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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. In most men, breast tissue or fat in the breast areaenlarges with the onset of puberty, but the tissue shrinks by age 20. It can also occur with aging in otherwise healthy males. 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. Most affected adolescent boys will grow out of it and no treatment is necessary. 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. In more extensive cases with large amounts of excessive skin, larger skin incisions – and therefore larger scars – are necessary to remove the redundant skin.

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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 amount of fat vs. the amount of breast gland present, and the amount and elastic quality of the skin.

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.

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 screen for any medical problems 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.

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. You will be measured for a compression garment at your preop visit that is to be worn after your procedure.

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.

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.

Any firm breast gland tissue cannot be suctioned out, so this is removed 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 days, the dressings are removed in the office 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. You may wish to use a topical scar treatment to optimize the appearance of the scars. This will be detailed in the post-operative period.

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