What is Gynecomastia and Who has It?
Gynecomastia is an abnormal enlargement of one or both breasts in men and is very common. It often occurs during puberty and fortunately often subsides spontaneously within a year. Gynecomastia also is also common among elderly men, particularly when there is associated weight gain.
What Causes Gynecomastia?
It may be caused by hormonal imbalance which is often due to medication or other disease processes. The more serious causes of gynecomastia include tumors and all patients with gynecomastia should have a complete medical evaluation before considering surgery on the breast. Once all non-surgically correctable causes have been ruled out or treated, then the patient may be appropriate for surgical correction.
When do we Operate?
Once all non-surgically correctable causes have been ruled out or treated, then the patient may be appropriate for surgical correction. The initial surgical workup includes a detailed physical examination which can distinguish between true gynecomastia (enlargement of breast tissue) and pseudogynecomastia (breast enlargement due to fat accumulation). If it is pubertal, watchful waiting is in order, since in most patients the condition will resolve spontaneously. Surgery is indicated to relieve marked pain and tenderness, severe embarrassment or emotional disturbance.
How is the Surgery Performed?
The surgery is usually performed through a small incision around one-half of the areola/nipple region which tends to heal with little visible scarring. In more severe cases additional or different incisions are necessary and may leave more prominent scars. There is usually dense, firm breast tissue that requires direct excision. Although liposuction is most often used in combination with the excision, it rarely is sufficient by itself. Additionally excess fat is removed from around the chest area and sometimes injected into the upper chest to create a more aesthetic contour.
During your Consult
At the time of your consultation we will review your goals. Dr. Brown will evaluate your medical conditions, drug allergies, current medications/herbal supplements and prior surgical history.
He will examine your chest, take measurements, and finally take photographs. He will discuss his findings with you and outline and appropriate treatment plan.
Prior to Surgery
To get ready for surgery there are a number important steps. We will obtain recent blood work and sometimes obtain medical clearance from your primary doctor
You must stop smoking. You must avoid taking Aspirin, anti-inflammatories and herbal supplements for 3 weeks prior to surgery as this increases the risk of bleeding. Certain hormones must also be stopped as these increase the risk of Deep vein thrombosis
Dr. Brown will perform some markings in the preoperative area. This surgery is typically done under a general anesthesia. Dr. Brown will inject the area with local anesthetic. Most patients are quite comfortable after surgery. An incision is made and the breast tissue removed. Adjustments to the surrounding chest with liposuction and fat grafting to the muscle are done to achieve a more aesthetic result.
How is the Recovery?
Some mild to moderate soreness persists for a few days or week but light activity and exercise is encouraged in the early post op period. Post operative recovery is not particularly painful or difficult. Normal activity is usually achieved within a week. There is a period of compression over the wounds that might range from a week or two to several months. Finally, most people can return to work within a few days or a week.
- Anesthesia Risks
- Poor Healing of Incisions
- Numbness or changes in breast skin or nipple sensation
- Breast Asymmetry
- Fluid Accumulation
- Deep Vein thrombosis
- Cardiac and pulmonary complications
- Possibility of Revision Surgery