You may find it unexpected. In the consultation room, there are times I bring up something else before talking about surgery.
The reason I bring up exercise first to someone who came to consult about gynecomastia—today I'd like to talk about that.
He came carrying two worries
The worry this patient was carrying most heavily before the consultation was this: "I'm scared it won't get smaller, and worried about what if the recovery time is long."
Worry about the result, and worry about recovery. These are the two I hear most in gynecomastia consultations. To answer this worry earnestly, I first have to confirm accurately why this patient's chest appears to protrude.
To those worried about recovery, I never leave out the compression garment. It's true the garment is uncomfortable. But it's a necessary process to press the skin, stretched after surgery, closely against the chest so it adheres. When I explain why it must be worn, most people endure the discomfort well.
That's why I bring up exercise first
Not all gynecomastia is the same gynecomastia. Cases where breast tissue is developed don't disappear with exercise. On the other hand, if fat is the main cause, exercise and weight management may come before surgery.
So depending on the state, I first say, "Try exercising hard for a while." I believe the first role of a consultation is to distinguish whether it's a condition that requires surgery, or one that can change through effort.
This patient heard that in the consultation too, and decided on surgery after confirming his own state. In his review he left words that the consultation had been done well. I believe a consultation that doesn't rush the decision actually makes the decision easier.
What stayed with him in the operating room
When I asked what was most memorable on the day of surgery, this patient said it was good that his tension was eased.
The tension of the moment of lying on the operating table is there for everyone. Noticing that tension and easing it with a word, with a touch, is also part of what we should do.
I think the best way to ease tension is to explain everything the patient is curious about. If needed, I explain the same content again several times. The explanation we give is not a procedure to obtain a surgical consent form, but a conversation carried on until the anxious mind is put at ease. Only after that conversation do we bring the patient into the operating room.
"I wanted to try wearing a short-sleeve white T-shirt"
This is the answer when I asked what he most wanted to do after surgery. It's not a grand goal. A short-sleeve white T-shirt, nothing to others, is to some a homework assignment postponed for years.
In a review left in the second week after surgery, this patient wrote: "I'd recommend consulting and having surgery rather than spending the time deliberating. I'm very satisfied."
But this is his experience, and whether to have surgery is best judged after confirming your own condition through an examination. There are people for whom exercise comes first, and people who need surgery.
I'll speak honestly starting from that distinction. I hope you won't worry alone but will come in for a consultation. I may recommend surgery, or I may tell you to try exercising first—but either way, I sincerely want to help.
