Who is not a good candidate for gynaecomastia correction?
If you have pre-existing medical conditions or are an active smoker it may be inappropriate to have cosmetic surgery. If you are obese you should loose weight before considering cosmetic surgery. Men who drink alcohol in excess, use anabolic steroids or smoke marijuana are not good candidates for surgery. It is prudent to first discontinue the use of these substances for at least 6 months before considering gynecomastia surgery. This procedure is not appropriate for men with unrealistic expectations or those who have been encouraged by others to change their appearance.
Types Of Gyneacomastia Correction
Male breast tissue is usually a combination of excess glandular (breast) tissue and fat. Occasionally there is also excess skin. Correction of gynecomastia therefore needs to address the personal needs of each individual. Therefore you treatment may involve one or a combination of the following.
Excision of Breast Tissue
Surgical removal of excess breast tissue is usually required to debulk the breast tissue. An incision is made underneath the areola at its junction with the chest skin. Glandular tissue and fat in the breast region can be removed via this incision.
Liposuction is often used as an adjunct to surgical excision to feather out the periphery of the breastplate and creates a smooth attractive contour. Liposuction alone is rarely enough to treat gynaecomastia except in a few specific cases. In combination surgery the existing incisions are used otherwise small incisions a few millimetres in diameter are made at the edge of the areola or in the underarm area to facilitate liposuction. Full details of liposuction can be found here.
Male Breast Reduction
Some men may have extremely enlarged and droopy breasts with redundant skin, particularly following massive weight loss. In these cases a more significant breast reduction may be indicated. This procedure removes a considerable area of skin with underlying breast tissue and fat. This procedure requires larger incisions and therefore the scars are more conspicuous. The scars are around the areola with a vertical scar beneath the areola and a horizontal scar at the base of the breast area.
What to Expect at Consultation
At your initial consultation, I spend a great deal of time getting to know you personally and taking a full medical history. The success of any cosmetic procedure relies on you being open with me at this stage. It is important for me to explore your reasons for seeking gyneacomastia correction, what you dislike and your expectations of surgery. I also need to know about your general health, lifestyle and medications, prescribed or otherwise. I will examine your chest and assess what components are problematic and what can be done to address your concerns. At the end of that consultation I will describe the surgical options to address your problems and devise your personal surgical plan. I will also explain the risks and limitations of surgery to you at this stage. I always have a second consultation to answer any questions before we book surgery. As a Plastic Surgeon who performs a great deal of breast surgery, I intimately understand how a man’s body image is often related to his chest contour. I aim to help you achieve a natural, masculine result.
Preparing for Gynaecomastia Correction
You should be physically fit and at or close to your ideal weight which should be stable prior to embarking on breast reduction. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop smoking at least 6 weeks ahead of surgery to reduce the risk of wound healing problems. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.
What to Expect on the Day of Surgery
You will need to come to hospital starved and ready for a general anaesthetic. Surgery generally takes one and a half to two hours, and an overnight stay may be required. You will return to the ward around an hour after surgery and be encouraged to mobilise and eat and drink. You will feel swollen and bruised and you will be given appropriate painkillers. I rarely use drains but if I do use drains they will be removed the following day. You will need to wear a compression garment immediately and day and night for four weeks. We can provide a medical device but most men find a tight fitting cycling top is more comfortable and it works just as well.
What to Expect After Surgery
You will go home with some light dressings under your compression garment. Wearing your compressive garment under your clothing will facilitate resolution of swelling. You should keep the wounds clean and dry for the first week. You will need someone to collect you and offer minimal support you at home for the first few days. You will be reviewed in clinic at one-week post op and the dressings are changed (if required). You should arrange to take up to a week off work depending on your job. You can return to light exercise at two weeks provided you do not do anything strenuous for 4 weeks. Contact sports and racquet sports should be avoided for 6 weeks. You may experience some mild discomfort over the first week and will be prescribed oral pain medication for this. Mild swelling of the chest area and bruising will resolve within two to three weeks. Once the scar has healed you can start to massage with a simple moisturiser. Bruising and swelling persist for a number of weeks and you may find that one side settles more quickly than the other leaving you asymmetric (lopsided) whilst the other side catches up. This is perfectly normal and we will not start to see the final results for at least six weeks, sometimes longer. The scar will be red/pink initially and slowly fade over many months or years. You should avoid exposing your incisions directly to the sun for a year. Tanning of the scars can cause hyperpigmentation, which means that they become darker and more visable rather than fading. Ideally you should wear a rash vest or similar when in the sun but otherwise use a sunblock (SPF 30+).
Potential Risks and Complications of Gynaecomastia Correction
Early complications include swelling, bruising and altered nipple sensation. These normally settle down with time although nipple sensation may take many months to recover and in some cases the changes are permanent. Occasionally patients experience infection, haematoma (a collection of blood under the skin), delayed healing and seroma (a collection of tissue fluid). Nipple loss due to interruption of blood supply has been described but is rare. There is also a small risk of asymmetry or a slight concave appearance to the chest after surgery. Complications of any general anaesthetic include potential cardiac or respiratory problems and blood clots in the leg (DVT or in the lung (PE). The scars will be red / pink for a number of months however some patients developed abnormally thickened scars, which may require additional treatment in the clinic. It is very unusual to have scars that require additional surgery.