The penile scrotal web or turkey neck is a problem for some pateints.  It creates the optical illusion of a shorter penis on the underside and during penetration the scrotum gains entrance into the vagina.

Penoscrotal webs can be appreciated on uncircumcised men, but more commonly seen on circumcised men when the doctor does not allow for enough remaining skin on the underside of the penis.  The remedy in our practice is not the Z-plasty incision which leaves a wavy scar line on the underneath (correcting that tomorrow) but rather to make a narrow inverted  V over that portion of the web that attaches to the underside of the penis and allowing it to drop downwards where it belongs, and close the penile skin multilayered and applying steristrips as this area is prone to tension tears,

The underside is closed typically with a minimally extended incision parallel to the normal chevron crease lines of the scrotum for concealment.

Harold M. Reed, M.D.

Have heard of and seen  tight frenulums pulling down the head creating the SST deformity.  Like the tilt down nose of the Concorde jet, but never saw it cause angulation of the penile shaft.  Think this may be my first case, where the frenulum which was attached to the distal shaft actually produced a 45 degree downward angulation of a medically induced erection in the office confirming “penetration not possible in all positions.”  

The remedy is release of the frenulum.

Please visit the Penis Doctor Blog again soon for new posts.