What is Gynecomastia Surgery?
Also known as male breast reduction, gynecomastia is a procedure performed to reduce the size of overly large breasts in men. Reduction methods include liposuction, cutting excess glandular tissue or using a combination of liposuction and excision. Gynecomastia can be effectively and safely improved or corrected completely.
Enlarged breasts may be excess fatty tissue rather than breast tissue and, in this case, can often be improved with diet and exercise alone. To treat the puffy nipples associated with gynecomastia, you will probably need liposuction combined with chest reduction procedure using glandular excision. Our board-certified plastic surgeon will determine the best course of treatment path for you, based on your physical appearance.
The Procedure
The goal of gynecomastia surgery is to restore a normal male breast contour and to correct deformities of the breast, nipple or areola. Surgical options include liposuction, excision (surgical removal of tissue) or a combination of both approaches. Glandular breast tissue is denser than fatty tissue and is not appropriate for liposuction.
General anesthesia is commonly used during your Gynecomastia procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. Your surgeon will follow the surgical plan discussed with you before surgery.
The choice of surgical technique depends on the possibility of skin redundancy after surgery. Skin shrinkage is greater in younger rather than older patients:
Intra-Areolar Incision :
The most common approach is the intra-areolar incision, which extends along the circumference of the bottom half of the areola in the pigmented portion.
The length of your incision will be based on your anatomy.
In severe gynecomastia, skin resection and moving the nipple (nipple transposition) may be necessary.
Liposuction:
Liposuction has improved the results of gynecomastia correction. In liposuction-assisted breast reduction, there is less compromise of blood supply, nipple distortion and areola slough. In addition, postoperative complications are fewer with this technique than with open surgical resection; however, liposuction-assisted breast reduction is not effective for correcting glandular gynecomastia. The fatty and glandular components of your breast must be assessed before surgery. Few patients can be sufficiently treated with liposuction only.
Scars resulting from gynecomastia surgery vary, depending on the amount of breast tissue you have and the elasticity of your skin. Even those who have larger breasts and tend to get larger scars are usually quite satisfied with the results.
After your procedure is completed, you will be taken into a recovery area, where you will continue to be closely monitored. Occasionally, drainage tubes may be used for a short time following surgery.
The procedure normally takes between 90-120 minutes.
Am I a candidate for surgery?
You are a candidate for Gynecomastia Surgery:
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Advantages of Gynecomastia Surgery
Disadvantages of Gynecomastia Surgery
Preparation for Surgery
Prior To Your Arrival
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire and will submit a recent Chest X-Ray and photographic images of the problem areas which you wish to have treated.
Initial Consultation: Once the images have been received by us, we will schedule a consultation with your chosen surgeon, via Skype or telephone. This will allow you to ask any questions regarding the procedure and will also allow your chosen surgeon to assess your condition and determine your eligibility for your chosen procedure.
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your chosen surgeon will evaluate you as a candidate for Gynecomastia and clarify what the procedure can do for you. Understanding your goals and medical condition, both alternative and additional treatment options may be considered. You should be prepared to discuss your complete medical history. This will include information about:
If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. The surgeon may recommend that you stabilize your weight before undergoing surgery.
If you think that you may want to become pregnant in the future, discuss this with your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your surgery.
Your treatment plan
Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, at this point including:
In advance of your procedure, your surgeon will ask you to:
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen cosmetic procedure.
Before your departure to come to Cyprus your records will be reviewed thoroughly by our surgeon. This includes Chest X-ray and a complete medical and surgical history.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Remove all your throw rugs or anything on the floor that may cause you to trip.
Move phone and electrical cords close to the walls.
Move necessary personal items you need to reach to shelves and tables that are above your waist level.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Upon Arrival
After traveling to Cyprus, a new set of blood tests, E.C.G and chest X-ray will be taken as well as an in person physical examination. To help detect and track any changes in your breast tissue, your plastic surgeon may also recommend a baseline mammogram before surgery.
The surgeon and anesthetist will meet with you and go through your medical and surgical plan.
During this consultation, your surgeon will discuss your surgical procedure and answer any further questions. Your plastic surgeon will proceed to examine measure and photograph your breasts for your medical record. Your surgeon will also consider and further discuss:
Day before surgery
Your doctor or nurse will give you more instructions based on the type of prep.
You should not eat or drink anything after midnight the evening before your surgery.
Morning of surgery
Bring all your medicines, if any in their original containers with you to the hospital.
You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery.
Your plastic surgeon shall consult with you once again and shall make any markings he needs on your chest, indicating the incision marks for the proposed procedure.
Recovery after surgery
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a couple of hours.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
After your Gynecomastiaprocedure, you shall be placed in a surgical dressing that can include a support bra or garment.
You will have some redness and swelling after the surgery. As the anesthesia wears off, you may experience some pain. Typically, the most pain is experienced within the first 48 hours after Gynecomastiasurgery. Your pain level will decrease each day and may be effectively treated with various pain medications.
Your breasts may feel tight and sensitive to the touch and your skin may feel warm or itchy. You may also experience difficulty raising your arms. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
Most people are able to go home on the day after their surgery.
Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of procedure performed.
Life After Surgery
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
Your recovery time postoperatively depends on how severe your condition is and what was performed for you. The average patient, treated with a combination of liposuction and breast gland tissue excision, will likely be back to work after a week. Gynecomastia surgery usually has a relatively gentle recovery period, however for two to five days, you may feel stiff and sore in your chest region.
The first three postoperative days are critical in your recovery. Movements of the waist and elbow are permitted, but you should curtail vigorous shoulder movement for the first few days. Lateral arm movements are generally allowed, but do not lift your arms up vertically.
Any surgical dressings will be removed within several days. You shall be instructed to wear a support garment.
If you have external sutures, they will be removed in about a week.
You may be able to return to work within a few days to a week, depending on the nature of your job.
Your Activity
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of surgery.
Walking is permitted and encouraged beginning the same day of surgery. At home, start short, daily walks and gradually increase the distance you walk.
Going up and down stairs is permitted. Initially, have someone assist you.
You may lift light objects (less than 10lbs.) after your discharge. This may be increased gradually after 2 weeks. If lifting an object causes discomfort, you should discontinue the activity. This restriction helps prevent hernias at the sites of your incisions.
Showers are permitted 3 days after surgery. Wash over your incisions gently with soap and water. Be careful to rinse well. Pat the incisions dry.
Driving is not permitted for 2 weeks after surgery or your first follow-up visit with your surgeon. If you are taking prescription pain medications or narcotics, DO NOT DRIVE.
Sexual intercourse may be resumed as your comfort level permits.
People with sedentary jobs have returned to work as early as 1week postoperatively. A physically demanding job may require 2-3 weeks before returning to work. This may be determined by you and your employer.
Your bowel habits
You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.
Your diet
There are generally no dietary restrictions following cosmetic surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
Call your surgeon right away if you have:
Long-term
Your surgeon will encourage you to schedule routine mammograms at the frequency recommended for your age group. Following breast reduction, you should continue to perform breast self-examination.
How Long Will the Results Last?
Under normal circumstances, the results of your Gynecomastia surgery will be long-lasting; Routine follow-up with your surgeon is important.
Avoid exposure to direct sun or tanning for about six weeks, until bruising and most of the swelling subside.
Sun rays will prolong swelling and may cause permanent discoloration. Sun exposure in the early stages can cause scars to become more noticeable later.
In some patients with diminished elasticity (most commonly older patients) there may be excess skin or creases postoperatively. Most of these creases will persist for six to twelve months and then lessen significantly and the loose skin usually tightens.
After male breast reduction surgery, there is a phenomenon of spontaneous shrinking of the entire areola. The diameter of the areola is known to decrease ten to fifty percent from the original size. This usually occurs when significant amounts of glandular tissue are removed.
Be patient. It may be three months or more before the swelling subsides and the final results are visible.
Follow-Up
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. For safety, as well as the most beautiful and healthy outcome, whenever you notice any changes in your breasts do not hesitate to contact your surgeon. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.