Male Breast Reduction (Gynecomastia)

Background

Gynecomastia is the medical term for abnormal breast development in males. A fairly common condition affecting almost half of males during development, it can occur on one or both sides of the chest, and is the result of excessive breast tissue, fat, or both. In most cases, the condition is due to a normal or "physiological" phase of development. It can occur with the onset of puberty, but usually regresses by age 20. It can also occur with aging in otherwise healthy males. Other "pathological" causes of abnormal male breast growth can occur, either due to decreased production of testosterone (male hormone), increased production of estrogen (female hormone), or certain drugs. The use of anabolic steroids (used by body builders), and other drugs (marijuana, alcohol, cimetidine, spironolactone, some anti-depressants, for example) can be the cause of gynecomastia . Gynecomastia can be a sign of liver disease. But the majority of cases have no known cause. Certainly, most affected adolescent boys will "grow out of it", if no treatment is rendered. If this does not occur, treatment is available to reduce the size of the soft tissues, either by removal of fatty tissue using liposuction, or by open removal of breast gland tissue using a small incision around the areola, or pigmented area of the nipple. In more extensive cases with large amounts of excessive skin, larger skin incisions (and therefore larger scars) are necessary to remove the redundant skin.

The Consultation

Dr. Creasman will take a thorough medical history, including any signs of abnormal secondary sexual development, history of alcohol or marijuana abuse, and a careful drug history. If other signs of either liver or endocrine malfunction seem evident, then a referral to a qualified medical specialist such as an endocrinologist may be warranted.

In most cases involving adult males, either a history of anabolic steroid use or no cause at all can be identified. In most cases, surgery is the only effective form of therapy. The approach that Dr. Creasman would advise will depend on the degree of breast enlargement, the ratio of fat to breast that exists, and the amount and elastic quality of the skin.

Photographs of patients are available in the PhotoGallery contained in this website and are also available for viewing in our office. If necessary, digital images can be obtained of your condition and a "morphed" image generated to demonstrate to you what the doctor estimates to be your expected result. Though not meant to represent a warranty of surgical treatment, this may help you in your decision as to whether or not the treatment will meet your expectations.

Risks of Breast Reduction for Gynecomastia

Complications from treatment of gynecomastia are infrequent and usually minor, though no surgical procedure is without risk. These potential problems include bleeding, infection, loss of sensation that may take up to a year to recover and could be permanent, visible irregularities in the skin, asymmetry, and fluid accumulation beneath the skin following the operation requiring drainage. Any of these complications could delay your recovery, and might result in additional expense to you. If ultrasonic-assisted lipoplasty is used for your recontouring, the risks of this procedure are also present, including a higher risk of seroma formation (fluid accumulation).

Before Your Surgery

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery.

Prophylactic antibiotics are administered intravenously prior to surgery to reduce the risk of surgical wound infection. A prescription for pain medication is written at your preoperative visit, so that you have your pain pills when you return home from the operation

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.

This is a preoperative checklist for you to follow in preparation for your gynecomastia surgery:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your chest and underarms with it for the three days prior to your operation.
2. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
3. Do NOT shave your chest prior to surgery. This will be done immediately prior to your procedure by the doctor. You may wear deodorant the day of your surgery.
4. Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks.
5. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts, including navels, nipples, and tongues, need to be free of jewelry for your safety.
6. Take any prescribed medications as directed.
7. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
8. Avoid smoking for six hours prior to surgery.
9. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
10. Stock up on Coca Cola Classic. It is useful to reduce any nausea you might feel after your anesthetic.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.

The Operation

Depending on the degree of breast enlargement present in your case, Dr. Creasman will explain the exact surgical approach he would take to provide you with the best contour using the least-invasive operation. In the least invasive approach, and if most of the enlargement is fatty in nature, he utilizes the technique of UAL (Ultrasonic-Assisted Lipoplasty) to contour the breast area. Under a general anesthetic (completely asleep), or sometimes using local anesthesia with an intravenous sedative, he makes very small incisions through which he inserts a small tube, which liquefies the fat using sound waves. Vacuum suction applied to the tube then extracts the fat, leaving you with a smoother, flatter contour. A pressure dressing is applied to assist the skin in conforming back to the underlying muscle. The procedure usually takes about an hour.

If you have primarily a glandular accumulation causing your abnormal contour, he can usually remove this through a small incision at the lower half of the periphery of your areola (pigmented part of the nipple). The breast gland is then completely removed. Often a small drain tube is placed to assist the skin in conforming back to the underlying muscle. The procedure takes about sixty to ninety minutes. It can be done either under a general or local anesthetic.

If you have a large amount of excess skin, the procedure is done as in the last description, with the exception that the excess skin is also removed with incisions that leave a horizontal scar across the chest. Dr. Creasman uses this approach only rarely, as in most cases the skin will shrink down on its own.

All stitching is done with self-absorbing type suture material, avoiding the need to remove stitches after surgery.

The Post-Operative Period

At the conclusion of your procedure, you will be placed into a pressure vest over tape and gauze dressings. The breasts become bruised, swollen, and tender for a week or so, but the pain should not be severe, and is usually well controlled with the pain medication that is prescribed.

After two to three days, Dr. Creasman or his nurse removes the dressings, and the incisions are checked to ensure that there are no problems or complications such as infection. You will then be able to shower. You will be asked to wear the vest around the clock for 2-4 weeks for support of the skin during the early stages of wound healing. Though the skin of the breast may feel numb for a while, usually the feeling returns in 6-8 weeks, but can take up to a year to feel completely normal. Heavy exercise should be avoided for 3-4 weeks, and you should stay away from sporting activities or work that risks a blow to the chest for 4 weeks as well. Avoiding sun exposure to the incisions sites for six months or more reduces the risk of dark pigmentation of the scars; you may need to use a sunscreen for up to a year for this reason.

It normally takes approximately 6-8 weeks for all of the initial swelling to subside, and it takes one to two years for the scars to mature and fade. Dr. Creasman will ask you to use a topical scar treatment to optimize the appearance of the scars. This will be detailed in the post-operative period.