The best candidates for gynecomastia?
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Correction surgery can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.
Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise and weight loss. Also, individuals who drink alcoholic beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.
When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia and excessive fluid loss or accumulation. Breast reduction may result in loss of breast sensation or numbness. 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.
The initial consultation with Dr. Haas is very important. We will need to complete a medical history, so check your own records ahead of time and be ready to provide this information. First, Dr. Haas will examine your breasts and check for causes of the 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.
Dr. Haas may, in extreme cases, also recommend a mammogram or breast x-ray. This will not only rule out the very small possibility of breast cancer but also will reveal the breast's composition. Once we know how much fat and glandular tissue is contained within the breasts, Dr. Haas can choose a surgical approach to best suit your needs.
We will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking and taking certain vitamins and medications.
Smokers should plan to stop smoking for a minimum of one to two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all of Dr. Haas' instructions.
Surgery for gynecomastia is most often performed as an outpatient procedure. It may be performed in our JCAHO-accredited office-based, surgical facility, an ambulatory surgical facility or a hospital. In extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself usually takes about an hour and a half to complete. However, more extensive procedures may take longer.
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. More extensive correction may be performed under general anesthetic, which allows the patient to sleep through the entire operation. Your surgeon will discuss which option is recommended for you, and why this is the option of choice.
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 surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, a slim hollow tube called a cannula is usually inserted through the existing incisions.
If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola, the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. The cannula, which is attached to a vacuum pump, is then inserted into the incision. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out. Patients may feel a vibration or some friction during the 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 these cases, excess skin may have to be removed to allow the remaining skin to firmly re-adjust to the new breast contour.
Sometimes, a small, temporary 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.
Glandular tissue must be cut out, usually through a small incision near the edge of the areola.
Fatty tissue can be removed by liposuction. A small, hollow tube is inserted through a tiny incision, leaving a nearly imperceptible scar.
Following surgery for gynecomastia, the patient has a more masculine chest contour.
Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can easily be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.
You'll be swollen and bruised for a while. In fact, you may wonder if there's been any improvement at all. To help reduce swelling, you might be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.
In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery and can return to work when you feel well enough, which could be as early as a day or two after surgery. Any stitches will generally be removed about one to two weeks following the procedure.
Dr. Haas may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You'll need to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you're back to all of your normal activities.
You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.
Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with Dr. Haas.
The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.