Treatments- gynecomastia and pseudogynecomastia
Treatments- gynecomastia and pseudogynecomastia
The following procedures should be discussed with an experienced Board Certified Plastic Surgeon who will help you choose the technique best suited for each individual.
1. For pseudogynecomastia: Liposuction or lipo sculpture of the of the pseudogynecomastia is used to remove the fatty tissue by suction using a negative pressure source (pump or syringe). Usually performed with tumescent method to decrease bleeding.
2. For true Gynecomastia: Excision of the male breast tissue. This real gynecomastia tissue cannot be suctioned and has to be removed by surgical excision. Usually performed through the lower part of the aerola (between the pigmented part and the skin). When done properly, this usually leaves inconspicuous scars (athletes and body builders cannot afford prominent scars).
3. For a combined pseudogynecomastia (fatty tissue) and true gynecomastia (breast tissue) The treatment of choice is a combination of surgical excision and liposuction (for better breast contour).
4. For treatment of severe Gynecomastia. For easy understanding, we will compare the male breast size to the female breast size (A, B, C, D, DD, etc.) and as such, there are a few modalities of treatment available:
A. Periaureolar (incision around the nipple aureola complex) breast reduction: this procedure is meant for mild to moderate reductions. This can be compared to size A and B in women.
B. Classical breast reduction with superior or inferior flaps: this is for larger breasts (C, D) and leaves an inverted “T” incision and periaurieolar incision. It is used very rarely.
C. Vertical incision breast reduction that results in a vertical subareolar scar (not horizontal scar) in large breasts: this is new and exciting alternative.
Certain specific risks of male breast reduction surgery:
When male breast reduction is performed by an experienced plastic surgeon, complications are infrequent.
1. Scarring can be minimized when the incision is done correctly and in the proper location. In my experience, noticeable scarring is minimal. Should adjustment be necessary, this can be done using several treatment modalities including Kenalog injection, laser and revision.
2. Hypoesthesia (reduced areola sensation). This condition usually improves within six months post surgery. Based on my experience, this has not been a major issue.
3. Areola or breast depression:
A. Static - Can be seen when the pectoral muscle is relaxed. This is the most severe form and sometimes requires correction.
B. Dynamic - Can be seen only when the patient lifts his arm or flexes the pectoral muscle. This is usually less bothersome to the patient.
C. Correction for these conditions:
I. Fat transfer
II. Fat and dermis transfer
III. Injection of Radiance, etc.
4. Recurrence of the breast tissue occurs, according to recent literature on the subject, 10% after excision and 35% after liposuction only. The best solution is prevention which requires a plastic surgeon who is experienced in this type of surgery. In my practice, this has occurred in less than 1% of my patients (intake of steroid after the surgery might increase recurrence rate).
5. Patient who have large areolas prior to surgery: This can be addressed during surgery in several ways:
A. Adequate thinning of the areola. In many cases this is enough to reduce the size. (should be done by a plastic surgeon who is experienced with this technique).
B. Pursestring sutures of the areola and nipple complex.
C. Surgical excision of the areola, which I rarely perform.
6. Hematoma and Seroma: this accumulation of blood and blood products may cause excessive swelling of the breast after the Gynecomastia surgery which sometimes requires intervention. This occurs more often in the following circumstances:
A. People who suffer from high blood pressure.
B. People who take aspirin or blood thinners prior to surgery.
C. People who take certain food supplements.
D. People who take anabolic steroids prior to surgery.
E. People who do not follow postoperative instructions.
Gynecomastia
Breast reduction is not a subject that is often associated with men, but the condition is actually quite common. The medical term means "woman-like breasts". Gynecomastia affects an estimated 40 to 60 percent of men in one or both breasts. While certain drugs and medical conditions can contribute to the breast overdevelopment, most cases do not have a known cause.
Breast reduction surgery can address this problem for men who feel self-conscious about their appearance. The procedure removes fat and/or glandular tissue from the breasts, and if necessary, excess skin. The result is a flatter, firmer chest consistent with masculine body contour. As with all cosmetic surgery procedures, healing and final results are very individualized.
If you think you are a candidate for Gynecomastia correction, this information will help you to understand the procedure. Scheduling a consultation with a board certified plastic surgeon is the best way to have your personal circumstances and all of your specific questions answered.
Breast reduction surgery can be performed on men of any age who are in good physical and emotional health. The best candidates for surgery have firm skin with sufficient elasticity to adopt the body's improved contours.
Certain lifestyle factors can contribute to Gynecomastia. Overweight men should first attempt to correct the problem with weight loss and exercise. Obese men will not be good surgical candidates. Also, men who drink alcoholic beverages to excess or regularly smoke marijuana should stop their use of substances, which may have caused their Gynecomastia. The same is true of anabolic steroids. In these cases, it is best to see if the breast fullness diminishes before surgery is suggested.
All surgery, even an elective procedure, has elements of risk and uncertainty. Using a board certified plastic surgeon minimizes this, but complications may include infection, skin injury, excessive bleeding, excessive fluid loss or retention and adverse reaction to anesthesia. There is also a possibility that the procedure may result in noticeable scars, permanent pigment changes in the breast area, or slight asymmetry of the breasts or nipples. A second procedure may be required to revise the results. There may be temporary loss of breast sensation or numbness after the procedure which may last for several months or even a year.
To Plan Your Procedure
The initial consultation with your surgeon will require your complete medical history, so you will want to be prepared to provide the necessary information. Your surgeon will examine your breasts and discuss lifestyle issues which may be causing your condition. You must be completely open and honest with your surgeon. If there is impaired liver function or another medical problem, you will be referred to a specialist.
A mammogram or breast x-ray may be recommended to determine how much fat and glandular tissue is contained in the breasts. The very small possibility of breast cancer can also be ruled out. With all of this information, your surgeon can plan the best procedure for your needs.
This consultation is also the time to ask all of your questions about the treatment and costs. If you have health insurance, treatment of Gynecomastia may be covered. Call your carrier, and if you are covered, obtain written pre-authorization for the treatment. Your surgeon's office staff will assist you with this.
Preparation For Your Breast Reduction Surgery
You will be given specific instructions, including diet, taking certain vitamins and medications, and stopping cigarette or other smoking for at least one to two weeks prior to your procedure, and during your recovery. You must follow your surgeons instructions carefully. Smoking decreases circulation and impedes healing.
The Surgical Facility
Your breast reduction surgery will most likely be an outpatient procedure, performed at your surgeon's office surgical suite, ambulatory surgical center, or hospital. If there are medical conditions of concern, an overnight hospital stay may be recommended. The procedure typically takes an hour and a half to complete, although individual factors may increase the length of the surgery.
Anesthesia
Your surgeon will choose either general anesthesia or local anesthesia with sedation. Your surgeon will discuss this with you during the surgery planning and will explain the basis for the option recommended.
Your Surgery
In a typical procedure, an incision is made in an inconspicuous location - either on the edge of the dark skin around the nipple, or in the underarm area. 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. If your surgeon has determined that liposuction will be used in conjunction with excision to remove excess fat, the cannula can be inserted through the incisions. In a reduction involving greater amounts of excess tissue, larger incisions may be necessary and can result in more noticeable scars.
If your surgeon has determined that your Gynecomastia consists primarily of excessive fatty tissue, liposuction would be an appropriate surgical technique for removal of this tissue. At the edge of the areola, the dark skin that surrounds the nipple, a very small incision, less than a half inch in length is made. Depending on individual factors and preferences, the incision may be made in the underarm area. A cannula, which is a slim, hollow tube attached to a vacuum pump, is inserted into the incision. Your surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out.
In cases where large amounts of tissue have been removed, it may be necessary for excess skin to be removed so that the remaining skin will adjust to fit the new breast contour.
Occasionally, a small drain will be inserted through a separate incision to relieve excess fluids. Upon completion, the incisions are usually covered with a dressing and the chest may be wrapped with an elastic bandage to hold the skin firmly in place.
Post-Operative Experience
It is normal to feel some discomfort for a few days after your procedure. This can be controlled with medication prescribed by your surgeon. You should arrange to be driven home after your surgery and have someone to help you manage for a day or two if necessary.
Bruising and swelling may make it appear that there's been no improvement in your condition initially. You will most likely be told to wear an elastic pressure garment around the clock for a week or two, and for several weeks longer at night. The extreme swelling will resolve in the first few weeks but it may be three months or longer before your true result is visible.
While you are waiting for this, it is important to begin to resume normal activity. You should walk around on the day of surgery, and return to work within a day or two, as soon as you feel well enough. If you have stitches, they will be removed one to two weeks after the surgery.
You should avoid sexual activity for a week or two, and heavy exercise for about three weeks. You must avoid any activity or job that risks a blow to the chest area for at least a month. Avoid exposing scars to the sun for at least six months. Sunlight can cause the scar to darken permanently. If sun exposure is unavoidable, use a strong sunblock.
The Final Result
Gynecomastia surgery can greatly improve your appearance and boost your self confidence, but individual results are unpredictable. Before undergoing any plastic surgery procedure, discuss your expectations candidly with your surgeon. The results of the procedure are significant and if you have realistic expectations, you will be extremely satisfied with your improved physique.
