Gynecomastia Treatment

Planning and marking before the gynecomastia

How the gynecomastia procedure is performed

We provide a range of cosmetic surgery gynecomastia treatments to help our patients. This varies from liposuction, open excision of excess tissue (removal by cutting) and reduction of excess loose and saggy skin. The table below outlines the combination of treatments we consider for the various types of enlarged male breasts:

Pseudogynecomastia (Fatty)

  1. Improves the contour
  2. Operative time is around 40-45 minutes and procedure is performed as a day case
  3. No drain (plastic tube)is inserted
  4. Performed under local or general anaesthetics
  5. Use of pressure garments is mandatory for at least 6 weeks following the procedure

Removal of glandular (fibrous) tissue

  1. Operative time is around an hour and procedure is performed as a day case and may or may not require overnight stay
  2. Drains are usually inserted in this procedure
  3. Performed under local or general anaesthetics
  4. Use of pressure garments is mandatory for at least 6 weeks following the procedure

Removal of localised fat and glandular (fibrous) tissue

  1. Operative time is around 1-2 hours and this procedure may requires overnight stay in the hospital
  2. Drains may beinserted in this procedure
  3. This procedure is performed either under local or general anaesthetics
  4. Use of pressure garments is mandatory for a period of 6 weeks following the procedure

Removal of fat, fibrous tissue and skin

  1. Operative time is around 1.5 to 2.5 hours and this procedure requires overnight stay in the hospital
  2. Drains are inserted in this procedure
  3. This procedure is performed under general anaesthetics
  4. Use of pressure garments is mandatory for a period of 6 weeks following the procedure

When we use open techniques with or without liposuction, the downtime is extended in terms that patients are advised not to perform any upper body workout, weightlifting, swimming and other physical contact sports for a period of 4 to 6 weeks.

Liposuction is usually used in the treatment of almost all types of gynecomastia to remove the fatty component as well as to improve the overall contour following the removal of the glandular component (fibrous tissue) using the open technique.

Types of gynecomastia

  1. Fatty (pseudogyencomastia) - associated with excess weight/obesity
  2. Glandular (fibrous)
  3. Mixed - where there is excess localised disposition of fat associated with residual glandular tissue
  4. Following massive weight loss reduction
  5. Gender reassignment patients from female to male.

1. Fatty Gynecomastia (pseudogyencomastia)

Fatty gynecomastia in common in young patients with good quality skin, but can effect all ages. These patients are normally suited for correction with liposuction only. Liposuction involves minimum scarring and can be performed under local or general anaesthetic and is suitable as a day case procedure. The downtime following liposuction is minimal and patient can resume day-to-day activities within 48 hours.

2. Glandular (fibrous) Gynecomastia

If a patient has got localised gynecomestia without much fat, then an open excision technique (removal by cutting) is used and there is no need for liposuction. This is common with muscular patients with a well defined chest and normal body mass index.

Liposuction is sometimes needed to improve the overall contour after the removal of the glandular component (fibrous tissue).

3. Mixed Gynecomastia

Patient with mixed Gynecomastia, where there is existence of glandular tissue/fibrous tissue associated with the localised deposition of fat are suitable for liposuction assisted open excision (open approach) surgery. In this technique, the fatty component is removed by liposuction. The glandular component, which is normally underneath the nipple area, is excised (removed) through a small cut within the areola (the area around the nipple).

This operation is relatively invasive. Mr Vadodaria prefers to insert a plastic tube (suction drain) underneath the skin following such a procedure for a period of 12 to 24 hours.

This type of procedure requires extended time in the hospital with a view to remove the drain either on the later part of the same day or next day. As a result, an overnight stay is often required (with the associated additional costs).

4. Massive weight loss reduction

Morbid obesity is a major challenge in western culture. There is increasing awareness about obesity related diseases and issues, for example diabetes, hypertension, reduced mobility as well as isolation in social and professional environments.

We receive patients who have successfully achieved their weight reduction target by exercise, diet or surgery. These patients are left behind with significant sagging of their chest wall skin as well as soft tissue. Correction of such type of gynecomastia requires liposuction, removal of soft tissue as well as removal of significant amount of loose redundant and saggy skin. These patients will require the suction drain as well as an overnight stay.

5. Gender reassignment (sex change)

There is increasing awareness of and demand for gender reassignment. The removal of female breasts remains an essential procedure for body contouring transformation in patients undergoing gender reassignment from female to male. We perform breast removal procedure which is also called subcutaneous mastectomy.

This type of breast removal procedure is the equivalent to the correction of grade 4 gynecomastia in patients following massive weight loss. This operation leaves behind more scarring. The level as well as size of the nipple are optimised. The patient may require one to two nights stay in the hospital. The operation consists of removal of breast tissue, adjustment of loose, excess and redundant skin as well as re-positioning of the reduced size nipples.

How Skin Quality & Excess Affects the Treatment of Gynecomastia

Grades of gynecomastia

  1. Normally only liposuction, no skin reduction is required in patients with good quality skin, particularly in the younger age group
  2. Open excision assisted liposuction
  3. Open excision of glandular tissue, removal of excess redundant skin assisted with liposuction
  4. Open excision of glandular tissue, removal of excess redundant skin assisted with liposuction. In addition to liposuction, these patient also require the removal and adjustment of the excess skin and a re-sighting of the location of the nipple area. The scar following this procedure is around the areola and can sometimes extends horizontally, vertically or in both directions.

Grade 1 gynecomastia is corrected with liposuction and/or open excision, and do not require skin reduction.

The majority of grade 2 gynecomastia in young patients are corrected with liposuction and/or the open technique. If loose skin is significant and less elastic, particularly in mature patients, then the skin reduction procedure is usually required, leaving behind a circumferential around the areola.

Grade 3 gynecomastia would involve liposuction, removal of the glandular component with an open technique and removal excess redundant skin and adjustment which will leave behind a relatively more conspicuous scarring as illustrated below:

Disclaimer: Individual results may vary from person to person.

Post operative care

All the patients are advised to use a pressure vest for a period of 6 weeks following the correction of gynecomastia.

Patients are prescribed with antibiotics and painkillers for a period of 5 to 7 days, and are advised to take Arnica homeopathic pills for a period of 2 weeks after the procedure. We also advised to restrict and/or avoid weightlifting, upper body workout, swimming, rock climbing, contact sports for a period of 4 weeks following open accession technique.

Patients are expected to see Mr Vadodaria/his team within 7 to 10 days for a wound check and within 6 weeks for the follow up.

When to contact the practice/hospital

You are advised to remain in touch with the hospital/practice/consultant if you have pain that is not controlled by the prescribed medication, if you notice painful swelling on the operative site or you have a fever. In the event of logistical difficulties of travelling distance, you should take medical advice from your local GP or accident and emergency department while you are establishing contact with the hospital and the consultant.

Complications and limitation

Every aesthetic plastic surgery operation has limitations and complications. Correction of gynecomastia is not a digitised, mathematically perfect operation.

The healing and scar formation varies from person to person and can also differ from one side to the other side in the same person. The incisions which are used for insertion of liposuction tubes (canular) leave behind scars although these are very small and normally inconspicuous. If an open technique is used, then there will be a scar within and around nipple areola complex.

There is a relatively small possibility of under or over correction and asymmetry. The incidence of pigmentary changes and thickening of the scar is known to be higher in darker skin (South Asian & Afro Caribbean) patients. There is a transient and temporary swelling and discolouration varies from patient to patient, but generally resolves by itself after one to three weeks time.

Sometimes there may be a collection of blood, particularly following the open approach, that may warrant a return to theatre for removal of the blood clot. Infection following the gynecomastia procedure is not so common.

Although rare, any operation done under general anaesthetic involves a risk of deep veined thrombosis and, very rarely, pulmonary embolism.

List of complication:

  • Scarring
  • Infection
  • Bleeding
  • Under correction or over correction
  • Asymmetry
  • Wound healing problems
  • Soft tissue death
  • Teathering of nipple
  • Surface irregularity
  • Temporary swelling, brusing and discolouration
  • Deep veined thrombosis (because of the general anesthetic)
  • Pulmonary embolism
  • Fat embolism
  • Internal injury

Why we ask patients to stop smoking

It is prudent to stop smoking before any kind of aesthetic plastic surgery, particularly gynecomastia, because smoking increases the incidence of wound infection, bleeding and soft tissue necrosis.

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