Gynecomastia is a condition of enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity, or the use of certain drugs.
Gynecomastia can cause emotional discomfort and impair your self confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.
Gynecomastia is characterized by:
- Excess localized fat
- Excess glandular tissue development
- Sometimes excess breast skin
- Presence unilaterally or bilaterally
Gynecomastia surgery reduces breast size and flattensthe chest contours.
In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced (separate stage)
Extremely large gynecomastia may require surgery akin to reduction mammoplasty (vertical short scar)
How is it performed?
The procedure is performed in an operation theatre under generalanaesthesia.
First, the excess fatty tissue is tackled using liposuction techniques. This requires insertion of a cannula, a thin hollow tube, through small incisions. There are several variations of the incision available –chest wall (in the crease below the breast), anterior axillary crease (near the arm pit) and areolar ( for liposuction of opposite side). Your doctor will recommend the best choice for you. Diluted local anesthesia is infiltrated to reduce bleeding and trauma through these incisions. Then a thin hollow tube or cannula, is inserted through the incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.
Next, the glandular breast tissue is removed to correct gynecomastia. This may be performed using:
- Peri-areolar method – curved incision along lower portion of areola
- Trans-nipple – A “+” shaped incision through the nipple. This is our preferred technique as it results in a scar that is barely visible.
A compressive pressure garment is applied over the areas that were suctioned.
This procedure can be performed as a day-care procedure.
Excision of skin or areolar excess is deferred to a second stage surgery. This is usually performed about 6 months after the first surgery. A “donut” shaped excision of excess skin is performed to either reduce the areolar size or to tighten the lax, sagging skin on the chest.
During your recovery, a compression garment is mandatory as it helps to control swelling and compresses the skin to your new body contours. You will notice swelling and bruising which is expected. Both will subside after a few weeks. Stitches will generally be removed by the seventh day after surgery.
The pressure garment must be worn as instructed for at least 4 to 6 weeks after surgery.
You may return to work in a few days and resume most of your normal activities within a week or two.
The healing process is gradual, so you should wait a while before enjoying the results of liposuction. Occasionally, a touch-up may be desired to further improve an area. This may be performed under local anaesthesia.
Gynecomastia correction is a surgical procedure and has some potential problems associated with it. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.
Gynecomastia surgery risks include:
- Anesthesia risks
- Bleeding (hematoma)
- Blood clots
- Breast asymmetry
- Breast contour and shape irregularities
- Changes in nipple or breast sensation may be temporary or permanent
- Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur (Very rare)
- Deep vein thrombosis, cardiac and pulmonary complications
- Fatty tissue found in the breast might die (fat necrosis)
- Fluid accumulation (seroma)
- Persistent pain
- Poor wound healing
- Possibility of revisional surgery
- Unfavorable scarring
During consultation be prepared to discuss:
- Your surgical goals
- Medical conditions, drug allergies, and medical treatments
- Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
- Previous surgeries
Your Aesthetic surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Take photographs
- Discuss your surgery options
- Recommend a course of treatment
- Discuss likely outcomes and any risks or potential complications
It’s very important to understand all aspects of your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your cosmetic surgeon.
Preparing for surgery
In preparing for surgery, you may be instructed as follows:
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medications
- Stop smoking
- Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding