Piedmont Plastic Surgery and Dermatology

A word about breast reduction, also known as Gynecomastia, in men...

Gynecomastia is a medical term that comes from the Greek words for "women-like breasts." Though this oddly named condition is rarely talked about, it's actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.

For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

If you're considering surgery to correct gynecomastia, this brochure will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

THE BEST CANDIDATES FOR GYNECOMASTIA CORRECTION

Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.

Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or 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 the breast fullness will diminish before surgery is considered an option.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue.

The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.

PLANNING YOUR SURGERY

The initial consultation with your surgeon is very important. Your surgeon will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, your surgeon will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist.

Your plastic surgeon may, in extreme cases, 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's composition. Once your surgeon knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs.

Don't hesitate to ask your surgeon any questions you may have during the initial consultation- including your concerns about the recommended treatment or the costs involved. Treatment of gynecomastia may be covered by medical insurance--but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the 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 vitamins and medications.

Smokers should plan to stop smoking for a minimum of one or two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon's instructions.

WHERE YOUR SURGERY WILL BE PERFORMED

Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or 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 complete. However, more extensive procedures may take longer.

TYPE OF ANESTHESIA

Correction of enlarged male breasts may be performed under general, or in some cases, under local anesthesia plus sedation. You'll be awake, but very relaxed and insensitive to pain. More extensive correction may be performed under general anesthesia, which allows the patient to sleep through the entire operation. Your surgeon will discuss which option is recommended for you, and why this is the option of choice.

THE SURGERY

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location--either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola--the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula which 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. Patients may feel a vibration or some friction during the procedure, but generally no pain.

In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly readjust to the new breast contour.

Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

AFTER YOUR SURGERY

Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.

You'll be swollen and bruised for awhile--in fact, you may wonder if there's been any improvement at all. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can 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 about 1 to 2 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'll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you're back to all of your normal activities.

You should also avoid exposing the resulting 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 Sunblock.

YOUR NEW LOOK

Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.

The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.

In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts.

The surgeon will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.

Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a "predetermination letter" if required.)

PREPARING FOR YOUR SURGERY

Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.

Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Breast reduction surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite. If you are admitted to the hospital, your stay will be a short one. The surgery itself usually takes two to four hours, but may take longer in some cases.

TYPE OF ANESTHESIA

Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.

THE SURGERY

Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.

In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)

Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. In some cases, techniques can be used that eliminate the vertical part of the scar. And occasionally, when only fat needs to be removed, liposuction alone can be used to reduce breast size, leaving minimal scars.

AFTER YOUR SURGERY

After surgery, you'll be wrapped in an elastic bandage or a surgical bra over gauze dressings. A small tube may be placed in each breast to drain off blood and fluids for the first day or two.

You may feel some pain for the first couple of days-especially when you move around or cough-and some discomfort for a week or more. Your surgeon will prescribe medication to lessen the pain.

The bandages will be removed a day or two after surgery, though you'll continue wearing the surgical bra around the clock for several weeks, until the swelling and bruising subside. Your stitches will be removed in one to three weeks.

If your breast skin is very dry following surgery, you can apply a moisturizer several times a day, but be sure to keep the suture area dry.

Your first menstruation following surgery may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This usually fades over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent.

GETTING BACK TO NORMAL

Although you may be up and about in a day or two, your breasts may still ache occasionally for a couple of weeks. You should avoid lifting or pushing anything heavy for three or four weeks.

Your surgeon will give you detailed instructions for resuming your normal activities. Most women can return to work (if it's not too strenuous) and social activities in about two weeks. But you'll have much less stamina for several weeks, and should limit your exercises to stretching, bending, and swimming until your energy level returns. You'll also need a good athletic bra for support.

You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell, and to avoid anything but gentle contact with your breasts for about six weeks.

A small amount of fluid draining from your surgical wound, or some crusting, is normal. If you have any unusual symptoms, such as bleeding or severe pain, don't hesitate to call your doctor.

YOUR NEW LOOK

Although much of the swelling and bruising will disappear in the first few weeks, it may be six months to a year before your breasts settle into their new shape. Even then, their shape may fluctuate in response to your hormonal shifts, weight changes, and pregnancy.

Your surgeon will make every effort to make your scars as inconspicuous as possible. Still, it's important to remember that breast reduction scars are extensive and permanent. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Fortunately, the scars can usually be placed so that you can wear even low-cut tops.

Of all plastic surgery procedures, breast reduction results in the quickest body-image changes. You'll be rid of the physical discomfort of large breasts, your body will look better proportioned, and clothes will fit you better.

However, as much as you may have desired these changes, you'll need time to adjust to your new image-as will your family and friends. Be patient with yourself, and with them. Keep in mind why you had this surgery, and chances are that, like most women, you'll be pleased with the results.