Gynecomastia

Gynecomastia surgery is a procedure to remove excess fat, glandular tissue and/or skin from overdeveloped or enlarged male breasts.  In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple).  In these cases, the position and size of the areola can be surgically improved and excess skin may need to be reduced, leading to additional scarring.  Gynecomastia may result from hormonal changes, heredity, disease, or the use of certain drugs, and can present unilaterally (one breast) or bilaterally (both breasts).

There are a variety of different techniques used by plastic surgeons to treat gynecomastia.  There is often a more solid breast tissue under the areola that may require excision and biopsy as well as additional fatty tissue around the chest often better removed with liposuction techniques.  Breast cancer can occur in males, although less frequently than in females, and the solid tissue removed may require pathologic evaluation. Gynecomastia surgery can be combined with other forms of body-contouring surgery, including liposuction, or performed at the same time with other elective surgeries.

Preparation

Your Kaiser Permanente plastic surgeon will work closely with you. Be prepared to discuss your expectations and desired outcome. Make sure to address all of your questions and concerns.

Aspirin, Motrin, non-steroidal anti-inflammatory medications, and some over-the-counter herbal medications must be discontinued at least two weeks prior to surgery. These and other drugs and substances may cause excess bleeding and bruising. You can usually begin taking them again after a week or so.

If you are a smoker, it is important to quit at least four weeks prior to surgery and refrain from smoking until four weeks after surgery to ensure your wounds heal properly. Your plastic surgeon will discuss this in detail with you and you will also be given a sheet with a list of common medicines to avoid for a short period. Your plastic surgeon will detail the risks associated with surgery. Plan to have a family member or friend drive you to and from your surgery appointment and stay with you for at least one night following surgery.

Recovery

Following your surgery, elastic bandages or compression garments will be used to cover your incisions and the areas treated. This will minimize swelling and to support your chest as it heals. Small tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect.

The immediate recovery will depend upon what type of anesthesia that your Kaiser Permanente plastic surgeon will employ for the surgery. Various anesthetic agents affect patients differently and will dictate the patient’s recovery. Most surgeons will incorporate extensive local anesthesia into the tissues which can allow patients to wake up pain free. The local anesthesia will begin to wear off in three to four hours and most patients will experience mild to moderate discomfort at this stage. Pain is usually well controlled with pain medication prescribed by your doctor.

You will be given specific instructions on how to care of your incisions and drains, including any medications that you may need to take. We will arrange for your follow-up visit at our Kaiser Permanente office. Drains are typically removed after one to two weeks. For most plastic surgeries, there are no sutures to remove. It is most common to use absorbable sutures which melt on their own within a few months. You can shower the day after your procedure but should stay out of the ocean or pool for 2-3 weeks, or until your drain has been removed.

It is important to avoid strenuous activity for two to three weeks after surgery to avoid bleeding and other complications. One of the potential risks of surgery is infection and this usually manifests itself around five to seven days after surgery and is usually effectively treated with oral antibiotics. Numbness around the incisions is normal after surgery and can persist for several months.

Healing time is variable. A significant amount of the recovery occurs within 2-3 months; but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. For breast implants, the full recovery period is at least a year and this involves a gradual softening of the tissues around the implant and time for it to settle into its natural position.