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Gynecomastia
San Francisco - Oakland - Santa Rosa
Gynecomastia is a term that comes from the Greek word for “woman-like breasts”. Even though this condition is not talked about, it is extremely common. Gynecomastia effects approximately 40-60% of the male population.
Breast enlargement is usually noted during childhood and puberty. However, in many cases, it disappears by the late teens or early twenties. I advise my patients to wait until they have fully matured before undergoing surgery.
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Certain drugs and medical conditions have been linked to gynecomastia, but the vast majority are due to unknown causes. Over the past several years, I have personally seen more and more men with male breast-over-development due to steroid use.
Who is a candidate?
All men with enlarged breasts are candidates but the more extreme cases
of gynocomastia will require more extensive surgery and possibly skin
excision. It is important for the patient to be healthy and emotionally
stable. Men whose gynecomastia is exacerbated by drugs should take this
into consideration prior to surgery.
View
chart of treatment options.
Consultation: The consultation is the first step. It is often a good idea to interview a few physicians. Let us assume you have chosen a board-certified plastic surgeon. These are the questions that are important to ask:
1. Have you
performed surgery for gynecomastia?
How many do you estimate
you have done?
2. Have you had any complications? What are the potential complications
of this surgical
procedure?
3. If I have a complication, how is it handled?
4. May I review your surgical casebook of other patients who have
had surgery performed by
you?
5. May I talk to a patient or two?
6. What are my surgical options?
7. Please explain your postoperative recovery, i.e.
a. Will I have a drain?
b. Is a compression garment used? How long must
it be worn?
c. When can I exercise?
8. What is the cost breakdown?
9. What type of anesthesia? Will it be done by a
board-certified anesthesiologist?
10. Where will the surgery be performed?
Before Surgery Prior to surgery, a personal consultation is the first step for every patient undergoing gynecomastia surgery. During that appointment, Dr. Delgado will ask you to discuss your concerns about your chest. He will use computer imaging to discuss any asymmetries that you may have and to display the locations of the incisions. He will examine your chest and check for causes of gynecomastia, such as liver function, use of estrogen-containing medication, or anabolic steroids. If a medical problem is the suspected cause, you will be referred to an appropriate specialist. If you have an extreme case of gynecomastia, he may 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 composition.
Dr. Delgado provides a precise preoperative booklet that gives pre and post operative instructions, including medications in advance of your surgery. All aspirin and aspirin containing products, including anti-inflammatory products must be stopped two weeks before and two weeks after surgery. Dr. Delgado preoperative instructions will have a complete list of these medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of homeopathic preparations as well as vitamins to take prior to and after surgery. This is done to promote healing and limit bruising.
Anesthesia General anesthesia is performed for gynecomastia surgery, however in some cases local anesthesia with IV sedation is adequate. If sedation is given, you will be awake but very relaxed and pain free. The surgery is performed in the hospital or an outpatient surgery center.
Operative Procedure The surgical management of gynecomastia, in the past, consisted mainly of surgical excisional techniques. The invention of liposuction in 1983 made a major breakthrough in the treatment of gynecomastia. The combination of the two techniques, gladular excision and liposuction ha now become the gold standard. Newer techniques such as ultrasonic assisted liposuction has also added to our armamentarium. This technique is good for removing fat in dense, fibrous areas such as the chest..
Before anesthesia is given, a surgical marking pen is used to draw a detailed “map” on the chest. This architectural plan enables the doctor to make the accurate changes from the sitting to the lying position.
After anesthesia is given, a small 3.0 cm incision is made at the breast crease and liposuction is performed. Next, an incision is made near the edge of the areola. The gland is appropriately excised and liposuction is used again to blend in the areas.
On rare occasions the gynecomastia is purely excessive fatty tissue and all that is required is liposuction.
Fine sutures are placed for skin closure and a bulky dressing and a compression garment is placed.
After Surgery The first few hours after surgery will be spent in the recovery room. When you are fairly alert, you will be able to go home with the assistance of a friend or a family member. At this time it is important to sleep with the head and back elevated to reduce the swelling in the area. The initial dressing is kept in place for approximately five days to reduce the amount of swelling, to re-adhere the skin to the chest area, and to reduce any fluid accumulation. After that time, the garment and the dressing can be removed and you may shower daily and the garment reapplied.
The chest will be uncomfortable for a day or so, but the pain is generally characterized as minimal. Patients may take medications during the first day or two in order to be comfortable during their recovery. By the third day, typically patient will no longer feel the need for pain medication. The recovery period is generally two weeks. Once the bruising and tenderness is gone, which is generally about one week, the patient can return to work in normal activities. Most patients may drive a car and return to work or social activities after one week. Strenuous exercise is avoided for three to four weeks following surgery.
Risks and Complications When male breast-reduction surgery is performed by qualified plastic surgeon, the complications are infrequent. In spite of this, there are risks and complications to every surgery, including infection, bleeding, or reaction to anesthesia. If asymmetry is present, a “touch up” procedure can be done in the future to equalize this asymmetry.
Gynecomastia surgery can enhance your self-confidence and give your chest a more masculine contour. The outcome of the procedure is significant and permanent. If you have realistic expectations, the chance of great satisfaction is extremely high.