GYNECOMASTIA AT POWER PLASTIC SURGERY
Gynecomastia may be associated with other medical conditions, medications, and lifestyle factors. A detailed medical history, physical examination, and other investigations may be performed to rule out an underlying cause. In some cases by addressing the underlying cause, gynecomastia may be reversible. The majority of cases of gynecomastia do not have an identifiable cause and are termed “idiopathic” cases. Surgery may be performed for persistent cases of gynecomastia to address enlarged breast tissue as well as redundant skin and fatty tissue.
What is Gynecomastia?
Gynecomastia refers to enlarged breasts in male patients. It ranges in terms of severity from excess glandular and/or subcutaneous fatty tissue to cases with excess skin as well. Many men express feeling self-conscious due to enlarged breast tissue, particularly when wearing tight-fitting clothing and when taking off their shirts. Others report localized discomfort due to enlarged breast tissue deep to the nipple areolar complex. Gynecomastia may occur in adolescence as well as in older men due to hormonal changes. Many cases resolve within 1-2 years.
Who is a candidate for male breast reduction?
A candidate for gynecomastia correction is otherwise healthy (or with well-controlled medical conditions) and has well-defined goals of surgery. It is important for appropriate work up to have been completed to rule out an underlying reversible cause. If a reversible cause is identified, it is recommended to wait for a period of time to assess whether the gynecomastia resolves. For adolescent patients, this is also an important point since the majority of cases will resolve within 1-2 years. A good candidate for male breast reduction has achieved and maintained a healthy body mass index (BMI) and is a non-smoker. Smoking may increase the risk of developing an infection, wound healing complications, and potentially skin flap or nipple necrosis. An appropriate candidate is able to understand the potential risks of surgery and able to comply with post-operative wound care instructions and activity modifications as healing takes place.
What are options for male breast reduction?
Options for male breast reduction vary based on clinical presentation. The most appropriate technique will depend on the individual patient’s appearance and may include resection of glandular tissue, liposuction, or a combination of these two approaches. In the most severe cases, resection of excess skin may also be required.
Minor cases of gynecomastia may present with a well-localized breast bud deep to the nipple areolar complex. A small focus of gynecomastia may be amenable to direct excision through a small incision along the lower half of the areola. The enlarged breast tissue may be removed through this approach, often leaving minimal scarring hidden at the junction between areola and breast skin. More pronounced cases of gynecomastia may present with more diffuse breast and fatty tissue enlargement. Liposuction may be an option to improve chest contour in these cases, occasionally requiring combined excision of enlarged breast tissue through a periareolar approach. Enlarged breast tissue may be too fibrous for removal with liposuction alone. The most severe cases of gynecomastia also present with skin redundancy. In these cases, a combination of liposuction and direct excision is generally performed.
Although redundant skin may be present, it may resolve in up to 50% of cases over 6-12 months post-operatively. Delaying removal of redundant skin may avoid further scarring in up to 50% of patients as the skin contracts. The most severe cases of gynecomastia may also require skin resection. The trade-off for this approach, although the most powerful in achieving breast reduction and chest contouring, is more prominent scarring.
In patients with significant skin redundancy, the nipple may also require repositioning to a more proportionate location on the chest wall, either through a breast reduction technique or free nipple graft. The most appropriate technique for male breast reduction will be discussed for your particular case during consultation and will be based on your clinical presentation and other factors.
Male breast reduction may achieve the following goals:
- Reduction of enlarged breast and fatty tissue
- Improvement of chest contour
- Repositioning of a low and often enlarged nipple areolar comple
What are risks of male breast reduction?
Risks of gynecomastia correction include delayed wound healing, scarring, infection, hematoma, altered nipple sensation, and potential for skin flap or nipple necrosis. Aesthetic complications may include nipple depression, asymmetry, or thickened scarring. The most common complication is bleeding, which may occur in approximately 5% of cases. If a hematoma develops (which refers to a collection of blood or ongoing bleeding within the breast), further surgery may be required to evacuate the blood collection and to stop any ongoing bleeding. A compression garment is recommended for one month post-operatively, which applies gentle compression to the breasts. This may reduce risk of bleeding and also reduce swelling as healing occurs.
What to expect during consultation for male breast reduction?
Consultation for gynecomastia correction is an important step in pre-operative planning. Dr. Power wishes to understand your motivation for undergoing surgery and specific aesthetic concerns. A detailed medical history will be performed, focusing on potentially reversible causes of gynecomastia. There is a well-known association between gynecomastia and certain prescription medications, anabolic steroids, and marijuana, for example. Other medical conditions (for example, liver, kidney, and endocrine disease) also pose increased risk of developing gynecomastia. Clinical examination will be performed to record various breast and chest wall measurements. It is important to assess whether skin redundancy is present in addition to enlarged breast tissue as this will potentially affect the surgical technique and outcome. In many cases, skin redundancy may not be addressed during the primary surgery to avoid further scarring since it may resolve in up to 50% of cases. Pre-operative photographs will be taken with consent. Routine lab work and potentially other investigations will also be ordered to ensure that you are otherwise healthy and an appropriate candidate to undergo elective surgery under general anesthetic in an out-of-hospital facility. OR paperwork will also be completed. Dr. Power will address your specific concerns and questions. If interested in proceeding with surgery, a second visit will be required to review operative details in more detail and to answer any remaining questions.
What to expect on the day of male breast reduction?
You will be given detailed information regarding when to arrive at the Surgical Suites. It is essential to begin fasting (no eating or drinking) at midnight before surgery. If any prescription medications are routinely taken, Dr. Power will advise whether to take on the morning of surgery with a small sip of water. Dr. Power will see you upon arrival at the Surgical Suites to perform surgical markings and review aftercare instructions. At that time you will also meet your anesthesiologist and nursing team before being taken into the operating room. Surgery will be performed under general anesthetic and you will awaken in the post-operative recovery room.
What to expect after male breast reduction?
Following surgery you may experience localized chest discomfort over the first few days. You may require prescription pain medication over this time period. The prescription will be given in advance and should be filled pre-operatively. A chest binder will be in place following surgery, which will apply gentle compression to the surgical site to reduce swelling and risk of bleeding. Once you are comfortable, tolerating fluids, and walking short distances, you will be discharged home with detailed aftercare and follow up instructions. You will require a responsible adult to drive you home following surgery and to stay with you for 24 hours following the general anesthetic to ensure personal safety. Dr. Power will call you on the evening of surgery to assess your progress. You will be given 24 hour contact information should any concerns arise during your recovery. You may resume showering the day after surgery and will be given information regarding appropriate wound care.
What is anticipated recovery following male breast reduction?
Prescription pain medication will generally be required for a few days following surgery. It is recommended to transition to Tylenol plain or extra-strength as soon as tolerated. You will generally be able to return to school or light office work within a week of surgery. It is important to refrain from exercise or strenuous activity for one month post-operatively to decrease swelling and to lower risk of bleeding. It is recommended to wear the compression garment full-time except when showering over the first month following male breast reduction. Once no longer taking prescription pain medication and able to turn and mobilize sufficiently, you may resume driving.
Male breast reduction is performed as out-patient surgery and is generally a well-tolerated procedure in appropriately selected patients. Patients often report enhanced self-confidence and high satisfaction rates. Results following direct excision may be apparent within a few weeks post-operatively. Swelling may settle more slowly following liposuction and early results may be apparent within 2-3 months. Scar maturation and final results are apparent by one year post-operatively.
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- DR. STEPHANIE POWER