Gynecomastia is a medical term that comes from the Greek words for "woman-like breasts." Although this condition has an unusual name and is rarely talked about, it is actually very common, affecting an estimated 40-60% of the male population. In some cases it may only affect one breast. Although certain drugs and medical problems have been linked with mail breast overdevelopment, there is no known cause in the 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.
The best candidates for gynecomastia corrective surgery are healthy, emotionally stable men of any age who have firm, elastic skin that will reshape to the new contours. Men who are obese may be encouraged to try a good diet and better exercise to correct the problem before surgery. Also, men who are heavy drinkers or marijuana smokers may be advised to cease these activities to correct the problem instead of surgery. These type of drugs, along with anabolic steroids may be the cause.
Complications are infrequent and usually minor if at all. Nevertheless, as with any surgery there are some potential risks to consider. 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. You may experience a temporary (or possibly up to a year) loss of feeling or numbness in the breast.
Planning your surgery
The initial consultation is very important to review your unique situation including your complete medical history. First there will be an examination of your breasts to check for causes of 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.
In extreme cases, a mammogram, or breast x-ray will be recommended. This will not only rule out the very slim chance of breast cancer, but also reveal the breast's composition. This will help assess the amount of fat and glandular tissue to help determine the best surgical approach to best suit your needs.
It's important to ask any questions or express any concerns you may have regarding the procedure during the initial consultation. Make sure to identify whether your insurance will cover the procedure and if so, be sure to get a pre-authorization letter written for the treatment recommended.
Preparing for your surgery
You will receive detailed instructions on how to specifically prepare for your surgery. These may include diet, drinking or vitamin taking guidelines. Smokers should plan on not smoking for one to two weeks before and after surgery. Smoking decreases circulation and interferes with proper healing. It is crucial to follow all of your surgeon's instructions to minimize risks or complications with your surgery.
Type of anesthesia
Correction of enlarged male breasts may be performed under general, or in some cases, under local anesthetic plus sedation. You'll be awake, but very relaxed and insensitive to pain. If the correction procedure is more extensive, a general anesthesia may be used which allows the patient to sleep through the entire operation. The best option for you will be determined beforehand.
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 underarm area. Working through the incision, the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast is cut away. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more noticeable scars. If liposuction is used to remove excess fat, the cannula, a slim hollow tube that is attached to a vacuum, is usually inserted through the existing incisions. Using strong deliberate strokes, the cannula is moved through the layers beneath the skin, breaking up the fat and suctioning it out. Patients may feel a vibration or some friction during this 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 such instances, the excess skin may be removed to allow the remaining 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'll most likely experience some form of discomfort. This can be moderated with prescribed medications. You should arrange for someone to drive you home after the surgery and help you out for a day or two if needed. The swelling and bruising may make you feel as if nothing has been accomplished by the procedure. To reduce swelling, you'll probably wear an elastic pressure garment continuously for a week or two, and at night for a few more weeks. It may be up to three months or possibly more for the final results of your surgery to be noticeable.
In the meantime, your life will get back to normal rather quickly. You'll be up and about a day or two after surgery and can return to work as soon as you feel up to it. Any stitches will generally be removed one to two weeks after surgery.
You may be advised to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You'll be advised to avoid any sports or job that may result in a blow to the chest area for about four weeks. Typically it will be a month before you are back to all of your normal activities.
You should avoid exposing the scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to darken. If sun exposure is unavoidable, use a strong sunblock.