Male Breast Reduction
Male breast reduction, also know as gynecomastia surgery, involves the surgical removal of unwanted fatty and glandular tissue from the male chest. As with all body contouring surgery, the aim of the surgical intervention is to leave the chest with a normal shape and in proportion to the rest of the body.
Before and after photographs
The New Zealand Medical Council has banned New Zealand doctors from using "Before and After" photographs in any form of public communication, including websites. The only permissible use of such photographs under the New Zealand Medical Council rules is during a medical consultation.
Dr Masters will show you examples of previous patient's "Before and After" photographs during your consultation.
The Procedure
The actual surgical intervention performed can vary from simple liposuction for more mild cases with primarily fatty excess, through to formal surgical breast reduction for cases with marked glandular excess.
Indications
Male breast formation is very common during puberty and teenage years, up to 70% of males may experience this, the condition usually resolves within one year. As such most teenagers do not require surgery.
Other causes of gynecomastia include hormonal imbalances, the use of certain drugs (e.g. steroids and digitalis), obesity, fluctuating body weight and/or after losing considerable body weight. Although one sided excessive breast development is possible, the condition is usually approximately symmetrical.
Surgery is indicated whenever correction of any of the above factors does not lead to resolution of the complaint and/or when the gynecomastia is causing significant embarrassment and lifestyle impedance.
Relevant Anatomy
The excessive breast tissue can be made up of either fatty tissue or true glandular tissue. Like the female breast, this tissue is located superficial to the pectoral muscles behind the nipple/areolar complex. Often these two components are intermingled. Even in breasts whose primary excess is fat, after removal of the fat component there can be a firm nubbin of glandular tissue remaining behind the nipple areola complex, which requires surgical removal.
Anaesthesia
This depends on the nature of the surgery performed; most commonly local anaesthetic with intravenous sedation is used. However for more extensive procedures, general anaesthesia is preferred. In either case the procedure is usually done as a day stay so that the patient can go home the same day.
Where is the surgery performed?
For smaller cases, that is those not requiring general anaesthesia, the surgery is performed in Mr Masters rooms in a designated procedure room area. This room is specially equipped with appropriate safety equipment to ensure the patients well being is monitored at all stages. Large cases requiring general anaesthesia are always performed in a fully equipped and staffed operating room.
Pre-operative Preparation
Mr Masters will provide you with precise instructions well in advance of your surgery to allow you a smooth and stress-free preparation for the procedure. Take the time to read your consent form thoroughly, along with any other written information Mr Masters has provided for you with regard to your surgery. This will allow you to have all of your questions answered prior to having the procedure, and ensure there are no unexpected surprises during the post-operative period.
If you are the main domestic executive in your home, or you live alone, you should plan ahead with regard to housework and meal preparation. Do your grocery shopping, cleaning, etc the day before your surgery and plan to have meals that require minimal preparation and/or cooking time.
If you are a smoker, stop smoking at least one month pre-operatively (see the "Disclaimer" page). Do not take any aspirin or aspirin-containing products for at least one week prior to the surgery. If you are on any other medications, ensure that Mr Masters is aware of the medications (including homoeopathic remedies) so that any other medications which require cessation during the pre-operative period can be discontinued.
The Surgery
The majority of cases are surgically corrected using a liposuction technique. The combination of power assisted liposuction equipment and a liposuction cannula tip designed for fibrous tissue removal, means that the vast majority of cases can be satisfactorily completed using liposuction alone. This requires two or three small incisions placed discreetly within natural occurring skin creases whenever possible. A full description of liposuction can be found under the liposuction section.
As the amount of glandular tissue requiring removal increases so too does the complexity of the operation. Having completed the liposuction if there is still a significant nubbin of glandular tissue behind the nipple/areola complex requiring removal then a small incision is made at the periphery of the lower half of each areola and the tissue is removed. These incisions heal with remarkably good scars.
Occasionally the degree of gynecomastia being treated has resulted in significant skin excess that also needs to be removed as well as the underlying fatty and glandular tissue. In these cases some external scaring is left on the chest, but once again every effort is made to disguise the final scars within naturally occurring body creases. For these cases at the completion of surgery Mr Masters will usually place surgical drains to ensure that no blood or fluid gathers within the wound within the first 24 to 48 hours.
Post-operative Period and Recovery
The vast majority of patients go home on the day of their surgery. You will need a responsible adult to be with you for the first 24 hours. The residual effects of the local anaesthetic are still in effect when the patient goes home and, as such, surgical discomfort is usually easily controlled. As the local anaesthetic wears off, the use of oral pain-relieving medications that Mr Masters will prescribe for you becomes necessary. Patients have a varying response to this discomfort. Some patients literally take no additional pain relief, others find themselves in considerable discomfort for a number of days, requiring strong oral pain relief. There is no way to predict how a certain individual will respond to the post-operative discomfort.
Not infrequently, the small incision wounds will ooze fluid for at least 24 hours. Although some patients find this alarming as it can frequently be bloodstained, it is completely normal following this kind of procedure.
Usually there are areas of altered skin sensation wherever liposuction has been performed. Full return of sensation is the norm, however this may take a number of weeks to months. When the nipple areola complex has needed to be addressed surgically there will be some initial decrease in sensation. Usually this sensation returns back to an essentially normal level, this may however take several months.
During the procedure the cannula tip often bumps into the underlying muscle layer. This causes some bruising of the muscle, which is reflected in muscular discomfort for a number of days after the procedure.
Most patients are able to return to gentle cardiovascular exercise by Day 3. Higher impact exercise (e.g. aerobics classes, running, etc) should not be resumed until at least 3 weeks after the procedure. Your body needs this time to help reform the fibrous tissue that joins your skin firmly to the deeper layers. Swimming is an excellent post-operative exercise; however, it should not be commenced until the wounds have absolutely healed (approximately 12 days).
Results
Although an initial result is immediately obvious at the completion of surgery, the final result is often not seen for at least 10 weeks after the surgery. As efficient as the fat removal systems are, there is always a degree of damage to fat cells left behind at the completion of the surgery. A percentage of these fat cells may recover from the surgical insult; however, others will not. It is these fat cells which go on to die which help to cause the post-operative swelling evident after liposuction. Once your body clears the fatty debris, the inflammation can subside and the final result becomes more evident. Meanwhile, the skin is shrinking and there is an increase in fibrous tissue under the skin caused by the surgery, both of which add to the final result.
You can expect to see a significant change in the contour of the areas which had been operated on, limited only by the fact that only fat can be removed β muscle, bone and skin are not re-fashioned as part of this procedure. You can expect to have, after the operation, approximately the same degree of skin waviness and dimpling as what you had before the operation. The small stab-like incisions will go onto heal using exactly the same process as any other cut you have ever had. Initially the scar will be red and, eventually, it will pass through a series of stages before becoming pale and inconspicuous. This process may take months.
Complications (general)
Before deciding to proceed with surgery, every patient needs to thoroughly consider the risks, as well as the benefits, of surgery. During your pre-operative consultation(s), Mr Masters will openly discuss the risks with you so that you can consider them. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website. There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being performed.
Generalised surgical risks include:
- Bleeding β usually occurs within the first 24-48 hours of the procedure and may require a return to the operating room. A quiet, restful post-operative period will help to avoid this problem.
- Bruising β whenever possible, Mr Masters uses medications and techniques that help to avoid post-operative bruising. The appropriate use of Arnica may help to speed the resolution of bruising.
- Infection β surgical incisions, even though created in ideal circumstances, can become infected.
- When appropriate, antibiotics will be prescribed to lower this risk.
- Unfavourable scarring β every surgical incision results in a scar. It is Mr Mastersβ role to maximise the quality of your scars and, whenever possible, to hide them in natural skin creases.
Risks and Complications (Specific to Gynecomastia)
Male breast reduction, when performed using modern techniques by a fully qualified surgeon who has undergone comprehensive training in their field, should not result in significant complications. However, surgery, even liposuction, should not to be undertaken lightly by either the patient or the surgeon because complications can and do occur from time to time. These include:
- Asymmetry β any right versus left asymmetry is usually within the normal levels of asymmetry which exists in our society in people who have never had an operation.
- Skin death β this is a rare complication usually associated with the inappropriate use of UAL technology. Mr Masters has never had a case of skin loss from liposuction.
- Dimpling, rippling, ridges and divots β once again, with modern techniques using tumescent fluid and small cannula, these occurrences should be rare. Mr Masters aims to leave the skin no wavier than what it was pre-operatively.
- Sagging of skin post-operatively β this complication can occur, but is much less frequent than one would expect. If Mr Masters believes your skin will not reduce in size to match the post-liposuctional volume of the area concerned, then he will recommend an alternative surgical technique.
- Sensory changes β As discussed above, there can be a period of time where the skin loses sensation. The norm is to have complete recovery of sensation after liposuction.
- Scarring β troublesome scarring from the liposuction cannulas is an infrequent occurrence as the wounds are so small.
Benefits of the Surgery
By restoring a more masculine shape and appearance to the chest and also restoring harmony in the body proportions, most patients who undergo gynecomastia surgery find an increase in their confidence and self esteem. The procedure eliminates self consciousness and embarrassment associated with physical activities requiring bodily exposure.
Approximate Costs
The treatment of gynecomastia is very individualised and a consultation is necessary to establish exactly what procedure is required and hence give a cost of treatment. This is because a pivotal part of the assessment is establishing how much glandular tissue there is verses fatty tissue. Unfortunately only in exceptionally advanced cases is it possible to estimate pricing from a photograph - a consultation is essential. Including the operating room charges, consumable items used, post operative garment and an anaesthetist (when necessary) the operative treatment of gynaecomastia usually costs from $8,000 (liposuction alone) through to approximately $15,000 (extensive fat, glandular tissue and skin breast reduction). Occassionally very early cases can be treated under local anaesthesia at a lower cost.
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