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Gynaecomastia or ‘male breast enlargement’ is an uncommon condition, which
can be corrected with surgery. This extra tissue is usually a combination of fat
and glandular tissue. If mainly fatty tissue is present then liposuction alone can
help, but often a cut around the nipple is needed to remove harder glandular tissue,
which cannot be liposucked away. The surgery always leaves scars although these
usually become inconspicuous with time. The larger the breasts, the more extensive
the surgery. This procedure is safe, the results predictable and an immediately
improved appearance is obvious to see. It does take about 12 months before the final
appearance is evident as complete healing takes this long normally. The recovery
is relatively pain free.
Initial Consultation
At your first visit, your suitability for the procedure and your fitness for surgery
will be assessed. Your breasts will be examined. It is important to decide what
is the cause for the gynaecomastia – usually hormonal alterations in puberty or
middle age. Occasionally medication may cause it, and need to be changed. Rarely
testicular tumours (different sized testes with a lump in one) or brain growths
(visual disturbances) or other pathology can lead to hormonal changes and I may
request blood or other tests to find help out the reason for your breast enlargement.
An operation plan will be made and an explanation given on anticipated recovery
time and use of chest supportive garments.
You should be aware of the risks and complications. All your questions should be
answered. A well-prepared patient will do better with surgery and will be more satisfied
with the final result.
Surgery
My usual method of gynaecomastia correction is described below. I will vary this
surgery according to patient's individual requirements, but I find the method below
provides me with excellent results in the majority of patients.
Surgery is usually performed under general anaesthetic. Either day case surgery
or a one-night hospital stay is needed. On arrival on the morning of surgery, you
will meet the anaesthetist who will explain the anaesthetic and risks. I will mark
the incision lines and various other landmarks on your skin with a pen. I will also
take pre-operative photographs at this stage.
After you are under aneasthetic, fluid is injected into the skin to give good pain
relief – the fluid contains a local anaesthetic and vasoconstrictor to stop bleeding.
The incisions for liposuction are usually 3 small (5mm) cuts around the breast mound.
Then the fat is sucked out with a small blunt tipped cannula. If an open approach
is required, then it will usually follow the edge of the nipple to hide the scar
as best as possible. The firmer glandular tissue is removed through this cut. Sometimes
the incision goes all round the nipple, and sometimes only part of the way around.
Rarely the cut will need to extend onto the chest – if the breasts are very big.
The surgery takes approximately one and a half hours. The wounds are closed with
dissolvable stitches and covered with waterproof dressings to allow you to shower
regularly. After surgery, you will be transferred to the recovery area and then
back to the ward. You will have an elasticized support garment placed around your
chest. This will need to be worn for 6-weeks continuously.
Post-Operatively
When you awake from surgery in the recovery area, you should be relatively pain
free. As the local anaesthetic wears off, you may feel a little sore, but painkiller
medication will be prescribed. On the first postoperative day you should be up and
about, and shower. Your breasts will be a little swollen and bruised. Most of the
swelling and bruising takes about 3-weeks to settle. However there still is some
firmness and a little swelling that slowly improves over the next 12-months. It
is only after a year that the final result is evident.
I will see you about 1-week post-operatively for your first visit. Following this,
you should slowly get back to normal domestic activity. Massaging the scars with
an aqueous cream helps them to settle, and should begin gently after the first dressing
change. Firmer massage can start after 3-weeks.
Some numbness in the breast and particularly the nipple may be noticed for the first
few months after surgery. Hypersensitivity can also occur. Both are usually transient.
With regards to driving, I usually advise a period of 1-week with no driving but
again this is very personal and some people recover very quickly and can get back
to driving in a short time. You should be able to return to work within a week to
two, depending on the level of activity required by your job. Physical exercise
can be begun when you feel ready, generally after 4-weeks.
Risks and complications
Gynaecomastia correction is a relatively straightforward procedure. As with any
surgery, however, there are certain risks and complications. It is important to
understand what these are.
- Bleeding (1-5%)
As with any surgical procedure, excessive bleeding following the operation may cause
some swelling and pain. If excessive bleeding occurs, another operation may be needed
to control the bleeding and remove the accumulated blood.
- Infection (under 2%)
A small percentage of patients develop an infection. This is most often seen within
a week after surgery. A postoperative temperature and local redness, warmth and
pain of the breast are signs that may indicate the beginning of an infection. This
can be controlled with the use of antibiotics, but in some cases further surgery
is needed to drain some pus.
- Sensory changes (frequent – transient usually)
Some men report sensory changes: their nipples become oversensitive, under-sensitive,
or even numb. You may also notice small patches of numbness near the incisions.
These symptoms usually disappear with time, but may be permanent in a few patients.
- Asymmetry (mild – frequent)
Mild differences in the shape of your chest exist prior to surgery (the dominant
hand has stronger, bigger chest muscles and there may be differences in the size
of each breast too). Every attempt is made to make each breast the same size/shape,
but small differences will exist. It is important to recognize that these often
were present prior to any operation.
In the unlikely event that you are unhappy with your appearance, this may be necessary.
It is always easier to remove a bit more tissue than put some back, and for this
reason I am always conservative with how much tissue I remove.
Checklist
- Make sure I know all the medication you
are on before surgery.
- Do not take any aspirin or blood thinning
drugs for at least 2-weeks prior to surgery. Paracetamol is safe. Smoking must be
stopped at least 1-week prior to surgery and afterwards until your wounds have healed.
- Arnica is the only homeopathic medicine I would recommend before
surgery.
- Nothing to eat or drink after midnight the night before your operation.
If you are worried post-operatively
• Telephone the ward of the hospital from which you have been discharged.
• Telephone my secretary during office hours – 07780 785186.
• In an emergency (and you have failed to contact me by the above two
methods) then please telephone St George’s Hospital (020 8672 1255) and
ask them to page the Plastic Surgery junior doctor on call (bleep 7050).
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