Gynecomastia is a medical
term that comes from the Greek words for "women-like
breasts." Though this oddly named condition is rarely
talked about, it's actually quite common. Gynecomastia
affects an estimated 40 to 60 percent of men. It may
affect only one breast or both. Though certain drugs and
medical problems have been linked with male breast
overdevelopment, there is no known cause in the vast
majority of cases.
For men who feel
self-conscious about their appearance, breast-reduction
surgery can help. The procedure removes fat and or
glandular tissue from the breasts, and in extreme cases
removes excess skin, resulting in a chest that is
flatter, firmer, and better contoured.
If you're considering
surgery to correct gynecomastia, this brochure will give
you a basic understanding of the procedure--when it can
help, how it's performed, and what results you can
expect. It can't answer all of your questions, since a
lot depends on your individual circumstances. Please be
sure to ask your doctor if there is anything about the
procedure you don't understand.
The Best Candidates for gynecomastia reduction
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 treatment 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.
Types 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
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.
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.
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.
