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Gynecomastia
Gynecomastia is a medical term that
comes from the Greek words for
"women-like breasts." Though this
oddly named condition is rarely
talked about, it's actually quite
common. Gynecomastia affects an
estimated 40 to 60 percent of men.
It may affect only one breast or
both. Though certain drugs and
medical problems have been linked
with male breast overdevelopment,
there is no known cause in the vast
majority of cases.
For men who feel self-conscious
about their appearance,
breast-reduction surgery can help.
The procedure removes fat and or
glandular tissue from the breasts,
and in extreme cases removes excess
skin, resulting in a chest that is
flatter, firmer, and better
contoured.
If you're considering surgery to
correct gynecomastia, this section
should give you a basic
understanding of the procedure--when
it can help, how it's performed, and
what results you can expect. It
can't answer all of your questions,
since a lot depends on your
individual circumstances. Please be
sure to ask your doctor if there is
anything about the procedure you
don't understand.
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The best candidates
for Gynecomastia
Correction
Surgery to correct
gynecomastia can be
performed on healthy,
emotionally stable men
of any age. The best
candidates for surgery
have firm, elastic skin
that will reshape to the
body's new contours.
Surgery may be
discouraged for obese
men, or for overweight
men who have not first
attempted to correct the
problem with exercise or
weight loss. Also,
individuals who drink
alcohol beverages in
excess or smoke
marijuana are usually
not considered good
candidates for surgery.
These drugs, along with
anabolic steroids, may
cause gynecomastia.
Therefore, patients are
first directed to stop
the use of these drugs
to see if the breast
fullness will diminish
before surgery is
considered an option. |
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All surgery carries
some uncertainty and
risk
When male
breast-reduction surgery
is performed by a
qualified plastic
surgeon, complications
are infrequent and
usually minor.
Nevertheless, as with
any surgery, there are
risks. These include
infection, skin injury,
excessive bleeding,
adverse reaction to
anesthesia, and
excessive fluid loss or
accumulation. The
procedure may also
result in noticeable
scars, permanent pigment
changes in the breast
area, or slightly
mismatched breasts or
nipples. If asymmetry is
significant, a second
procedure may be
performed to remove
additional tissue.
The temporary effects of
breast reduction include
loss of breast sensation
or numbness, which may
last up to a year.
Planning your surgery
The initial consultation
with Dr. Carp is very
important. He will need
a complete medical
history, so check your
own records ahead of
time and be ready to
provide this
information. Dr. Carp
will examine your
breasts and check for
causes of the
gynecomastia, such as
impaired liver function,
use of
estrogen-containing
medications, or anabolic
steroids. If a medical
problem is the suspected
cause, you'll be
referred to an
appropriate specialist.
Dr. Carp may, in extreme
cases, also recommend a
mammogram, or breast
x-ray. This will not
only rule out the very
small possibility of
breast cancer, but will
reveal the breast's
composition. Once he
knows how much fat and
glandular tissue is
contained within the
breasts, he can choose a
surgical approach to
best suit your needs.
Don't hesitate to ask
any questions you may
have during the initial
consultation- including
your concerns about the
recommended treatment or
the costs involved.
Treatment of
gynecomastia may be
covered by medical
insurance--but policies
vary greatly. Check your
policy or call your
carrier to be sure. If
you are covered, make
certain you get written
pre-authorization for
the treatment
recommended by Dr. Carp.
Preparing for your
surgery
Dr. Carp will give you
specific instructions on
how to prepare for
surgery, including
guidelines on eating,
drinking, and taking
certain vitamins and
medications.
Smokers should plan to
stop smoking for a
minimum of one or two
weeks before surgery and
during recovery. Smoking
decreases circulation
and interferes with
proper healing.
Therefore, it is
essential to follow all
your surgeon's
instructions.
Where your surgery
will be performed
Surgery for gynecomastia
is most often performed
as an outpatient
procedure, but in
extreme cases, or those
where other medical
conditions present cause
for concern, an
overnight hospital stay
may be recommended. The
surgery itself usually
takes about an hour and
a half to complete.
However, more extensive
procedures may take
longer.
Types of anesthesia
Correction of enlarged
male breasts may be
performed under general,
or in some cases, under
local anesthesia plus
sedation. You'll be
awake, but very relaxed
and insensitive to pain.
More extensive
correction may be
performed under general
anesthesia, which allows
the patient to sleep
through the entire
operation. Dr. Carp will
discuss which option is
recommended for you, and
why this is the option
of choice.
The surgery
If excess glandular
tissue is the primary
cause of the breast
enlargement, it will be
excised, or cut out,
with a scalpel. The
excision may be
performed alone or in
conjunction with
liposuction. In a
typical procedure, an
incision is made in an
inconspicuous
location--either on the
edge of the areola or in
the under arm area.
Working through the
incision, the surgeon
cuts away the excess
glandular tissue, fat
and skin from around the
areola and from the
sides and bottom of the
breast. Major reductions
that involve the removal
of a significant amount
of tissue and skin may
require larger incisions
that result in more
conspicuous scars. If
liposuction is used to
remove excess fat, the
cannula is usually
inserted through the
existing incisions.
If your gynecomastia
consists primarily of
excessive fatty tissue,
your surgeon will likely
use liposuction to
remove the excess fat. A
small incision, less
than a half-inch in
length, is made around
the edge of the
areola--the dark skin
that surrounds the
nipple. Or, the incision
may be placed in the
underarm area. A slim
hollow tube called a
cannula which is
attached to a vacuum
pump, is then inserted
into the incision. Using
strong, deliberate
strokes, the surgeon
moves the cannula
through the layers
beneath the skin,
breaking up the fat and
suctioning it out.
Patients may feel a
vibration or some
friction during the
procedure, but generally
no pain.
In extreme cases where
large amounts of fat or
glandular tissue have
been removed, skin may
not adjust well to the
new smaller breast
contour. In these cases,
excess skin may have to
be removed to allow the
removing skin to firmly
re-adjust to the new
breast contour.
Sometimes, a small drain
is inserted through a
separate incision to
draw off excess fluids.
Once closed, the
incisions are usually
covered with a dressing.
The chest may be wrapped
to keep the skin firmly
in place.
After your surgery
Whether you've had
excision with a scalpel
or liposuction, you will
feel some discomfort for
a few days after
surgery. However,
discomfort can be
controlled with
medications prescribed
by Dr. Carp. In any
case, you should arrange
to have someone drive
you home after surgery
and to help you out for
a day or two if needed.
You'll be swollen and
bruised for awhile--in
fact, you may wonder if
there's been any
improvement at all. To
help reduce swelling,
you'll probably be
instructed to wear an
elastic pressure garment
continuously for a week
or two, and for a few
weeks longer at night.
Although the worst of
your swelling will
dissipate in the first
few weeks, it may be
three months or more
before the final results
of your surgery are
apparent.
In the meantime, it is
important to begin
getting back to normal.
You'll be encouraged to
begin walking around on
the day of surgery, and
can return to work when
you feel well
enough--which could be
as early as a day or two
after surgery. Any
stitches will generally
be removed about 1 to 2
weeks following the
procedure.
Dr. Carp may advise you
to avoid sexual activity
for a week or two, and
heavy exercise for about
three weeks. You'll be
told to stay away from
any sport or job that
risks a blow to the
chest area for at least
four weeks. In general,
it will take about a
month before you're back
to all of your normal
activities.
You should also avoid
exposing the resulting
scars to the sun for at
least six months.
Sunlight can permanently
affect the skin's
pigmentation, causing
the scar to turn dark.
If sun exposure is
unavoidable, use a
strong sunblock.
Your new look
Gynecomastia surgery can
enhance your appearance
and self-confidence, but
it won't necessarily
change your looks to
match your ideal. Before
you decide to have
surgery, think carefully
about your expectations
and discuss them frankly
with Dr. Carp.
The results of the
procedure are
significant and
permanent. If your
expectations are
realistic, chances are
good that you'll be very
satisfied with your new
look. |
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