Gynecomastia is a medical term that comes from a Greek word for “woman-like breasts”. Though this condition is rarely talked about, it is actually quite common. Gynecomastia affects an estimated 40-60% of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male gynecomastia, or over-development of the breast tissue, there is no known cause for the vast majority of cases.
For men who feel self-conscious about their appearance, a breast reduction type surgery can be helpful. The procedure removes fat and/or glandular tissue from the breasts and in extreme cases, removes excess skin. This results in a chest that is flatter, firmer and better contoured.
If you are considering surgery to correct gynecomastia, this will give you a basic understanding of the procedure, when it can help, how this is performed and what results you can expect. It will not answer all of your questions, since a lot depends upon your individual circumstances. Please be sure to ask Dr. Dufresne if there is anything about the procedure you do not understand.
The best candidates for gynecomastia correction: Surgery to correct gynecomastia can be preformed on healthy, emotionally stable men of any age. The best candidates for surgery have firm elastic skin that will reshape the body’s contours. Surgery may be discouraged for obese or overweight men who have not first attempted to correct the problem with exercise and 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 breast fullness will diminish before surgery is considered as an option.
All surgeries carry some risk and uncertainty: When male breast reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nonetheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reactions to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigmentary changes in the breast area or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissues. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.
Initial Consultation: The initial consultation with your surgeon is very important when considering having this procedure. First, a review of your medical history and exam are usually performed to check for signs of other causes gynecomastia, such as impaired liver function, use of estrogen containing medications or anabolic steroids. If medical problems are suspected, you will be referred to the appropriate specialists for further examination. Dr. Dufresne, in extreme cases, may 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 composition. Once your surgeon knows how much fat and glandular tissue was contained within the breasts, he may choose a surgical approach to best suit your needs. Do not hesitate to ask Dr. Dufresne any questions you may have during initial consultation including concerns about the recommended treatment or the cost involved. Treatment of gynecomastia may be covered by medical insurance, but the policies vary greatly. Check with your policy or call your carrier to be sure. If you are covered, make certain you get written preauthorization for 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 medicines or vitamins. Smoker should plan to stop smoking for a minimal of one to two weeks before surgery and during recovery. Smoking decreases circulation, interferes the proper healing and therefore has a higher complication rate. It is therefore, essential to follow all Dr. Dufresne’s surgical instructions.
Types of Anesthesia: Correction of enlarged male breast may be performed under general or, in some cases, under local anesthesia plus sedation. Dr. Dufresne will discuss which option is recommended for you and why this is the option of choice.
The Surgery: Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases of 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 two hours to complete. However, more extensive procedures may take longer.
If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out with the scalpel. The excision may be performed alone or in conjunction with liposuction. The typical procedure and incisions are made in an inconspicuous location: either along the edge of the areolar or in the underarm area. Working through the incision, the surgeon will cut away the excess glandular tissue, fat, and skin from around the areola and from the size and bottoms of the breasts. Major reduction that includes removal of significant amount of tissue and skin may require further incisions that result in more conspicuous scars. If liposuction was used to remove excess fat, the cannula is usually inserted through the existing incisions.
If the gynecomastia consists primarily of excess fatty tissue, Dr. Dufresne will likely use liposuction to remove the excess fat. The small incision, usually less than half an inch in length is made around the edge of the areola, which is a dark part of the skin that surrounds the nipple or, the incision may be placed in the underarm area. A slim hollowed tube called a cannula 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.
Extreme cases where large amounts of fat or glandular tissue are being removed, the skin may not adjust well to this new smaller breast contour. In this case, excess skin may have to be removed in order to allow the remaining skin to firmly readjust to the new breast contour. Sometimes, a small drain is inserted through a separate stab incision to draw off excess fluids. Once closed, incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.
After Your Surgery: When you have had an excision with the scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be easily controlled with medications prescribed by the surgeon. In any case, you should arrange to have someone drive you home after surgery and to help out with activities for a day or two if needed. You will be swollen and bruised for a while. In fact, you may wonder if there has been any improvement at all. To help reduce swelling, you may probably be instructed to wear an elastic pressure garment continuously for a week or two and for a few weeks longer at night, although worse the swelling would dissipate in the first few weeks, it may take three months or more before the final results of the surgery are apparent. In the meantime, it is important to begin getting back to normal. You will be encouraged to begin walking around on the day of surgery and continue to 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 in one to two 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 will be told to stay away from any support or job that risks a blow to the chest area for at least four weeks. In general, it may take about a month before you are back to all your normal activities. You should also avoid exposing resultant 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 sun block.
Your new look: Gynecomastia surgery can enhance your appearance and self-confidence, but it would not necessary change your looks to match your ideal. Before you decide to have surgery, you must think carefully about your expectations and discuss them honestly with Dr. Dufresne. The results of the procedures are significant and permanent. If your expectations are realistic, you will be very satisfied with your new look.
Craig R. Dufresne, M.D., F.A.C.S. is conveniently located to serve Arlington, Alexandria, and Fairfax County