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  • What is Gynecomastia?

    Labiaplasty is a cosmetic surgery procedure that reduces the size of the inner lips of the vulva (labia minora) so that they are smaller than the outer lips (labia majora). But what actually happens during this process? Labia Minora (inner lips) Reduction – Many women dislike the large protuberant appearance of their labia minora. This may cause severe embarrassment with a sexual partner. The overly large labia minora can also result in constant irritation in tight pants. Surgical labial reduction can greatly improve the aesthetic appearance of the abnormally enlarged labias. Some women are born with large labia, others may develop this condition with childbirth or age. Labia Majora (outer lips) Reduction – This common anatomical variation may be worsened by childbirth or by weight gain or loss. They may sometimes be improved by liposuction. In more severe cases, surgical reduction is necessary.

  • Results of Gynecomastia

    For young boys, having enlarged breasts may take only a few years, and in most cases resolved at the age of 18. However, enlarged breasts on men can be awkward, not to mention socially and psychologically destructive.

    In today’s demanding corporate world, looking your best is essential. This is the reason why an increasing number of men opt to have cosmetic surgery, a trend that studies have proven is associated with career development. A study showed that 84 percent of men surveyed deemed that physical appeal is vital in attaining power and success on the job.

    Many patients who went through breast reduction surgery are pleased with their new, attractive shape and have boosted their self-confidence.

  • What are the potential causes of Gynecomastia?

    Gynecomastia is triggered by a decrease in the amount of the hormone testosterone compared with estrogen. The cause of this decrease can be conditions that block the effects of or reduce testosterone or by a condition that increases your estrogen level. Several things can upset the hormone balance, including:

    Natural hormone changes (The testosterone-estrogen balance)

    – The hormones testosterone and estrogen control the development and maintenance of sex characteristics in both men and women. Testosterone controls male traits such as muscle mass and body hair; estrogen controls female traits including the growth of breasts.

    – Most people think of estrogen as an exclusively female hormone, but men also produce it — though normally in small quantities. Estrogen helps regulate bone density, sperm production and mood. But male estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.

    Gynecomastia in infants

    – More than half of male infants are born with enlarged breasts due to the effects of their mother’s estrogen. Generally the swollen breast tissue goes away within two to three weeks after birth.

    Gynecomastia during puberty

    – Gynecomastia caused by hormone changes during puberty is common. In most cases, the swollen breast tissue will go away without treatment within six months to two or three years.

    Gynecomastia in men

    – The prevalence of gynecomastia peaks again between the ages of 50 and 80. At least one-quarter of men are affected during this time.

    Medications

    A number of medications can cause gynecomastia. These include certain:

    – Anti-androgens used to treat prostate enlargement or cancer and some other conditions. Examples include cyproterone, flutamide, finasteride and spironolactone.
    – AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz is more commonly associated with gynecomastia than are other HIV medications.
    – Anti-anxiety medications, such as diazepam (Valium).
    – Tricyclic antidepressants.
    – Antibiotics.
    – Ulcer medications, such as cimetidine.
    – Cancer treatment (chemotherapy).
    – Heart medications, such as digitalis and calcium channel blockers.
    – Street drugs and alcohol

    Substances that can cause gynecomastia include: – Anabolic steroids and androgens
    – Alcohol
    – Amphetamines
    – Marijuana
    – Heroin

    Certain health conditions
    Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:

    – Hypogonadism. Any of the conditions that interfere with normal testosterone production, such as >Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia. Aging. Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.
    – Tumors. Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
    – Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine.
    – Kidney failure.
    – Liver failure and cirrhosis
    – Malnutrition and starvation.
    – Herbal products Plant oils, such as tea tree or lavender, used in shampoos, soaps or lotions, have been associated with gynecomastia. This is probably due to their weak estrogenic activity.

    In about 25 percent of cases, the cause of gynecomastia is never found.

    What are the Symptoms

    Signs and symptoms of gynecomastia include:

    – Swollen breast gland tissue – Breast tenderness Prognosis
    Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss.

    Massive weight loss can result in sagging tissues about the chest, chest ptosis. The size and geometry of the fibro-glandular tissue present is unique to each patient. This results in a range of physically apparent aesthetic deformities, for which, classification systems have been devised

    Types
    There are multiple manifestations of gynecomastia. The following types have the same basic features of gynecomastia in common, namely, hypertrophy of the male breast glandular tissue, but vary in size, shape, and the extent to which they are intermixed with adipose and fibrous tissue.

    Puffy Nipples
    Puffy Nipples is among the most common forms of gynecomastia. This glandular tissue accumulation is concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola.

    Pure Glandular
    In bodybuilders this may be a result of the use of anabolic steroids. Due to their low level of body fat, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue. Proper treatment of pure gynecomastia can be done only by excision of the breast tissue, which in the case of bodybuilders is by itself sufficient to achieve a flat nipple-areola complex. Liposuction is only rarely necessary.

    Adolescent
    Congenital or Hereditary Gynecomastia is typically evident by the ages of 9 to 14 in boys. Thirty percent to sixty percent of young boys suffer from large male breasts. As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases the gynecomastia will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, in consultation with the patient, the parents, and child development professionals.

    Adult
    The most common form of gynecomastia. Gynecomastia in most adults is composed of glandular tissue but may contain varying quantities of adipose and fibrous tissue.

    Pseudogynecomastia
    Pseudogynecomastia is composed not of glandular tissue, but of adipose tissue. It looks much like real gynecomastia but requires different treatment. Exercise and diet may be effective in combating pseudogynecomastia. Only if this regimen is unsuccessful should surgery be considered. This is generally the only type of gynecomastia which can be improved with liposuction, but excision may be indicated in some cases. This is also known as “false Gynecomastia” and is often attributed by obesity whereby insulin interacts with an excess of sugars or certain carbohydrates, namely those of which that have been processed.

    Severe gynecomastia
    Severe gynecomastia is characterized by excess and/or saggy skin and severely enlarged breasts. This is itself determined in part by age, as older persons suffering from gynecomastia tend to have less skin elasticity and thus will have a greater abundance of excess skin related to gynecomastia. Experienced cosmetic surgeons will perform as much of the surgical treatment of severe gynecomastia as possible through an aereolar incision so as to avoid extensive scarring. However, some scarring may be unavoidable when treating extreme cases of gynecomastia.

    What are tests for Gynecomastia?
    Your doctor will ask you questions about your medical history, what medications you’re taking and what health conditions run in your family. The doctor will also do a physical examination that may include careful evaluation of your breast tissue, abdomen and genitals.

    Your doctor will want to be sure your breast swelling is actually gynecomastia and not another condition. Other conditions that can cause similar symptoms include:

    – Breast cancer. This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
    – A breast abscess (mastitis).

    Initial tests to determine the cause of your gynecomastia may include:

    – Blood tests – Mammograms

    You may need further testing depending on your initial test results, including:

    – Chest X-rays
    – Computerized tomography (CT) scans
    – Magnetic resonance imaging (MRI) scans
    – Testicular ultrasounds
    – Tissue biopsies

    Coping and Support/Psychological Issues

    Gynecomastia can be emotionally devastating. Feelings of shame, embarrassment and humiliation are common. One does not feel masculine in a society where masculinity is exalted. Self-hate threads itself through all aspects of the individual’s life, creating an insidious web of powerlessness. A man or boy with gynecomastia struggles with anxiety over such simple acts as taking off his shirt at the beach.

    For many men, the best solution is surgery. That accomplishes step one of the healing. Step two is psychological redress. From childhood taunting to a lifetime of hating his chest, the hurt feelings will not go away with the fact of breast reduction alone.

    Men who have developed gynecomastia later in life from steroid abuse or some other cause may have little to no psychological distress. However, for some in this situation, it can leave them feeling out of control of their body or emasculated in some matter. Hopefully, corrective surgery will resolve these feelings, for some it will not and therapy will needed to relieve the distress.

    It is important to recognize the scars on the inside. This is difficult work because it means coming to terms with one’s body and past. Acknowledging the pain, moving into a new relationship with one’;s body and changing how he thinks the world sees him is the key to healing and freedom.

    Men often have a very difficult time talking about their breasts to anyone, but it is the first step toward relief. Realizing that they are not alone is a powerful antidote for the shame and a beginning toward healing.
    For a man, enlarged breasts can be stressful and embarrassing. Gynecomastia can be difficult to hide and a challenge to romantic relationships. During puberty, gynecomastia can make boys a target for teasing from peers. It can make activities like swimming or changing for gym class traumatic. Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself. These feelings are normal, but there are a few things you can do to help you cope:

    Get counseling.Talk therapy can help you avoid anxiety and depression caused by gynecomastia. It can also help you communicate with your partner or family members so that they understand what you’re going through.

    Reach out to your family and friends.You may feel embarrassed to talk about gynecomastia with the people you care about. But explaining your situation and asking for help will likely strengthen your relationships and reduce stress.

    Connect with others who have gynecomastia.Talking with men who have had a similar experience can help you cope. Web sites such as Gynecomastia.org provide a forum for connecting with others who have the condition.

    Prevention

    There are a few factors you can control that may reduce the risk of gynecomastia, including:

    – Don’t use illicit drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
    – Avoid alcohol. Don’t drink, or drink very little.
    – Review your medications. If you’;re taking medication known to cause gynecomastia, ask your doctor if there are other choices.

    Treatments and Drugs for Gynecomastia

    Most cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you’re taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.

    In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than three years. However, treatment may be necessary if gynecomastia doesn’t improve on its own, or if it causes significant pain, tenderness or embarrassment.

    Medications

    Medications used to treat breast cancer and other conditions, such as tamoxifen and raloxifene, may be helpful for some men with gynecomastia. Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for this use.

    Surgery to remove excess breast tissue

    If you still have significant bothersome breast enlargement despite initial treatment or observation, your doctor may advise surgery. Two types of surgery are used to treat gynecomastia:

    – Liposuction. This surgery removes breast fat, but not the breast gland tissue itself.
    – Mastectomy. This type of surgery removes the breast gland tissue. The surgery is done on an endoscopic basis, meaning only small incisions are used. This less invasive type of surgery involves less recovery time.

    Surgical Remedy

    In cases of obesity, weight loss can alter the gynecomastic condition, but for many it will not eliminate it. For all other causes, surgery is the only known physical remedy. Once the physical encumbrance is lifted, psychological scars still need to be addressed. One must come to terms with one’s body, accept it, and heal the wounds from the past.

    Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should talk with their doctor about revising any medications, such as risperdal, that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternative eplerenone can be used). Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens (typically testosterone) or aromatase inhibitors such as Letrozole are medical treatment options, although they are not universally approved for the treatment of gynecomastia.

    Endocrinological attention may help during the first 2–3 years. After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction, gland excision, skin sculpture, reduction mammoplasty, or a combination of these surgical techniques) the only treatment option.

    Many American insurance companies deny coverage for surgery for gynecomastia treatment on the grounds that it is a cosmetic procedure. Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy. Compression garments can camouflage chest deformity and stabilize bouncing tissue bringing emotional relief to some. There are also those who choose to live with the condition.

    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.

    – For pseudogynecomastia: Men 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.

    – For true Gynecomastia: Excision of the male breast tissue. This real gynecomastia tissue cannot be suctioned and has to be removed by surgical excision – male breast reduction. 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).

    – For a combined pseudogynecomastia (fatty tissue) and true gynecomastia (breast tissue) The treatment of choice is a combination of surgical excision and liposuction for men (for better breast contour).

    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:

    – Periaureolar (incision around the nipple aureola complex) male breast reduction: this procedure is meant for mild to moderate reductions. This can be compared to size A and B in women. – Classical breast reduction with superior or inferior flaps: this is for larger breasts (C, D) and leaves an inverted xTx incision and periaurieolar incision. It is used very rarely.

    – Vertical incision breast reduction that results in a vertical subareolar scar (not horizontal scar) in large breasts: this is new and exciting alternative.

  • Candidates for Gynecomastia

    Gynecomastia surgery is best recommended for healthy men who have overly developed breasts. Overweight or obese men who have not sought exercise or weight loss as preliminary solutions are discouraged from undergoing surgery. Gynecomastia is also not recommended for individuals who drink too much alcoholic beverages or smoke marijuana. These drugs, combined with anabolic steroids, may cause Gynecomastia. Patients are advised first to stop the use of these drugs to know if the breast fullness will be reduced before resorting to surgery.

  • Your Consultation

    RVB will discuss with you your goals and expectations of the surgery. The doctor will evaluate the nature of your breasts and the elasticity of your skin to determine the cause of your breast enlargement, which can be brought about by fatty tissue and/or glandular tissue.

    Your doctor may present you several pre- and post-surgery photographs of patients having similar breasts. The procedure will then be explained to you as well as the possible outcome.

    Planning 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 of your 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. Before surgery you will have a complete medical checkup to rule out any curable medical cause of your enlarged breasts. Obesity, impaired liver function, excessive use of alcohol or marijuana, estrogen containing medications and anabolic steroids can all contribute to gynecomastia. If any of these conditions are detected, they must be corrected before surgery can be performed. Overweight men are encouraged to diet and exercise prior to their surgery.

  • The Gynecomastia Procedure

    Male Breast Reduction is done on an outpatient basis with the use of a local or general anesthesia. The procedure takes from 1 to 3 hours depending on the extent of correction.

    Your surgeon will make an incision under your breasts or around the areola (the dark skin around the nipple). Liposuction is usually the treatment of choice to remove these excess localized fat deposits. Persistent excess glandular tissue, fat and skin can be surgically removed from around the areola and from the bottom and sides of the breasts to create a new smaller breast contour if liposuction is not indicated.

    Swelling and bruising are normal and will subside over the next few weeks. You will need to wear an elastic bandage or pressure garment as your breasts heal. Scarring is usually minimal and will fade with time. You should avoid direct sun exposure for six months.

    Options and Alternatives

    Liposuction
    – Liposuction is preferred if your Gynecomastia shows fatty tissues as the primary cause. Liposuction surgery is the process used to actually take out unwanted loaclized deposits of fat cells from the body. A straw-like cannula is inserted through a tiny incision placed in an inconspicuous location on the skin. With the use of a vacuum system attached to the cannula, excess fat cells are sucked out. The result is the transformation of bulging breasts into more attractive contours. Traditional Surgical Excision
    – Should your Gynecomastia prove to be a result of a glandular disorder, liposuction alone may not likely be beneficial. Traditional surgical excision may be the best way to go.

    – The excision may be done alone or in combination with liposuction. The incision is typically placed on the edge of the areola (colored area of the nipple) or in the underarm area. What your surgeon will do is he will work through these incisions to eliminate the excess glandular tissue, fat, and skin from the breast. If your reduction necessitates the removal of significant amounts of tissue, larger incisions may be required.

    – In extreme cases where there are large amounts of fat and/or glandular tissue that have to be removed, excess skin may also have to be excised.

    Pectoral Implants
    – Silicone implants for men are called “Pec” implants. These are used to enhance the pectoral muscles of a man’s chest. Pec implants can be inserted simultaneously with your breast reduction surgery and may add an hour to the process.

    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.

  • Risk

    As with any other surgery, the risks with a procedure like this involves bleeding, infection, numbness, poor healing or a reaction to anesthesia. The specific risks of Male Breast Reduction surgery can be discussed thoroughly in your personal consultation with our doctors.

    You can minimize the risk of bleeding by terminating Aspirin products a few weeks before your surgery, as well as two weeks after your surgery. Patients can diminish the risk of poor blood supply or dead tissue by not smoking before or after the surgery.

    Certain specific risks of male breast reduction surgery:
    When male breast reduction is performed by an experienced cosmetic surgeon, complications are infrequent.

    – 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 Triamcinolone injection, laser and revision.

    – Hypoesthesia (reduced areola sensation). This condition usually improves within six months post surgery.

    – Areola or breast depression:

    – Recurrence of the breast tissue occurs, according to recent literature on the subject, 10% after excision and 35% after male liposuction only

    Patient who have large areolas prior to surgery: This can be addressed during surgery in several ways:
    Adequate thinning of the areola. In many cases this is enough to reduce the size. Pursestring sutures of the areola and nipple complex.
    Surgical excision of the areola. Hematoma and Seroma: this accumulation of blood and blood products may cause excessive swelling of the breast after the Gynecomastia treatment surgery which sometimes requires intervention. This occurs more often in the following circumstances:

    – People who suffer from high blood pressure.
    – People who take aspirin or blood thinners prior to surgery.
    – People who take certain food supplements.
    – People who take anabolic steroids prior to surgery.
    – People who do not follow postoperative instructions.

  • Recovery

    Bed rest is advised for the first day. You will experience some pain for a couple of days. For the first few days after your surgery, you will have to wear surgical dressings which will be substituted for a special compression garment. This will have to be worn for a period of two weeks. Your surgeon may prescribe oral medication for the control of discomfort related with breast surgery. Antibiotics may also be prescribed.

    A majority of men who undergo the procedure experience some degree of swelling, bruising, and tenderness. These symptoms should mellow down in a short time. Within about two weeks, all sutures are cleared away. Your surgeon will discuss with you the appropriate time of returning to your normal activities. Most patients are back to work within the first week.

  • 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.

FAQs

    What type of anesthesia will be used for this procedure?
    – General or local anesthesia with sedation is often utilized in Gynecomastia surgery procedures.


    How long will the procedure take?
    – The Gynecomastia surgery usually takes between 1 to 3 hours.


    How will I feel after the procedure?
    – The healing process of each patient varies. Some may experience temporary pain, swelling, some bruising, soreness, numbness, a burning sensation, or fatigue.


    How long can I return to work after the surgery?
    – Recovery periods may vary, but patients who have undergone Gynecomastia surgery are oftentimes able to go back to work within 5 days to one week following the surgery. It should be noted though that exercise and any strenuous activities should wait until after 3 to 6 weeks after the surgery.


    Does it matter what causes Gynecomastia?
    – Yes. Gynecomastia can be drug induced (i.e. steroids, excessive marijuana or alcohol use). Medications such as Propecia (prescribed for hair loss) can also cause Gynecomastia. It is highly advisable to discontinue the use of these substances prior to surgery.


    Is there a minimum age requirement for patients interested in GRS?
    – There is not a minimum age requirement for GRS, however many surgeons prefer to wait until the sufferer has completely finished puberty (18-20 years old). The reason for this being that for many teens who are still in their pubescent period, the Gynecomastia they’re experiencing can, and usually will, go away on its own. The surgeon will use his clinical judgment if the case is severe and causing severe social/psychological issues. This may encourage surgery at a younger age.


    Is there a maximum age limit for patients interested in GRS?
    – There is not an age limit for GRS, however if you have any medical conditions that could compromise your health during surgery, your surgeon may be hesitant to proceed or decline to perform the surgery altogether.


    Will there be any scarring?
    – If the surgeon removes glandular tissue, he/she will make a small peri-areolar incision, a half-circle incision around the lower half of the areola. In most cases the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot distinguish them from your normal skin.


    What is the most common technique for GRS?
    – The most common technique for GRS is where the surgeon makes a peri-areolar incision to remove glandular tissue and then performs liposuction of the area for definition. Some surgeons only use liposuction, but in most cases I think this is a mistake unless it is pseudo-gynecomastia (all fat content). Twenty percent of my practice is re-do surgery from unhappy patients. This is most often due to the technique of liposuction only. This leaves the glandular tissue behind.

    I understand that there are two types of liposuction, tumescent and ultrasonic. Is one better than the other?
    – The tumescent technique is the gold standard for liposuction. Basically, the surgeon enlarges the area to be suctioned with a large amount of sterile fluid combined with a vaso-constrictive agent such as epinephrine to reduce bleeding. The fat and the fluid are then suctioned out. Ultrasonic liposuction uses sound waves to break up fat which is then suctioned out. In my opinion, there is no advantage to this technique and I do prefer tumescent. In some surgeons’ hands it works very well.


    I have large pendulous breasts. How do you remove them and how much scarring will there be?
    – This is a very different and often more complicated problem. The skin has a tremendous ability to contract, especially if a patient is young. I usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. At the end of the procedure, I usually place drains in the area to allow fluids to drain for a few days following the surgery. Foam padding and a compression garment are also used as part of the post-op care. I have only had to perform a full breast reduction on one patient in the past that had a very extreme case of gynecomastia. I try to avoid these extensive scars at all costs.


    What do I need to do in preparation for surgery?
    – It is absolutely necessary to quit smoking starting at least 2 weeks prior and continuing until four weeks after your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote excessive bleeding. Herbal remedies such as, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding. Bottom line is it is best to avoid all medications/vitamins/supplements such as these for two weeks prior and two weeks after your procedure. In my practice we supply the patient with a comprehensive booklet of pre-operative instructions before the surgery, clearly outlining these recommendations.


    What is the recovery time following GRS?
    – The initial recovery period is the 7 to 10 days right after your procedure. If drains are used, they will typically remain in for about three days after which they will be removed at your first post-op appointment. Total recovery time can vary from patient to patient. Most patients can expect to be fully healed by 3-6 months. At this point most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. Sometimes, it may take as long as a year to completely heal to the point where the scars are no longer visible.

    – For the first 4 to 6 weeks after surgery, it is necessary to avoid all strenuous activities, especially those involving the upper body such as lifting weights or intense workouts at the gym. In addition I advise my patients to wear a compression garment for 6 weeks post-operatively.

    – You as a patient have invested a lot of time and money into this procedure, and as such you owe it to yourself to also invest the time and patience needed for healing in order to achieve optimum results.


    How much pain will I be in post-surgery and for how long?
    – A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimum discomfort and most never complain of any severe pain, only soreness of the area. Regardless of you pain level after surgery, I always prescribe pain medication for you to have on hand should you need it.


    What if I don’t like my results? Will I need to have more than one surgery?
    – Within the first year, a redo or touch-up procedure is covered by the patient’s initial surgical fee. However, it is important to remember that one must have realistic expectations for the outcome of any type of cosmetic surgery. That being said, I do want all my patients to be happy and I will always do what I can to achieve that.


    Do I need to wear a compression vest? What is it for? How long do I have to wear it?
    – It is necessary to wear a compression vest for about four to six weeks following the procedure. After the gland is excised and liposuction is performed, a large open space exists. The compression garment helps the tissue come together and close properly. The placement of the drains helps as well. Another function of the garment is to help reduce the initial swelling and contract the skin over the surgical site.


    When can I return to work?
    – Usually patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity then it is easy to return shortly after the procedure. If you do physical labor then it is recommended to wait at least 10 to 14 days or whenever you feel you are ready. Listen to your body! It will tell you when it is ready to return to your normal activities.


    Are there any post-operative complications that I should be aware of, i.e. painkillers, constipation, excessive swelling, etc.?
    – Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication, this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood underneath the skin, made noticeable by excessive bruising, swelling and pain, typically of only one side of the chest. If this happens it is imperative to contact your surgeon immediately.


    Am I too young to have gynecomastia surgery?
    – In general, we recommend you wait until the age of 18 years. There are some circumstances where a person should consider it earlier. For this you will have to consult a Plastic Surgeon.


    What results can I expect?
    – You should discuss this with your surgeon prior to surgery, and make sure you fully understand everything that is involved while keeping your expectations realistic. Your experienced surgeon can help you with this.


    What kind of scar should I expect?
    – Usually periareolar (about 1 inch scar in the lower part of the areola) that is generally inconspicuous. Sometimes, tiny scars remain in the armpit or chest after liposuction. Some people need more extensive procedures, and this should be discussed with your surgeon in detail prior to surgery.


    Will I have pain that will require medication?
    – Usually pain is minimal, but since we want to make sure you will be comfortable, we do provide you with a prescription for pain medication.


    How much time should I take off from work or school?
    – This depends on the type of work you do and the extent of the surgical procedure. Usually it’s between 3 and 10 days, but healing time varies for each individual and should be discussed with your surgeon