Gynaecomastia

Surgery for gynaecomastia is a commonly sought procedure amongst men. The problem can have considerable physical, pain, social and psychological consequences.

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It may commence at any stage after puberty and may have an underlying cause such as hormonal imbalance, liver malfunction, side effects of certain drugs or cannabis usage. However in the majority of cases, there is no known cause. There are 3 main components that contribute to gynaecomastia – and excess of fat, breast gland and skin. Depending on the degree to which these various components contribute to the problem, I will discuss with you in detail which surgical procedure would be most suitable, taking into consideration your expectations and desired outcomes.

Your gynaecomastia journey

Consultation

During the consultation, I will explore the reasons for you requesting surgery to your male breasts. We will discuss what you expect from surgery and I will examine you and take some measurements that will guide me in giving the correct advice.

Removal of fat

Removal of glandular breast tissue

Removal of excess skin

Once the excess breast tissue has been excised and liposuction has been used to remove any remaining fat around the edges, then the skin excess needs t be addressed. There are a number of ways of doing this, depending on the degree of excess skin. For milder degrees of excess skin, it might be worth waiting and seeing how much your own skin contracts. For moderate skin excess, a donut of skin may be removed around the areola, leaving a scar that just sits around the nipple-areolar complex. For more severe degrees of skin excess, the skin excision pattern may result in a scar that resembles an anchor (around the areolar, vertically down and a short horizontal component).

After the Procedure

Sutures
The incision is closed using absorbable sutures. The incision is then covered with a state-of-the-art waterproof dressing which will come off after about 3 weeks.

Garments
You will be provided with a special garment appropriate for your size, which will provide compression to the chest wall, minimise the risk of bleeding or other fluid collection, and reduce the time taken for swelling to subside. This garment must be worn continuously for 6 weeks, and be taken off only when showering or to wash the garment.

Recovery

Medications

I will see you immediately after surgery to discuss how things went and to check that all is well. I will make sure you are comfortable before you go home. In the vast majority of cases, patients undergoing gynaecomastia surgery are able to go home the same day. You will be given adequate pain relief. Please avoid taking any aspirin or blood thinning medication such as aspirin. You will also be given a 5 day course of oral antibiotics to reduce the chances of infection. Finally, you will be given a 3 day course of a medication that reduces the chances of bleeding.

Recovery

For the first 48 hours following surgery, please minimise the activities you are undertaking. Any activity that increases your blood pressure may trigger bleeding. You may return to light duties after a week and back to work within 2 weeks. I strongly advise against any heavy lifting or gym activity for 6 weeks as this may be uncomfortable.

Eat well and stay well hydrated by drinking lots of fluids. Abstain from alcohol for at least a week as this can cause dehydration. Smoking or use of any nicotine replacement product is to be avoided for at least 6 weeks before and 6 weeks after surgery to allow the body to heal as quickly as possible.

You may return to driving after 2 weeks if you feel comfortable and able to maintain full control of the vehicle. You may fly ideally after 6 weeks, but make sure you drink plenty of fluids (not alcohol) and wear compression stockings on your calves.

Scar management

After 3 weeks, wounds have generally healed. You are advised to gently massage the scars as tolerated as this helps to soften, flatten and desensitise them. I would advise massaging the entire breast as well as the scar. You may use any lotion of your choosing, such as E45 or bio-oil. 5 minutes morning and evening for about a year. Make this part of your ‘routine’. Secondly, scars tan faster than normal skin. Therefore avoid exposing the scars to the sun, but if you have to, then apply factor 50 sun block daily, for a year. It takes about a year for a scar to fully mature and caring for your scars in this manner will ensure optimal healing. In some cases, I may advise using silicone gel (such as Kelocote), to be smeared onto the scar daily for a year.

Potential Complications

General anaesthesia

Any operation involving a general anaesthetic carries a risk of developing blood clots in the calves (deep vein thrombosis – DVT), which could break off and move to the lungs causing a pulmonary embolism (PE). Early mobilisation and keeping hydrated will reduce this risk, as will avoiding smoking before and after surgery for at least 6 weeks. There is a risk of allergy to the drugs for anaesthetic and antibiotics / pain relief, and a very small but theoretical risk of major life threatening complication / death related to the anaesthetic (1 in 100,000 risk).

Bleeding and haematoma

This is rare and precautions are taken during surgery to minimise the risk of this. You will also be given medication to reduce the change of bleeding after surgery. However, in the rare instance that significant bleeding occurs, one breast may swell quite obviously and become painful. The nipple may change colour and become dusky (purple and dark). This will require a return to theatre and stop the bleeding. After 48 hours, it is extremely uncommon for such bleeding to occur.

Infection & scarring

Many precautions are undertaken during surgery to minimise the chances of infection, including giving you antibiotics after surgery for 5 days. Unfortunately infections can occur and this may be very superficial to the incision site, and easily treated with antibiotics. Sometimes, some of the fat within the breast may die (fat necrosis) and either become infected, become hard (calcified) or burst and become an oil cyst.

The shape of the scar is discussed above. How it heals depends on your body’s ability to heal scars. The scars will be red for a few weeks before becoming pale over the course of the first year. In a small number of patients, the scar may become thick and lumpy (hypertrophic scar) and this can happen as a result of your body’s healing process.

Asymmetry

Nipple sensation

Swelling

Seroma

Contour irregularities

Other Information

The outcome of all cosmetic surgery is highly subjective. Whilst your surgeon will try to give you a realistic expectation, the satisfaction which you feel about your result depends on many things.

Most people are delighted with their outcome. If there are elements of your surgery that fall short of what you had hoped for, you MUST feel free to discuss them with me, as the majority of issues are easily resolved.