Gynecomastia

Also known as 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.

You are a good candidate for if  you are reluctant to remove your shirt in public, to swim, to participate in sports or to exercise at a gym, and if you experience psychological discomfort associated with large breasts. After the surgery ,you can feel comfortable revealing your chest contours, clothed or unclothed, and you  can gain more social confidence and enjoy permanent results.

The risks of the procedure are that scarring may make you feel self-conscious.You may be disappointed with your final results. Weight gain following this surgery will compromise results.

Gynecomastia is usually not caused by any serious medical problems; in fact, its cause is rarely identified. However, because there are some medical problems that do cause gynecomastia, your first step is to see your family doctor to rule this out.

Diet and exercise-resistant fat in the chest area can cause both physical and social discomfort.
Maintaining a stable weight will ensure that your improved body contour will be long lasting.

some common reasons why you may want to consider 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 do not use marijuana, steroids or drink alcoholic beverages excessively (it is theorized that these substances may cause gynecomastia).
-If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

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.
Ultrasonic liposuction: Vaser has improved the results of gynecomastia correction. 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; however, liposuction-assisted breast reduction is not effective for correcting glandular gynecomastia. The fatty and glandular components of your breast must be assessed before surgery. Few patients can be sufficiently treated with liposuction only.

Scars resulting from gynecomastia surgery vary, depending on the amount of breast tissue you have and the elasticity of your skin. Even those who have larger breasts and tend to get larger scars are usually quite satisfied with the results.

If you have small breasts that are only fat, then your scars will be tiny (just large enough to admit a liposuction cannula).
If you have large female-like breasts, then the scars may extend across each side of your chest, but your surgeon will attempt to hide them in a crease.
With firm breast tissue, there is usually a scar under the areola.
If the areolas are large and need reduction also, then the scar goes all the way around the areola.
Small incisions for liposuction treatment are placed in hard to see areas on and around the chest.
If surgical excision is required, the incision is commonly made around the areola and under it

Ask you to look in a mirror and point out exactly what you would like to see improved.
Take photos for your medical record, using computer imaging to show improvements you can expect.
Evaluate the elasticity of your skin.
Discuss your options and recommend a course of treatment.
Discuss likely outcomes, including risks or potential complications.
Discuss the type of anesthesia that will be used.

Avoid sunbathing for two weeks before surgery. Tanning your chest skin can potentially increase the risk of permanent scarring.
Quit smoking and nicotine use at least four weeks before surgery since nicotine can impair and delay healing. This includes any nicotine patch or nicotine-containing product.
Two weeks before surgery, stop all aspirin-containing products, medications that contain blood thinners (Ibuprofen Motrin, Advil etc.), vitamin E and herbal supplements, including St. John’s Wort, green tea, Gingko and garlic supplements. You may take one multivitamin a day.
Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Your doctor will advise you to purchase surgical chest compression garments ahead of time, which you should bring to your surgery. You will wear these over a tee shirt, following surgery, for a time specified by your doctor.
Have some comfortable shirts available to wear during the first four weeks after surgery. These need not be larger in size, just comfortable.
Tend to all of your chores before your surgery, so you don’t have to worry about taking care of things during your recuperation. You are not allowed to engage in heavy lifting for several weeks after surgery.
If you routinely have your chest hair removed, avoid doing this for two weeks before and six weeks after surgery.
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.

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 asked to apply Fucidin 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.

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.