Gynecomastia Surgery (Male Breast Reduction)

What Is Gynecomastia?
What Causes Gynecomastia?
Do You Have Gynecomastia?
What Are My Options?
What To Expect At Your Gynecomastia Consultation
Your Pre-operative Appointment
Preparing For Your Gynecomastia Surgery
Swelling & Bruising Recommendations
Surgery Day Is Here
How Gynecomastia Surgery Is Performed
The Road To Recovery
Risks & Complications Of Gynecomastia
The Average Costs Of Gynecomastia
Related Links
References
Talk About Gynecomastia On Our Surgery For Men Message Board RECOMMENDED!

No matter how hard you work out, no matter how rigorous your training, you have what appears to be fatty breasts. You may be embarrassed to remove your shirt in front of others and you don't quite understand why you have fatty breasts to begin with. After all you are a man, not a woman. Well, the truth is, it's more common than you think and it is definitely nothing to be embarrassed about. There are many causes and our bodies are all different, but, there are treatment options if you wish to have

What Is Gynecomastia?
The word gynecomastia stems from the Greek word, gyne, meaning woman, or female and mastos (mastia ), meaning breasts. Which together seem harmless unless you are a man who doesn't want them. Gyncomastia is the presence of larger than "normal" breasts on the male form.

What Causes Gynecomastia?
The condition is normally from abundant growth in glandular and fatty tissue in the male breast, giving the appearance of small to medium breasts and occurs in roughly 40 to 60% of men. The causes can range from hereditary factors, hormonal imbalances, obesity, steroid use, marijuana use, benign or malignant breast tumors, fibrosis, genetic disorders, Klinefelter Syndrome, testicular atrophy and/or failure, supplemental hormones and other medications, and lastly, liver disease.

Gynecomastia may be present at birth, occur during the onset of puberty, throughout life due to any of the above reasons or from something as simple as the normal aging process toward the end of our lives.

Do You Have Gynecomastia?
Although gynecomastia can and does occur in persons of normal weight or body fat composition, it may occur simply from being overweight. If this is the case, you may wish to follow a sensible diet and exercise program to see if this corrects the problem. If you presently adhere to a good diet and healthy exercise regimen and you still feel as though you have fatty breasts, you may have gynecomastia. If you suffer from any of the causative factors in section 2 (What Causes Gynecomastia?), and feel as though your breasts are larger than they should be, it is quite possible you may have gynecomastia.

"Gynecomastia is divided into four grades: grade I: small enlargement, no skin excess; grade IIA: moderate enlargement, no skin excess; grade IIB: moderate enlargement with extra skin; and grade III: marked enlargement with extra skin. Grades IIB and III require some skin excision. Letterman and Schuster simplified the classification into three types of gynecomastia based on the required correction: (1) intra-areolar incision with no excess skin; (2) intra-areolar incision with mild skin redundancy corrected with excision of skin through a superior periareolar scar only; and (3) excision of chest skin with or without shifting the nipple.One can reduce the gland through a periareolar incision and perform a skin correction at a later date if necessary.

For surgical planning, there are three classifications of gynecomastia.
Grade I: A localized button of tissue that is concentrated around the areola. These buttons are usually easy to remove; the chest is not fatty, and there is no skin excess.
Grade II: Diffuse gynecomastia on a fatty chest where the edges of the tissue are indistinct. This tissue is difficult to taper. Dishing was common before the addition of suction lipectomy.
Grade III: Diffuse gynecomastia with excessive skin. These patients require external (outside the areola) skin excisions or nipple repositioning, or both." (Source: Yale Medical Core Curriculum)

What Are My Options?
Your options depend upon the cause, however you may choose to have breast tissue and fat removal at any time as long as you are in good health and have realistic expectations. If you wish to tackle the cause rather than the symptom, then determining the cause is your first course of action.

If you choose to have the tissue removed it can be done by liposuction (traditional liposuction, internal or external ultrasound-assisted liposuction, tumescent liposuction, and ultrasound lipolysis), manual fat extraction or mesotherapy. Liposuction options and nonsurgical lipolysis can be researched on www.liposuction4you.com, while mesotherapy is the reduction of fat and other tissues by the use of localized injections of medications.

What To Expect At Your Gynecomastia Consultation
Arrive at your consultation on time, although be prepared for the office to possibly be running a little late--consultations are time-consuming and some patients ahead of you may have needed a little more time than others. You will bring with you your folder of questions, photos and anything else you can think of.

You will meet with the surgeon (at least you should. I have heard where you don't even meet the surgeon until the day of surgery and I find this poor practice as you should be able to meet up with the surgeon before he performs your surgery). You will interview him or her as though your life depended upon it, because it does. Not all surgeons are created equal.
You will address all your questions, concerns, fears expectations, etc.
You will discuss your medical history completely.
You will discuss your options in technique, incision placements, anesthesia and more. Anything that you wish you should discuss during this time.
Your surgeon might determine a rough cc amount he or she believes should be removed to give you your desired result.
Your surgeon may even ask you to exercise and diet before undergoing your procedure so please know that this appointment is very important all around.
You will discuss risks at length.
You may be given an informed consent sheet at this meeting
You will discuss the anesthesia risks. Just make sure that the surgeon does address the risks. This is surgery, not getting a tooth pulled.
Ask to see the surgeon's before and after photo albums or discs.
Ask if you may speak to any of his patients which may be listed on a referral sheet.
You may also request to tour the facilities if your surgery will be performed on site.
You may receive literature regarding the surgeon's education and training (curriculum vitae) or any other pertinent information.
You may even discuss costs and fees with either the surgeon during your meeting or with a financial planner towards the end of the consultation.

The Physical Examination
You will be asked to remove your shirt and possibly told you may cover yourself with a gown. After you are finished your surgeon and a nurse will come in to examine your skin condition, type, thinness and elasticity. Your surgeon may possibly take measurements. He may pinch or tug on your skin gently to test your laxity, and determine the density of fat or breast tissue accumulation. You may feel uncomfortable during this time so prepare yourself for it.

Scheduling Surgery & Pre-op Appointments
You may or may not schedule a surgery date at the end of this consultation, you are by no means obligated but this is generally the next step. If you should choose to schedule a surgery with a particular office you will usually give a deposit to hold your date. You will also make a preoperative appointment for lab work, preparation, medications, etc. etc. After your preoperative appt. Your surgery should take place within 2 weeks of the last meeting and/or lab work.

You should go away with enough to go on and request a second meeting if need be, should you feel that more could have been covered. You will notice that intuitions will kick in about judgment of character, trust and faith in one's abilities. This is important so listen to any instinct triggers which may become apparent during the meeting.

Your Pre-operative Appointment
If you schedule a surgery date you will more than likely schedule a pre-operative visit appointment, as well. This will entail another trip to the surgeon's office or an independent lab for "bloodwork" to check your red and white blood cell counts (a CBC test), among other things. For a better understanding of just what a CBC is for and means, I suggest this link: Understanding Your Complete Blood Count (CBC) Test And please quit smoking now. It will highly reduce your risk of necrotic tissue. Do not take any chances with this. Smoking can significantly alter your body's ability to re-vascularize the treatment area and not heal well at all.

You will also be given (or should be given) a list of medications that you must cease or avoid taking. These medications will mostly be aspirin-containing products and supplements that may inhibit clot formation or cause problems with anesthesia. However medications which may cause clotting (such as Vitamin K) may be prohibited, do ask your surgeon. Please visit the Medication & Supplement List page for more information or Click Here to view a Printable List of Medications To Avoid.

You will also be given a list of things to buy or have around you in your healing room. Things like frozen peas, raspberries or blueberries for icing you down to ease the swelling and bruising. You may be asked to buy antibacterial soap, perhaps Hibiclens, or it will be given to you for cleansing a few days before surgery (to kill Staph and other surface bacteria). Some surgeons simply suggest Dial antibacterial soap. You may even be asked to purchase gauze, "maxi-pads" and other types of dressings to tend to your incision areas.

Preparing For Your Gynecomastia Surgery
Now is the time for you to have second thoughts, run around looking for supplies, experience anxiety and have your life in an emotional upheaval. For many, this is a very stressful time, but it doesn't have to be. It is perfectly natural for you to be "freaking out" now that surgery is a few weeks away. Just following the advice composed with the help of real patients and things will go much more smoothly.

We have provided a few lists for your convenience below:

Swelling & Bruising Recommendations
Want help in the swelling and bruising department? Maybe some Arnica montana or Bromelain. Some patients even drink fresh pineapple juice, although with juice comes high amounts of sugar. Please read the linked sections for more information and always ask your surgeon before taking any medication or homeopathic remedy.

Surgery Day Is Here
Sometimes with our pre-operative jitters we forget what we did to prepare and what we read that we would feel like or look like, what to bring and how to act. With the below tips and information I hope that you will be more at ease and know what to expect today. This list is just an example, as you should have received a similar list from your own surgeon. Always abode by your surgeon's instructions.

Arrive on time. You should have the arrival time in your information packet or at least confirm the night before and make the proper notation. If you are late, the surgeon may cancel your surgery and charge you for it anyway. Then the surgery fee is non-refundable.
Arrive Clean. This means freshly-scrubbed with your instructed soap, clean DRY hair, NO lotions, deodorant, powders, cologne--zilch!
DO NOT eat or drink anything after midnight on the evening prior to your surgery. Unless your surgery is an evening surgery, which you should abide by your surgeon or anesthesiologist's instructions, which is usually 6-8 hours beforehand.
DO NOT bring rings, watches, chains, or other jewelry or large sums of money to the surgery center or hospital; leave these items safely at home. If they become lost the hospital or surgeon is not responsible.
Wear your surgery gear; comfortable, easily-accessible, loose-fitting clothing with slippers are great items to have.
Ask about Vitamin C capsules or tablets, or medications such as Vicon-C to be taken a few weeks prior to surgery. This is thought to promote good healing and ward off colds. Although Vitamin C promotes healing and helps with bruising it is possible that excessive Vitamin C consumption can cause over-production of collagen (excess scar tissue formation) so adhere to your own surgeon's instructions.
Also, discuss with your doctor the use of arnica montana or Bromelain, a pineapple extract, for added anti-bruising and anti-swelling properties. Even drinking pineapple juice for 3 days pre-operatively is reported to help, however juice contains a lot of sugar so please abide by your surgeon's instructions.
Vitamin A has been recomended by many surgeons, but as with any drugs, supplements or remedies ALWAYS check with your surgeon before you take anything.
Take any medications you were instructed to take with only a few sips of water. Such medications may be Catapres (blood pressure), prednisnone, anti-inflammatory, valium, antibiotics, blood thickeners, etc. You should been given your medications and instructions at the pre-op appointment unless your surgeon gives you your medications when you get to his office.
Prior to surgery, should you develop any fever, chills or other signs of a cold or other infection, call your surgeon's office immediately. If you do not and HAVE to cancel it is possible you may lose a significant portion of your money, or at least your deposit. You should never be operated on with already stressed immune system.
Bring with you any instructed meds for after surgery, your garments or any instructed bandages, etc.
Bring a bucket or can, with a lid (like an empty and clean coffee can) and some cool, bottled water to sip and rid you of the nasty taste you get after vomiting. Besides cool water really helps keep the nausea at bay.
Maybe bring a few packs of crackers to help with the nausea. Ritz crackers always seem like the best although plain saltines are fine. Low Sodium is recommended. Increased sodium levels can cause more water retention, hence more swelling.

They will ask you to change into your gown and have the gown close from the front. Your doctor will come in to talk to you and you will feel a little nervous. He may begin to make the surgical markings with a single-use surgical felt tip pen on your breast area which may resemble circles like tree trunk rings, with your nipple in the center. This will help your doc determine how much to remove and where to begin feathering if using a liposuction cannula. Feathering assist in making a smooth transition from removed tissue to non-treated tissue.

You will ask any last questions before your surgery, discuss anything that concerns you. It is almost time!

On To The Operating Room...
If you had been given an oral sedative or valium prior you usually could care less what they are going to be sticking in you, namely IV's, which you will more than likely have. If you haven't been given a sedative, it can be more stressful for some patients. It feels sort of like blood being drawn, but for a shorter period of time. It's the initial placement of the IV catheter that may sting a bit. After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein. The catheter is taped to your skin so it is not knocked out and is ready to be used as a sort of doorway for anything they deem suitable for your body. This is usually done before you get into the actual O.R. by a nurse and you will have a saline bag hooked up to you. Any medications will more than likely be given via a drip system with this saline. Most patients usually get their IV in the crook of the elbow, some the hand. I personally dislike the hand ones as it's a nasty place for a bruise to be, at least with the arm you can hide it, but it all depends upon your veins. If you have difficult veins, any place they can insert your IV will be used. The saline will keep you hydrated both during and directly post-operatively.

You are then brought to the O.R. if you aren't on the table yet. If you are going to have IV sedation, they insert a hypodermic into the tube for your IV or they attach a bag of sedative/cocktail with a drip system to add a few drops every few minutes and when they spring open the stopper and it starts heading towards your body. The the effects of the anesthesia are felt soon after injection or opening the stopper, a few seconds in fact. It feels like heat going into you veins then creeping up your arm, then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.

Gaseous-state anesthesia (Twilight, Gaseous General): If you are getting gaseous sedation, all this entails for you is breathing through a mask. Some types fit over your mouth and nose usually and force air into your lungs. With intubation you will have a tube down your throat but you don't usually remember it going in because you are asleep first via IV sedation or gaseous sedation. You may wake up with a raw throat because of the tube.

*Also be advised that if you have bronchospasm, asthma or other disorders such as this, intubation is contraindicated. Please make sure you read the risks associated with Anesthesia and discuss and respiratory issues with your surgeon or anesthesiologist.

What To Expect: The mask is placed over your face and you are basically told to count down from 100, and see how far you can make it -- usually 96 or 97. Or they talk to you to distract you while you are going under. After the gas hits the aveoli in your lungs, your blood is saturated by the anesthesia gases where they are carried to your central nervous system (CNS) and then out you are! If they intubate you it will be about now, if not, they will begin your surgery.

How Gynecomastia Surgery Is Performed
Your frontal torso area is swabbed and scrubbed with a Betadine solution to remove surface bacteria such as Staphylococcus
aureus, or simply 'staph' for short. This will cut down on the risk of infection. Your surgical markings will be lighter but still visible. The treatment area is then injected with Lidocaine and epinephrine and possibly saline for tumescent liposuction.

Incisions are made near the nipple and either a liposuction cannula is inserted for fat removal only or if removal of excess breast tissue is needed, it is excised manually. The area is recontoured to a more pleasing appearance. Your surgeon may close the incisions with tissue glue, surgical paper tape like Steri-Strips by 3M Corp., or other bandages and dressings or close your incisions with one to three sutures or more if the incisions require it. You are then gently woken up.

Coming out of Anesthesia
This transition period can be very rough for some patients. You may experience sickness, dizziness, crying, depression, anxiety, haziness, etc. It is generally like drinking a lot of alcohol and feeling as if you've had too much alcohol, or very little sleep, but with even less control over your body's movements at first. You may also be cold and shaking and this is usually from the epinephrine and cold O.R. This will pass. Your throat may be sore if you were given General anesthesia via intubation.

Recovery Room
You will be taken to the recovery room, which is usually located right off of the operating room, and more than likely placed in a recliner, or hospital bed. You will usually still be hooked up to the monitors so that your recovery can be properly tracked. If you do feel sick or are in pain, alert the recovery nurse. He or she may give you a pain reliever and possibly some sickness relief medication or a few sips of cool water to ease your stomach.

If you were given Light Sleep Sedation (a lighter form of IV Sedation) you may be allowed to go home within 2 to 3 hours, depending. If you were given General the office will want to keep you around for a bit longer, plus you may get a little sick. They can give you medication to remedy this but it may or may not work for you. Ask your surgeon at your consultation if he gives medications which will help alleviate post-operative nausea. You may have to urinate directly after surgery due to the amount of intravenous fluid. In fact the surgeon may insist that you do before releasing you. You may need assistance in doing so, so be prepared for an audience of at least one.

You MUST have someone to drive you home and care for you for the first few days. This person must be dependable as he or she will need to help you to the bathroom, dressing, walking, eating, etc. Hopefully you will have prepared your home and recovery area as we have suggested in our preparation list.

The Road To Recovery
You may not remember your surgery, or at least as the days go by you may forget the details as well as lose track of time. This is because of the amnesiac properties of the anesthesia which is covered in the All About Anesthesia Section.

If a drain was inserted to allow the fluids an exit from the incision sites or from the bottom most portion of the treatment area, this may be removed withina few days, so be sure to ask your surgeon about them if he opts to insert these. You will be swollen and possibly bruised and may be asked to wear a compression garment. If you are bruised, don't panic. We've all had bruises before, it will subside.

Your chest may feel tender, stiff and/or sore for a few says and will more than likely not want to move too much. But, listen to your surgeon's instructions as for when you should move around for a few minutes, even if it is around your house. Sitting around all day increases your risks of blood clots which is very dangerous, so if you have had liposuction with your gynecomastia procedure you may be asked to move about a bit. If you have stitches they are removed within the first 5 - 10 days. Be sure to take your required medications and follow the precise instructions provided to you by your surgeon.

You may also experience sharp pains, burning sensations, heat, tingling, prickling, etc. This is from minor nerve damage and the sensations of the returning function of the nerves will result in the physical descriptions above.

Asymmetry may be a fact of life for you until you are fully healed. The body does not heal equally on each side of the body so oneside may seem larger than the other. Be patient and wait it out before looking into revision surgery. Swelling can alter the appearance of your body and mask the true results. This goes both ways, - a good result or a bad result (lumps). Patience is the only remedy until you are able to make a true judgment. And this judgment cannot be made until you are healed. Prepare yourself beforehand and know what to expect lest you hurl yourself into a depression.

You will be instructed not to exercise or engage in strenuous activities for at least 2 to 4 weeks. You may be swollen for up to 4 months, although this could be very slight and only noticed by you. Drinking plenty of water can significantly help with edema and help flush your system clean of medications. Almost 85% of the population is dehydrated, drink more water! Please know that diets high in sodium will assist in prolonging swelling and general fluid retention. Drinking caffeine may seem like a good idea for a diuretic effect but if your body is balanced naturally and you are drinking enough water your body will expel the excess.

Overall Improvement will be appreciated in just a few weeks. The majority of the swelling will have subsided by this time and the results will be apparent. It takes about 3 to 4 months for the rest of the swelling to subside, although it can remain up to 6 months.

Also you should be taking your temperature regularly, a raised temperature could mean an infection so please alert your doctor to fevers over 101F.

Please be patient. Visit our Male Surgery Forum for support from real patients.

Remember to keep your chin up, you may be very uncomfortable and regret having had your surgery but in a few weeks it will be at the top of your "Best Things I Have Done For Myself" list!

Risks & Complications Of Gynecomastia
As with all surgeries, there are risks - please read this section thoroughly so you are well informed.

Anesthesia
There is a risk of a negative reaction to the anesthesia and other medications and products used in this procedure. Epinephrine sensitivity can be an issue. Please see our anesthesia section for more information.

General Risks & Complications
There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Hematoma, seroma and infection are possible issues.

Fat & Tissue Necrosis
Fat and its surrounding tissues can become necrotic (dead tissue) if significant amounts blood vessels are severed. If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision, however some drainage will be normal. If the tissue becomes necrotic, it must be taken care of immediately. If this is the case you will need to have the tissue removed before a major infection develops, possibly causing gangrene. Necrosis resembles very black, and discolored skin (different from a normal bruise) which spreads and does not clear up. Necrosis will cause the need for excision of all affect tissue. Hyperbaric treatments can significantly improve problematic wounds and prevent further spread of necrosis. Hyperbaric Oxygen Therapy also may significantly decrease your healing time.

Risks As Associated With UAL-assisted Procedures
With the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic sound waves. Although ultrasound is not a form of heat, the high frequency radio waves excite the fat molecules and fluids. The fat cell is literally ruptured with ultrasonic energy. If the ultrasonic cannula or external ultrasonic pads/paddles are are not kept mobile burns and untargeted tissue damage can result. Blisters can form if the tip of an ultrasonic cannula gets too close to the under part of the skin. Skin thinning can also happen if there is too much undermining. Permanent irregularities can develop from excessive undermining.

Irregular Contour Deformities
Dents, bumps and waves may appear after your procedure which may require additional surgery, deep tissue massage, subcision or fat grafting. This can be from lack of skill of the surgeon, failure to comply with some post-operative protocol such as massage and walking, etc. Fibrous scar tissue formation can naturally happen and be the fault of no one - merely happenstance.

General Dissatisfaction
Please be sure to convey, and re-convey your desires and expectations with your surgeon. Lack of communication can easily ruin your chances of a good result the first time around. Also, unreasonable expectations or emotional problems can severely impact a patient's perception of their results.

The Average Costs Of Gynecomastia
The costs of gynecomastia surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who need additional or more extensive surgery will require more intensive and expensive treatment. In non-private Surgery Centers or in-office Operating Rooms the prices may include the following. However, in hospitals, surgery charges can usually be separated into five parts:

the surgeon's fee
the anesthesiologist's fee (if applicable)
the hospital charges, which includes nursing care and the operating room
the medications (antibiotics, topicals, dressings)
and any additional charges

All fees are averages; out-patient charges, including surgeon fees, anesthesia, Operating Room charges, unless otherwise noted. Lab fees, such as routine blood work (CBC), are normally an extra $35. - $75., plus medications are usually an additional $120. If you are to be staying in a hospital or are opting for home healthcare, these expenses are additional.

Average Price: $2,298. - $5,000. for an average procedure

Financing Your Surgery
Of course, surgeries can be financed. There are many companies out there who will offer financing for your procedure although not many are plastic-surgery or surgical-specific. I recommend companies that do deal in plastic surgery-only financing as they are more aware of the time you need to recover and seem to have more empathy for the patient and not only their pocket book. Just be sure to read the fine print in regards to what you receive or what the particulars are before signing with a finance company.

Are you lost? View Site Index