Gynaecomastia
Gynaecomastia is excess breast that can occur in men. It is due to a combination of breast tissue and fat and is sometimes large enough to give a female sized breast. It can occur soon after puberty and in older men. It may be due to medication such as ranitidine, prescribed for gastritis or recreational drugs like marijuana. Rarely it may be due to a testicular or liver tumour and very rarely, if is only on one side, it may be due to breast cancer. If you are considering surgery for gynaecomastia, the information below should help you understand how it is performed and the results you can expect.
The initial consultation
At the initial consultation you will tell me about the problems you are having, which is usually embarrassment when wearing teeshirts and a reluctance to take your shirt off on holiday or when swimming. Your goals are very important but should be realistic. Would you like to have an improved shape or do you want to have a completely flat chest. i will also ask about your medication and reactional drug history and i am looking for the development of normal male characteristics. i will exmaine your breasts and measure them and I will discuss the available operations and the one that is likely to help you most. You should buy a compression garment, like a biking top which you can buy from a sports shop or macom online; https://www.macom-medical.com/
You should always remember that there is an option of not having surgery at all.
I will ask you about all long-term medication, allergies, and bleeding tendencies, as well as any problems with local or general anaesthesia. I will ask you about your smoking history and whether you have had any mental health issues. Photographs will be taken and a BMI measurement made.
The Surgery
Ideally you should be near your normal weight for your height when the operation is done. The type of surgery offered will depend how big your breasts are. If is just behind the nipple, fat can be removed with liposuction, but the breast tissue usually needs to be removed as well and this is done through a small incision around the bottom half of the nipple. I use desolveable stitches and they wont need to be removed. If there is also excess skin, some of it may need to be removed using different and more extensive wounds which will give a longer scar.
Risks
When performed by a qualified surgeon, gynaecomastia is safe. Nevertheless, surgery carries risks which are listed below.
Bleeding and bruising after the surgery can occur, which can rarely require a return to theatre to remove it.
Seroma is a build up of clear fluid coming from the underlying muscle.
Contour deformity if too much breast tissue/fat is removed, an indent may form, called a dinner plate deformity. This is very difficult to correct amnd may require fat transfer from another part of the body.
Wound breakdown is a possibility but rare.
Infection can happen but it usually occurs 7-10 days after surgery.
Wounds may be slow to healand part of the breast can skin die and may need dressings.
The Nipple can partly or fully die, but this is very unusual.
Sensation in the nipples may be altered becoming very sensitive but more often they become less sensitive.
Scars may become thickened or widened and treatment is available to help with this.
Shape, size and symmetry the breasts may not be the same size and the shape and final size cannot be guarenteed.
Numbness the breast may feel numb, but this should improve over the next few weeks and is rarely permanent.
Preparation for surgery.
Your BMI should be less than 30 and you should mentally and physically fit. You should stop smoking 6 weeks before surgery and can start again when the wounds have healed at 2-4 weeks. Please do not take aspirin, naproxen for 10 days before surgery. You should have a shower the night before or the day of surgery. I will have emailed you a consent form, which you should print, read and sign and date the bottom of each page and bring the full document with you on the day of surgery , so that we can sign the last page together.
What to bring with you
Toiletries, regular medications and the pressure garment.
The Surgery
On the ward before surgery, I will and draw the incision lines on your breasts and where the new nipple will be on the breast if you have large breasts. Surgery will be done under a general anaesthetic and takes about 2 hours. After surgery, you will waterproof dressings and a drain in each breast and will usually spend 1 night in hospital. The drains after removed before going home.
Recovery period
Please keep the dressings in place and we will arrange a wound check at 1 week with the hospital nurses and i will see you at 2 weeks, to remove the dressings and advise about scar care.
You should not to return to work for the 1-2 weeks after surgery, depending on your work and full recovery may take to 2-4 weeks. You will need to wear the garment for 6 weeks after surgery, day and night.
You should not fly for 6 weeks after surgery.
The Results
It will take 6-12 months to see the final results and these may last for 10 years. This longevity however can not be guarenteed and is dependent on skin quality, change of weight, pregnancy and smoking.
If you are worried post operatively
Please call the hospital ward you were on or Jan Richards 07722841078 9am-2pm Monday-Friday.
In an emergency, you may need to seek advice or attend your local hospital Accident and Emergency department.
Appointments
These can be made directly through the hospitals, via my PA Jan Richards or completing the form in the 'Contact' link above.
