Gynecomastia

Gynecomastia (Male breast reduction)

The goal of gynecomastia treatment is to reduce breast size in men who are embarrassed by overly large breasts. Reduction methods include liposuction, cutting out excess glandular tissue or using a combination of liposuction and excision. If you are treated by a board-certified plastic surgeon,
gynecomastia can be effectively and safely improved or corrected completely.

When to Consider Gyanecomastia Treatment

• If you are reluctant to remove your shirt in public, to swim, to participate in sports or to exercise at a gym.
• If you want to improve your overall body proportions.
• If you experience psychological discomfort associated with large breasts.
• If you want to increase your social confidence.

Considerations

Pros

• You can feel comfortable revealing your chest contours, clothed or unclothed.
• You can gain more social confidence.
• You can enjoy permanent results.

Cons

• Scarring may make you feel self-conscious.
• You may be disappointed with your final results.
• Weight gain following this surgery will compromise results.

Am I a good candidate for gynecomastia treatment?

• You are unhappy with the size or appearance of your breasts.
• You experience physical discomfort because of your breasts.
• You have good skin elasticity. Successful gynecomastia surgery involves adequate skin contraction after your excess skin is surgically removed. Your skin may lack the necessary elasticity for good contraction if you are age fifty or older, have significant sun damage, have breasts with a lot of
  stretch marks or have undergone gastric bypass surgery.
• You have first tried diet and exercise to reduce your breast size.
• You are not significantly overweight. Although surgery will help this patient population, the results will not be as good. For this reason, you should try to get within thirty to forty pounds of your ideal body weight before surgery.
• You do not use marijuana, steroids or drink alcoholic beverages excessively (it is theorized that these substances may cause gynecomastia).

About your Procedure

How is a gynecomastia procedure performed?
The goal of gynecomastia surgery is to restore a normal male breast contour and to correct deformities of the breast, nipple or areola. Surgical options include liposuction, excision (surgical removal of tissue) or a combination of both approaches. Glandular breast tissue is denser than fatty tissue and is not appropriate for liposuction.

• The choice of surgical technique depends on the likelihood of skin redundancy after surgery. Skin shrinkage is greater in younger than older patients.
• The most common approach is the intra-areolar incision, or Webster incision, which extends along the circumference of the bottom half of the areola in the pigmented portion.
• The length of your incision will be based on your anatomy.
• In severe gynecomastia, skin resection (surgical removal of part of an organ or structure) and moving the nipple (nipple transposition) may be necessary.
• Minimally invasive gynecomastia surgical procedures have gained popularity. In the “pull-through technique,” a very small incision (approximately 5 mm) is made at the areolar edge. Following liposuction, the glandular tissue from the overlying areola is pulled through the incision. The major advantage of this procedure is the smaller incision. This technique is used in well-selected patients.
• In liposuction-assisted breast reduction, there is less compromise of blood supply, nipple distortion and areola slough. In addition, postoperative complications are fewer with this technique than with
  open surgical resection;

Preparing for Your Procedure

• Avoid taking aspirin, certain anti-inflammatory drugs and some herbal medications that can cause increased bleeding.
• Stop smoking at least six weeks before undergoing surgery to promote better healing.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and critical outcomes.
• Keep alcohol consumption at less than two to three drinks per week.

Aftercare and Recovery

Immediately after your gynecomastia surgery

• Generally, you can expect to be bandaged, wearing a compression garment, and you may have a surgical drain.
• The first three postoperative days are critical in your recovery. You must be at full rest at home, but not necessarily in bed; sitting and watching TV or having meals in the kitchen or living room is permissible.
• Movements of the waist and elbow are acceptable, but you should curtail vigorous shoulder movement for the first few days. Lateral arm movements are generally permitted, but do not lift your arms up vertically.
• Recovery time frame Your recovery time after surgery for gynecomastia depends on how severe your condition is and what was performed for you. The average patient, treated with a combination of liposuction and breast gland tissue excision, will likely be back to work after a week. Gynecomastia surgery usually has a relatively gentle recovery period.

It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic if
prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly
among individuals.

• Your first follow-up visit will probably be five to seven days after surgery. Your sutures will be removed at this time, as well as your drain if the discharge is diminished or has disappeared.
• How long you wear your compression dressing will be based on your surgeon’s assessment.
• In terms of exercise, be guided by your plastic surgeon. Generally, you may resume low impact activities at two to three weeks; you may begin gentle upper extremity progressive resistance exercises at three to six weeks.
• You will probably return to work within seven to ten days after surgery.
• Avoid strenuous activities for the first two to three weeks to ensure optimal healing.
• Pain tolerance varies from person to person. For many, the pain is moderate at best. When extensive liposuction is done, you may experience soreness equivalent to a day of exercise. You may be provided with a prescription for a painkiller, but most patients do not need more than extra
  strength Tylenol.
• You may be asked to apply Neosporin or other antibiotic ointments to the wound.
• Avoid exposure to direct sun or tanning for about six weeks, until bruising and most of the swelling subside.
• Sun rays will prolong swelling and may cause permanent discoloration. Sun exposure in the early stages can cause scars to become more noticeable later.
• Swelling and bruising are normal after surgery. Bruising can appear in various degrees, ranging from minimal to massive. It can be confined to the breast area or expand to the chest and abdomen.
  Bruising can appear as bright red, black, blue, purple or a combination of colors. It will increase in intensity over the first three to four days and then will diminish and become yellowish for another week or so. The discoloration will usually disappear in two to three weeks.
• As with most surgeries, you may notice a decrease in sensation in the area around the operated wound. This is usually more frequent in patients with enlarged male breasts that require significant liposuction. Most men find the temporary loss of sensation to be insignificant. Sensation returns after a year for most.
• In some patients with diminished elasticity (most commonly older patients) there may be excess skin or skin creases that are more noticeable postoperatively. Most of these creases will persist for six to twelve months and then diminish significantly, and the loose skin usually tightens.
• After male breast reduction surgery, there is a phenomenon of spontaneous shrinking of the entire areola. The diameter of the areola will decrease ten to fifty percent from the original size. This usually occurs when significant amounts of glandular tissue are removed.
• Be patient. It may be three months or more before the swelling abates and you can see the final results.

How Long Will the Results Last?

Gynecomastia surgical results are permanent, assuming your weight is stable. If your condition arose from the use of medication or anabolic steroids, further use could lead to recurrence.

Limitations and Risks

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in skin sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures Blood clots in the legs or lungs.