.--Gynecomastia

Consultation  Pre-Operative Period  Day Of Surgery  Recovery Process  Risks


Background On Gynecomastia
Gynecomastia is the medical term for abnormal enlargement of the male breast. 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. Excessively large breasts are also a very frequent concern for men following weight loss. Following weight loss, men often have remaining excess skin, fat and sometimes dense fibrous tissue in the region of the breasts. These excess tissues may not only involve the breast but extend towards the sides and back as well. Dr. Capella has a very large experience in treating male weight loss patients with these concerns. Male weight loss patients may either be candidates for liposuction or a combination of liposuction and excess skin removal.

Most cases of gynecomastia not relating to obesity and weight loss are part of 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. Although most cases of gyncomastia are part of a normal phase of development, there are pathologic causes. These causes may be related 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; however, 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.

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Gynecomastia Consultation
Dr. Capella will take a thorough medical history, including a history of obesity and weight loss and a history of alcohol or marijuana abuse, and a careful drug history. If there are signs of either liver or endocrine malfunction or if there are any signs of abnormal secondary sexual development, then a referral to a qualified medical specialist such as an endocrinologist may be warranted. In most cases involving adult males there is usually a history of obesity and weight loss or a history of anabolic steroid use or no cause at all. In most cases, surgery is the only effective form of therapy. The approach that Dr. Capella would advise will depend on the degree of breast enlargement, the ratio of fat to breast tissue that exists, and the amount and elastic quality of the skin. He will then determine and discuss with you what approach he feels is necessary to best manage your condition.

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Gynecomastia Pre-Operative Period
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 just 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. Prophylactic antibiotics are prescribed prior to and for a few days after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have 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. You will need to arrange for an escort to drive you to and from the operating suite located in our office. 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.

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Day of Gynecomastia or Male Breast Reduction Surgery
Depending on the degree of breast enlargement present in your case, Dr. Capella will review 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 may utilize liposuction 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. 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, and is done as an outpatient.

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, and is done as an outpatient. It can be done either under a general or local anesthetic. All stitching is done with self-absorbing type suture material, avoiding the need to remove stitches after surgery.

For many men following massive weight loss, there is a combination of excess fat and skin remaining at the breasts and often extending onto the sides and back. If this is the case, Dr. Capella may either suggest liposuction as a first stage and having you return in three months to then remove excess tissue at the breasts and sides and perhaps back. If however, you have mostly excess skin at the breasts, sides or back, Dr. Capella may suggest you a have a breast lift with removal of excess tissue at the sides and back as an initial procedure.

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Gynecomastia Recovery Process
At the conclusion of your procedure, you will be placed into a pressure vest over 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. Capella 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 1-2 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.

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Risks Associated With Breast Reduction For Gynecomastia
Complications from treatment of gynecomastia are infrequent and usually minor, though no surgical procedure is without some risk. These would 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 accumulations beneath the skin following the operation that may require drainage.

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