Male Breast Reduction for the Correction of Gynecomastia
by Dr. A.H. Nezami at Jacksonville Cosmetic Surgery Center
Gynecomastia, or enlarged male breasts, is a common condition. The enlarged breast can consist of fatty tissue, glandular breast tissue or a combination of the two. This condition can impair a man's ability to lead an active life, and cause emotional distress and self-consciousness. Surgery to reduce excess glandular tissue and fat can effectively restore a more masculine chest contour.
Gynecomastia may occur due to hormonal changes during infancy, adolescence, or advancing age; an imbalance of the hormones testosterone and estrogen may trigger the condition. Several medications can activate such imbalances, such as androgens, anabolic steroids, Valium, tricyclic antidepressants, some antibiotics, Cimetidine or Digoxin. Alcohol, and some street drugs like amphetamines, marijuana, heroin, and methadone may also contribute to gynecomastia. Hypogonadism, hyperthyroidism, kidney failure, liver failure, and malnutrition can also create a hormonal imbalance that promotes gynecomastia.
A complete check-up with an internist or endocrinologist may determine the cause of this condition, and is recommended by Dr. Nezami. Any underlying medical issue should be corrected before a surgical solution is employed, as surgery will not stop further growth of the breast in this case. However, in many instances, the cause remains unknown or results from excess fat in the chest . Male breast reduction surgery removes the excess tissue either by direct excision or through liposuction. When fatty tissue is the primary cause of over-development, and there is no excess skin, a liposuction technique removes fat to recontour the chest.
One Month before Surgery
Smoking patients must refrain from smoking at least one month before the surgery, and must continue to refrain for one month afterward. Smoking interferes with blood flow to the skin, which prevents rapid healing and causes tissue loss. Hormonal therapy in any form can increase risk of blood clot and more serious complications. Therefore they should be stopped one month before and one month after surgery. Authorization from the prescribing physician should be obtained.
Two Weeks before Surgery
Patients must avoid certain medications such as aspirin, Ibuprofen, vitamin E, and any other blood thinning or clotting medication. Patients who are taking prescription blood thinners will require authorization from their prescribing doctor before cessation. No herbal medications should be taken without the approval of Dr. Nezami.
One Week before Surgery
The patient will meet with Dr. Nezami for a pre-operative consultation. Dr. Nezami will review the patient's medical history, and perform the pre-surgical final examination. A surgical assistant will review the pre- and post-operative patient instructions at this time. Alcoholic beverages must not be consumed beginning two days before the surgery.
One Day before Surgery
The patient should have fasted at least eight hours beforehand. He will continue to wash his body, especially his chest and armpits, with Hibiclean (as he has already been doing for three days). The patient should shave his chest that morning. The patient will arrive for surgery dressed in a front opening sweatshirt and comfortable shoes. Any jewelry, including wedding ring should be removed. He will refrain from applying deodorant or lotion on the day of the surgery.
Correction of gynecomastia surgery can take up to two hours, and is performed under general anesthesia administered by a board certified anesthesiologist. Located within the Baptist Medical Center Complex, our surgical suite is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
For liposuction of the male breast, the incisions are small, and hidden in the crease of the armpit, under the breast, or along the edge of the areola. For surgical removal of glandular breast tissue, the incision is on the lower part of the areola border. If removal of excess skin is needed, then the incision will be around the areola and in the crease under the breast.
After surgery, patients require minimal wound dressing; two pieces of foam are secured beneath a front-closing compression vest to protect the areas where liposuction has been performed. After ten days of recovery, patients replace this vest with a compression undershirt. Dr. Nezami instructs his patients to wear this garment at all times for six weeks, in order to achieve the smoothest possible chest.
After complete healing post-liposuction, the scar is nearly invisible. In the case of excision, there will be a scar around the areola, and possibly another at the breast crease line. For patients with chest hair, these excision scars will be barely visible.
Post-surgical discomfort can be easily controlled through medication. The patient should arrange for a driver to transport him home on the day of the surgery. In addition, a caregiver should stay with the patient during the first 24-48 hours of recovery at home. A return to light activity is possible as soon as patients feel ready, usually within a few days of surgery. To minimize the risk of blood clot, we ask patients to walk several times a day following their surgery. Initial swelling dissipates within two to four weeks, and the final results appear in three to six months. Incision lines continue to fade for one year. The recovery period varies from patient to patient.
- In addition to weight gain, gynecomastia can be caused by certain medications such as estrogen derivatives, or steroids taken for bodybuilding.
- Typically, patients can return to work after a few days of recovery. For patients whose work involves heavy lifting or strenuous activity, Dr. Nezami recommends a three week recovery period.
- Insurance companies consider male breast reduction a cosmetic concern, and therefore do not cover the cost of the surgery.
- Surgery for gynecomastia is typically performed under general anesthesia, but it can be performed under sedation and local anesthesia. Dr. Nezami uses a board certified anesthesiologist in either case.
- The patient may shower three to five days after his correction of gynecomastia procedure, but should avoid hot tubs and baths until the incisions have healed completely.
- Prior to surgery, patients should not discontinue any prescribed medications without the authorization of the prescribing physician.
- Patients may travel after ten days of recovery.
- Three weeks following their breast reduction surgery, patients may resume normal physical activity, gradually reintroduce their exercise regimen, and lift heavy objects.
- Two weeks following the surgery, exposure to sunlight is considered safe if the incision area remains covered.
- Patients should avoid driving for the first five days after surgery.
We work with several companies that offer our patients convenient financing at the most competitive rates available. In most cases, patients can obtain approval within 24 hours.