GYNECOMASTIA (Male Breast Reduction)

About Gynecomastia Suregery(Male Breast Reduction)

A significant number of men in the United States will develop enlarged breast tissue in their chest.  Some estimates suggest 40 to 60% of men can be affected to some degree.  This condition is called Gynecomastia and can be a source of significant embarrassment for some men.  It can occur at any age.  Often, men who suffer from Gynecomastia will refuse to remove their shirt even when at the pool or gym because of social embarrassment.  There are several ways to improve this physical problem by removing the unwanted enlarged breast tissue and skin.  It is necessary, however, to look for underlying treatable medical causes prior to surgical correction.

What Causes Gynecomastia?

There are many causes for enlarged breast tissue in men, Gynecomastia.  Many times several factors are involved; however, frequently, there is no identifiable cause.  Some of the contributing factors include obesity, certain prescription medications, alcohol, marijuana, and steroid abuse.  Many medical illnesses can contribute to Gynecomastia such as thyroid disease, prolactinemia, renal failure, and even some benign and malignant tumors.

Is Male Breast Reduction Right For Me? 

First, a correctable medical cause for Gynecomastia should be sought.  Once this has been done, most healthy men who are bothered by the appearance of their chest are reasonable candidates to be evaluated for surgery.  Patients should be mature enough to understand the procedure, its limitations, and the resultant scaring (if any).

 If you are an adolescent male who suffers from enlarged breast tissue, often the best advice is to wait until the end of puberty to allow hormonal changes to settle out.  Gynecomastia will often disappear in adolescents and patients can avoid a scar from surgery.  However, there are rare cases that warrant surgical correction earlier.

Preparing For Your Gynecomastia Surgery
(Male Breast Reduction)

You will get a set of pre-operative instructions describing how you should prepare for surgery.  Certain medications and nutritional supplements can thin the blood and need to be stopped 2 weeks prior to surgery.  The need for a blood transfusion because of Male Breast Reduction surgery is extremely rare and is not anticipated for this surgery.  Patients should stop smoking one month prior to surgery because smoking is known to increase the risk of surgical complications, slow wound healing, and worsen scars.

Gynecomastia Surgery (Male Breast Reduction)

There are several techniques for correction of Gynecomastia depending on the severity of the breast deformity and the physical characteristics of the breast gland itself. 

Each patient is different, so your surgeon will discuss with you the best option after examining you.  Some techniques only address the underlying gland with minimal scaring of the skin.  Other techniques for severe Gynecomastia must remove extra skin as well as the breast gland which will leave larger visible scars.  Often the scars can be kept just around the nipple.  For the worst cases, a scar along the bottom of the breast, mimicking the natural chest muscle fold (Pectoralis muscle fold) is sometimes needed.  Sometimes the surgeon will recommend a second stage to allow the skin to shrink from the first operation to keep from making a larger scar.

Liposuction may be used to remove excess fat and glandular tissue from the breast area in select cases.

Stitches are usually buried and dissolve.  The patient will usually never see them or have the unpleasant experience of having multiple sutures removed in the office.

INCISION TYPES

All Surgery Carries Some Uncertainty & Risk.

Gynecomastia Surgery or Male Breast Reduction is a relatively straightforward case when performed by a qualified surgeon.  Nevertheless, as with any surgery, there is always a risk of complications.  These include excess bleeding, infection, poor skin healing, poor breast healing.  Because it is sometimes necessary to make incisions around the areola (the round, dark part of the nipple) to remove excess skin, the nipple can be at risk.  In very rare circumstances, the skin of the nipple can loose its blood supply.  If this happens, the nipple can die and cause permanent scarring.  This can be corrected to a large extent after healing by rebuilding the nipple (as is done for female patients with breast cancer), but permanent scars of the nipple itself are still a rare risk of Gynecomastia Surgery, especially very large Male Breast Reductions.  Smokers are at higher risk for many of these complications.  It is important to stop smoking at least a month before surgery.

Delayed wound healing and dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.

Scars: A surgeon must often make incisions to remove excess breast gland and skin except in very select patients who may have their chest recontoured by liposuction alone.  Any incision will produce a permanent scar.  Your surgeon will discuss with you one of several options depending on your excess breast shape and size.  However, most scars heal well and almost all patients are happy to trade these incisions for an improved figure and a greater sense of self-confidence.  In the rare incidence, a scar will be thick and unattractive.  If this is the case with your scars, your surgeon will provide several options to fix or improve them.

Asymmetry: Almost every patient has some natural asymmetry of their chest when comparing one side to the other.  Your surgeon will endeavor to correct any natural differences in your breasts and chest wall and make the two sides of your chest match in size and shape. However, in any type of breast surgery, there can be slight differences in nipple position, breast/chest shape, fullness, and healing that are impossible to predict.  If large differences occur after surgery, your surgeon is committed to provide you with the most pleasing result he thinks he can provide. 

Breast Sensation: Breast and nipple sensation can be changed by any breast surgery and especially Gynecomastia Surgery.  Depending on the amount of tissue that needs to be removed, some men experience reduced chest and nipple sensation because the nerves to the skin can be cut during surgery. These changes are usually temporary and tend to improve with time.  However, numbness can be permanent and may affect your sexual response to breast/nipple stimulation. Many men will have no change in their sensation.

Pain: If you experience severe pain not relieved by pain medicine, notify your surgeon immediately. Some discomfort is expected after surgery and you will receive a prescription for pain medication. The intensity and duration of pain after Gynecomastia Surgery will vary among men. Prolonged or intense pain can be due to scarring around a nerve.

Infection: A small number of men develop an infection. This typically can occur several days to several weeks after the procedure. If an infection does not respond to antibiotic pills, a patient may need intravenous antibiotics in the hospital.  Hospitalization is very rare.

Hematoma and Seroma:A hematoma is a collection of blood under the skin, and a seroma is a collection of the watery portion of the blood under the skin. Hematomas or seromas typically develop within the first few days after surgery; however, they may occur at any time after injury to the breast. The body can reabsorb small hematomas or seromas. Larger ones require the placement of drains for proper healing. A small scar can develop at the surgical drain site.

After Your Gynecomastia Surgery

You will be given a comprehensive set of post-operative instructions prior to your surgery.  You will have steri-strips covering your incisions.  Some patients will have tape or bandages covering the breasts to help shape or support the skin after surgery.  You will be given a post-surgical garment to wear for approximately 4 weeks.

Some patients will need drains under the chest skin for a short time.  If you have drains, you and your family will be instructed on how to care for them. Most patients are able to return to work 10 to 14 days after surgery if they do not have a very active job that requires heavy physical lifting or activity. It can take several months for the chest skin to “settle” and achieve its final contour. 

Patients can experience random, shooting, discomforts or pain after surgery.  This is normal and typically improves within several weeks to months. Some men will notice changes in their breast and nipple sensation after surgery.  Some men are more sensitive, while others are less sensitive.  These sensations tend to even out over time and return to normal, but in a few cases can be permanent.

Additional Surgeries

In the vast majority of cases, your chest can be reshaped in one surgery.  However, in some patients, healing can be unpredictable resulting in significant differences in breast/chest shape, symmetry, or nipple position.  In some cases a second smaller “touch up” surgery is required to give you the best result possible.

Preparing For Surgery

At least 1 month before surgery
Stop smoking at least 1 month prior to your procedure. Smoking reduces circulation to the skin, impedes healing, and can lead to major postoperative complications.

2 weeks prior to surgery
Stop all medications that can thin the blood 2 weeks prior to surgery. These include drugs such as Aspirin, Coumadin, Lovenox, Ibuprofen, Vitamin E, and multiple herbal preparations. These medications may cause bleeding during and after surgery. Please see the last page of this pamphlet for a list of drugs that must be stopped.

Report any signs of a cold or infection that appear the week prior to your surgery. You may need to postpone your procedure to avoid unnecessary complications.

1 week prior to surgery
Do not eat or drink anything after midnight before your surgery. This includes water, ice, or hard candy. The only exception is that you may take your blood pressure or heart medication with a sip of water the morning of surgery.

The day before surgery
Plan to wear comfortable loose fitting clothes to the procedure.
Do not wear jewelry or bring valuables with you on the day of surgery.
You must arrange to have a responsible adult drive you home after your procedure.

What To Expect On The Day Of Surgery

When you arrive, you will be escorted to a preoperative evaluation area where you will be asked to change into a gown and will be given foot covers. Your surgeon and the anesthesiologist will meet with you before you enter the operating room suite. During this time, the surgical consent form will be reviewed with you in detail and special markings may be made on your skin at the surgical site. You will have the opportunity to ask any last minute questions.

Once in the operating room, you will be transferred to our padded operating room table. A nurse will start an intravenous drip in your arm and connect you to monitoring devices. The anesthesiologist will give you medication through your intravenous drip to make you feel drowsy.

When your surgery is completed and your dressings are in place, you will be moved to the recovery room. During this period a recovery room nurse will assure your comfort and continue to monitor you closely.

Your stay in the recovery room will last approximately 1 to 1 1/2 hours. Most patients are fully awake within 30 to 60 minutes after their surgery, but they may not remember much about their time in the recovery room due to some of the anesthesia medication. Once you are ready for discharge, a postoperative appointment will be scheduled and your discharge instructions will be reviewed.

You must have a responsible adult drive you home from the surgery center. This individual should have your prescription filled at the pharmacy prior to taking you home. A responsible adult must stay with you the first night after your surgery because you have been sedated.

Post-operative Instructions

Diet: Start with clear liquids and toast or crackers. If those are well tolerated, progress to a regular diet.

Driving: No driving for 48 hours after your procedure or while taking pain medicine.

Activity: You may walk and climb stairs immediately after surgery. After 4 weeks you may resume light activity such as brisk walking. During the first 6 weeks do not lift anything heavier than a gallon of milk. After 6 weeks you may resume more strenuous aerobic work and lifting activities as tolerated.
Work: Depending on your career and your rate of healing you should be able to return to work within 2 weeks of surgery. Your surgeon will be able to give you a better estimate depending on your physical and professional profile.

Wound Care: Keep your dressings clean, dry, and intact for the first 48 hours. Then remove the top dressing, and leave the paper tapes in place; these will fall off in approximately 1 week. If you go home with a drain, empty and record its daily output. Keep a sterile dry dressing over the site where the drain enters the body. Change this dressing daily. Once the drain is removed, you need to keep a dressing over the drain site for 1 to 2 days or until the drain site heals.

Swelling: Moderate swelling and bruising should be expected during the first 2 to 3 weeks after surgery. During this period wear your post-operative garment under-wires that provides support at all times (except when showering) to minimize swelling and discomfort. Mild swelling will continue for 2 to 3 months.

Bathing: If you do not have a drain you may shower 48 hours after you remove your dressing. If you go home with a drain, you may shower once it is removed. Your surgeon will typically remove your drain 1 to 2 days after surgery. When you do shower do not direct the water spray over your incision site. Do not submerge the incision in a bath or swimming pool for 4 to 6 weeks.

Medications: Ask your surgeon when you should resume your blood thinning medications. All other prescription medications may be resumed immediately.  While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Take the full course of antibiotics given by your surgeon to help prevent infection.

Smoking and Alcohol: Do not smoke for the first month after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption is dangerous while taking pain medicine because it has a tendency to worsen bleeding.

Post-operative Appointment: Your surgeon wi1l schedule follow-up visits at appropriate intervals. Please keep all these appointments so that your progress may be followed closely.

Special Considerations: Call your surgeon immediately if you experience any of the following: excessive pain, bleeding, redness at the incision site, or fever over 101° F.

Final Results: It may take 6 months to year before the chest/breasts reach their final contour and shape. This may seem like a long time, but significant improvement will be immediate and will continue to improve with time.  The ability to wear more stylish clothes or go without a shirt and perform a wider range of activities is very rewarding and worth the wait.