Gynecomasty

Why opt for surgery to correct gynecomastia (enlarged breasts in men)?

Men, as well as women, have fatty tissue under their nipple, which can under certain conditions grow and in combination with the adipose tissue that surrounds it – which in turn can overgrow – form a large breast, without this being due to a specific cause in the case of idiopathic gynecomastia. Gynecomastia can also result from a hormonal disorder, certain medications, alcohol or even aging. The composition of breast enlargement may be due primarily to fat or tissue mass or a combination of both. The plastic surgeon who specializes in gynecomastia correction techniques must preoperatively identify the cause that may have caused gynecomastia and advise the patient on the diagnosis and treatment. Gynecomastia can occur at any age, -most commonly in adolescent boys in the form of idiopathic gynecomastia-, and although in some cases the condition may be improved or even cured on its own, it often remains for life if left untreated for more than a year without signs of regression.

The operation in brief

Gynecomastia can be caused by the combination of hyperplasia of the mammary gland and adipose tissue of the male breast. The size of the breast can vary from a small and very hard lump to a fully developed and shaped “feminine” breast. When the swelling of the breast is due to a small piece of massive tissue, it is considered better to correct it through a small incision that will be made under the nipple, while if it consists mainly of fat, liposuction is applied.

The procedure involves the use of 1-2 small holes of 3-4 mm each made in places that are not immediately visible and from where fat is suctioned from the breast. In cases where the problem of hyperplasia of the mammary gland is more extensive, it is often necessary to remove a larger area of ​​breast tissue. This surgery practically develops into a subcutaneous mastectomy (removal of the gland with preservation of the skin and the nipple) and is usually performed through a crescent incision under the nipple. In very rare cases, where there is a large excess of skin and sagging breast, the incisions need to be larger and extend more circularly around the nipple.

Scars

The scars will depend on the surgery technique applied (as mentioned above). The incisions along the nipple become almost invisible over time. At first, they will be quite pink/red for the first 6 weeks or so, purple over the next 3 months and then they will fade to white. Scar maturation takes up to 12-14 months. In most cases, the quality of scars will be extremely good in the long run. Some patients get to this point relatively quickly, but for others, it may take longer. In rare cases, hypertrophic or keloid scars may form. The way your other wounds have healed in the past may be an indication of the wound healing process.

Medication

A complete medical history must be taken before every surgery. As a precaution, over-the-counter medicines or herbal products should not be taken before and for 3 days after surgery. It is also necessary to avoid taking non-steroid, anti-inflammatory drugs such as aspirin (salospir), ibuprofen (Nurofen), diclofenac (Voltaren), and any other anticoagulant or antiplatelet drug following a discussion with your treating physicians. It would also be helpful to bring a list of any prescription medications you are taking for your preoperative checkup.

Smoking

If you are a smoker, try to stop smoking for at least 2 weeks before and 1 week after the surgery as this will dramatically reduce the chances of postoperative complications.

Recovery from Gynecomastia correction surgery

Duration of the procedure

The procedure takes 45 minutes to 2.5 hours depending on the technique used and the size of the breast.

Duration of hospitalization

Depending on the type of operation, a patient may be required to stay in the hospital for a few hours (daycare) – as is the case when a patient needs only liposuction – or for one night – as is the case when a patient needs subcutaneous mastectomy.

Wound dressing

At the end of the surgery, you will wake up and have a small gauze on each incision as well as an elastic corset that will cover the entire chest area – the corset should be worn continuously for 4 weeks (you can remove it when you take a bath) and afterward only at night for two extra weeks.

Drainages

In the event that the mammary gland is surgically removed, it is necessary to place a small surgical drain inside the breast to remove any unwanted blood/fluid; said drain will remain in the body for 24 to 48 hours.

Absence from work

People differ in terms of recovery time, but as a general rule, a period of three days to at least two weeks should be given, depending on the extent of the surgery. Patients who do manual labor and require intense movement at work may need more time.

Refraining from exercising

Patients who have undergone gynecomastia surgery usually feel able to walk a distance in 5-7 days and swim in 10-14 days (if they have fully recovered). However, vigorous exercise (aerobics, etc.) should be avoided for 3-4 weeks.

Driving

Patients who have undergone surgery to correct gynecomastia should ideally avoid driving until they are completely free of any discomfort or restriction, in order to be able to make a sudden movement, such as braking, freely and without any pain. This is proposed so that patients can secure coverage from their insurance company in case of an accident. Thus, it may take up to two weeks for them to fully recover. There are of course patients who feel able to drive after 1-2 days, but always at their own risk.

Postoperative follow-up

Your incisions will be checked and a dressing change will be made on the third and seventh postoperative day, and then, after approximately three months and after you have healed completely, you will have another appointment with Mr. Kontantinos Benetatos. There will be no extra charge for any postoperative follow-ups related to your surgery.

Recovery from Gynecomastia correction surgery and Final Outcome

Bruises and slight swelling on your chest are expected to last one to two weeks. In addition, it is quite common during the first few days to feel a slight discharge of fluid from the wounds as they begin to heal. You should immediately have a satisfactory flat breast shape that will continue to improve (especially after longer operations) over the next four to six weeks. After this time the skin and nipple will be much softer.

Possible complications from the Surgery to correct gynecomastia

The treatment of gynecomastia is a routine procedure and is completely successful for the vast majority of patients. However, as with any surgery, it is very important to understand that there is a possibility of complications. Possible complications are listed below:

Loss/necrosis of the nipple-areola complex

It is extremely unusual (less than 0.5%) and occurs when the blood supply to the nipple is interrupted. In this case, the nipple will be lost and replaced by a scar. Although extremely rare, the factors that increase the risk in each patient are smoking, obesity, and old age. Also, the possibility of nipple necrosis increases if the reduction concerns very large breasts. If you belong to any of these categories, Mr. Konstantinos Benetatos will discuss with you during your preoperative session possible alternative surgical techniques to avoid this risk.

Asymmetry

Although most patients can expect an extremely satisfactory result on both sides of the breasts there is nevertheless a possibility of a slight asymmetry between the two sides.

Wound disruption

It is extremely rare.

Hematoma

There is a small chance of postoperative bleeding which can sometimes form a hematoma under the skin of the breast, which will cause the patient to return to the operating room. This will usually become evident within the first twenty-four hours after surgery. Hematoma occurs in about 1% of patients.

Wound infection

Inflammation is very unusual but if it occurs the patient will need to be treated with antibiotics.

General risks of surgery/gynecomastia correction surgery

Chest infections and thrombosis in the leg or lungs (deep vein thrombosis – pulmonary embolism).

Although rare, it is important to avoid them by not smoking, not being overweight, and moving as soon as possible after surgery.

If you experience any symptoms that may worry you, please do not hesitate to contact us.