A word about breast
reduction in men...
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 CORRECTION
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
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.