Details of Male Breast (Gynecomastia) Procedure
Consultation
Excess male breast tissue (called “gynecomastia”) is a problem which most commonly affects adolescent and middle-aged men. In young boys going through the puberty stage it is often a normal physiological process that resolves after a few years. However, it can also be due underlying genetic or endocrine disorder, taking certain medications, or other causative factors.
If your family physician is concerned that your gynecomastia is due to an underlying disorder, they will arrange an assessment by a pediatrician or endocrinologist. In middle-aged or older men gynecomastia is commonly due to a generalized increase in body fat, or obesity.
For a more detailed overview of this condition, please click here for a link to the Wikipedia website: Gynecomastia – Wikipedia, the free encyclopedia
Some patients seek a plastic surgery opinion regarding removal of excess breast tissue. Several different options are available, depending on the severity of the condition and the preference of the surgeon and patient. During the consultation, Dr. Andrade will take a focussed history regarding the onset of your condition, its potential causes, and any investigations that have been undertaken. The physical examination of the chest will focus on the amount, if any, of excess skin that needs to be excised, and the amount and type of underlying breast tissue. Currently in Ontario, gynecomastia surgery is an OHIP-insured service if it is performed for the treatment of adolescent gynecomastia or if it is caused by a genetic disorder (eg. Klinefelter’s Syndrome) or chemotherapy. Removal of male breast fat tissue by liposuction is not an insured service.
Surgical Options
Patients with mild-to-moderate gynecomastia who have good skin tone and no significant sagging often only require removal of breast tissue without excision of any overlying skin. This can be accomplished by performing liposuction and/or making a small incision around the lower border of the areola. Dr. Andrade often uses a combination of both techniques. Liposuction provides an effective way to remove excess fatty tissue through a small 4-6mm incision disguised in the skin crease under the breast. A thin metal tube is inserted through this incision and used to aspirate the fat. Any remaining breast tissue which is too dense or adherent to be removed by liposuction, can be directly excised through the incision around the areola.
Patients with severe gynecomastia, particularly those with loose or sagging skin (similar to the appearance of a mature female breast), may wish to have a more extensive procedure involving excision of breast skin plus glandular tissue. These procedures are more effective at tightening the breast skin but the scars are much more obvious.
Preoperative Preparation
Prior to any surgical procedure, a general physical examination by a family physician is recommended. Dr. Andrade is pleased to send a consultation letter to the family physician if the patient wishes to keep them informed of their operation. Routine preoperative blood tests and other tests usually need to be arranged prior to surgery. It is very important to inform Dr. Andrade about all medications, vitamins, and herbal supplements. Some of these substances can increase the risk of bleeding and must be stopped prior to surgery. Do not have anything to after midnight the evening before surgery. Water (no other liquids) may be consumed up to 4 hours before surgery. Dr. Andrade and a registered nurse will review all of these details prior to the operation.
Day of Surgery
Gynecomastia surgery is performed under a general anesthetic, either in Dr. Andrade’s private facility in Newmarket, or at Southlake Regional Health Centre. The anesthetic is delivered by a board-certified Anaeshesiologist. The operation takes approxiamtely 2 hours and total time spent in the facility is approximately 4-5 hours.
Postoperative Recovery
Patients are given a prescription for a narcotic analgesic (pain reliever). Most patients are doing their own self-care and other their light activities the day after surgery, but Dr. Andrade recommends patients avoid heavy lifting or vigorous excercise involving the chest muscles for 4-6 weeks following surgery. Showering is permitted 48 hours postoperatively. Tapes (Steri-Strips) are adherent to the skin and seal off the wound. They usually remain in place for at least 10-14 days, after which time they may be removed. A scar reduction program will be prescribed by Dr. Andrade. Immediately following gynecomastia surgery, the chest may be bruised, swollen, and tender. Most of these symptoms resolve within a few weeks. Dry Andrade will supply a compression garment which should be worn for 4-6 weeks postoperatively to help decrease swelling. The scars generally soften and fade significantly by 6-12 months postoperatively.
Benefits and Risks of Surgery
Most patients are very satisfied with the overall improvement in the appearance of their chest after surgery and have no significant postoperative problems, but unanticipated complications can occur after any operative procedure.
Immediately after surgery, all patients will have some degree of breast pain, swelling, and bruising. Uncommon problems immediately following gynecomastia surgery include but are not limited to bleeding, infection, wound healing problems, chronic pain, changes in breast or nipple sensation, or loss (necrosis) of the areola. Long-term problems can result such as asymmetry, puckering or irregularities of the breast or nipple area, or prominent scars. Rarely, unanticipated life-threatening complications can arise during or after any operation. Dr. Andrade will discuss other specific risks and answer any questions during the consultation.
