Many men have gynecomastia - enlarged, female-like breasts - causes by excess glandular tissue or fat (or both).

Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.

Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.

All surgery carries some uncertainty and risk

When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue.

The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.

Planning your surgery

The initial consultation with your surgeon is very important. Your surgeon will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, your surgeon will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist.

Your plastic surgeon may, in extreme cases, also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition. Once your surgeon knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs.

Don't hesitate to ask your surgeon any questions you may have during the initial consultation- including your concerns about the recommended treat- ment or the costs involved. Treatment of gynecomastia may be covered by medical insurance - but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by your surgeon.

Preparing for your surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, and taking certain vitamins and medications.

Smokers should plan to stop smoking for a minimum of one or two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon's instructions.

Where your surgery will be performed

Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself usually takes about an hour and a half to complete. However, more extensive procedures may take longer.

Type of anesthesia

Correction of enlarged male breasts may be performed under general, or in some cases, under local anesthesia plus sedation. You'll be awake, but very relaxed and insensitive to pain. More extensive correction may be performed under general anesthesia, which allows the patient to sleep through the entire operation. Your surgeon will discuss which option is recommended for you, and why this is the option of choice.

The surgery

 

Glandular tissue must be cut out, usually through a small incision near the edge of the areola.

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location - either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola - the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula which is attached to a vacuum pump, is then inserted into the incision. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out. Patients may feel a vibration or some friction during the procedure, but generally no pain.

 

Fatty tissue can be removed by liposuction. A small, hollow tube is inserted through a tiny incision, leaving a nearly imperceptible scar.

In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly re-adjust to the new breast contour.

Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

After your surgery

Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.

You'll be swollen and bruised for awhile - in fact, you may wonder if there's been any improvement at all. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

 

Following surgery for gynecomastia, the patient has a more masculine chest contour.

In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough - which could be as early as a day or two after surgery. Any stitches will generally be removed about 1 to 2 weeks following the procedure.

Your surgeon may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You'll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you're back to all of your normal activities.

You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.

Your new look

Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.

The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.

Frequently Asked Questions About

Introduction

Gynecomastia refers to enlargement of the male breast. In the vast majority of men, there is no known cause. Gynecomastia treatment involves the removal of fat and breast tissue, resulting in a chest that is flatter and better contoured.

The surgery should not be considered a substitute for weight reduction. The best results are seen in men with average body weights and firm skin tone. Also, certain drugs (eg. marijuana, anabolic steroids) and medical conditions (eg. liver disease) can aggravate gynecomastia - these should be dealt with before considering gynecomastia surgery.

What type of anesthesia is used during the operation?

This procedure is usually performed under General Anesthesia. An Anesthetist is always present. If you have any particular problems with anesthesia, please let us know.

How long is the operation?

The procedure takes up to 2 hours.

Where are the incisions made?

Two incisions are usually made for each breast. The incisions are very small, no more than 1 centimeter, placed inconspicuously near the armpit, adjacent to the flat part of the nipple (the ‘areola’), or at the outer edge of the fold under the breast.

What else is done during the procedure?

Gynecomastia is most commonly treated with ultrasonic liposuction. First, a salt water and anesthetic solution is injected - this is called tumescence. An ultrasound probe is then inserted into the fat and breast tissue. Vibration of the probe liquefies these tissues. Finally, a thin, long, hollow tube, called a cannula, is inserted under the skin through the small incision. A high pressure suction machine removes the fat and / or breast tissue as the cannula is moved back and forth underneath the skin. Tumescent and Ultrasonic Liposuction are the state of the art in this type of surgery. They help to reduce bruising and swelling, and to speed recovery.

Much less commonly, it is necessary to make a longer incision part way around the nipple in order to remove breast tissue under the nipple. Rarely, excess skin also needs to be removed.

How long is the hospital stay?

Gynecomastia surgery is usually an outpatient procedure, meaning you can go home the same day once you have recovered from the anesthetic.

When are the stitches removed?

Stitches are removed between 7-10 days. Sometimes dissolving stitches are used that don’t have to be removed.

What happens after the surgery?

Most people feel tender and bruised after surgery, but are not in a great deal of pain. Pain medication will make you comfortable.

You should plan to be off work for 4-7 days. During that time you are encouraged to go for leisurely walks. Athletic activities usually have to wait until approximately 2 to 3 weeks.

A support garment is worn for 6 weeks - night and day for the first three weeks, and then during the day for another three weeks. This garment will help reduce swelling and conform the skin to your new shape. Showering is permitted on the 2’nd day after surgery. Massage of the treated areas will begin 7-10 days after surgery to help decrease the swelling faster and to smooth out any irregularities. Scars will initially be red and a little raised, but over 3-6 months they usually get lighter in colour and flatten out.

What are the results?

Reduction in the size of the breasts can be predictably achieved. The scars are usually well hidden. Most patients are very happy with their results.

Is it permanent?

The procedure re-contours the body by reducing the number of cells. This is permanent. If one does gain a significant amount of weight, however, the cells that do remain can enlarge diminishing the benefits. Overall contour, however, remains improved.

Some additional points:

Make sure you let me know your complete medical history as well as any medications, drugs, vitamins, or natural herbs you are taking. For example, diabetes is known to affect wound healing.

Smoking also affects your ability to heal, and I recommend that you stop smoking at least 2 weeks before

surgery. Aspirin, anti-inflammatory pills (like anaprox or motrin), and vitamin E also should be stopped 2 weeks before surgery because they can cause extra bleeding.

I strive to make sure all my patients are well informed. Your questions are more than welcome.

 

 

This symbol designates surgeons who are active members of the American Society of Plastic Surgeons. They are certified in the specialty of plastic surgery by the American Board of Plastic Surgery and are dedicated to the highest standards of patient welfare and surgical excellence.