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Breast reduction in men
Gynecomastia is a medical condition that is rarely talked about but is actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.
For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.
Click here to watch a video on Gynecomastia. (Requires Windows Media player.)
At the Plastic Surgery Clinic we perform approximately 100 to 150 gynecomastia procedures per year. This makes Dr Lista an extremely experienced gynecomastia surgeon. Dr Lista has one main philosophy when performing male breast reduction: to make all his patients look soft and natural and perform the operation as safely as possible. Today, a number of new techniques are helping plastic surgeons to provide selected patients with more precise results and quicker recovery times.
Power Assisted Liposuction (PAL) is one of the newest techniques available for use in gynecomastia surgery. PAL removes fat and glandular tissue with less bruising and even faster recovery. Dr Lista at the Plastic Surgery Clinic is one of the first surgeons to begin using PAL in Canada.
If you're considering surgery to correct gynecomastia, this web page will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask Dr Lista if there is anything about the procedure you don't understand.
The best candidates for gynecomastia correction
Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.
Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.
The Office Visit
Dr Lista sees all his patients before surgery. If the patient lives in the Toronto area he prefers to see his patients twice, if possible, before their operation. In the consultation process we spend considerable time obtaining a careful history and physical examination. We also spend a long time discussing the patientâ€™s desires, goals and expectations. It is important that the patient discuss with Dr Lista their desired result. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how they may look after surgery.
How Gynecomastis surgery is performed
Most gynecomastia procedures are performed at The Plastic Surgery Clinic. Dr Lista performs all of the procedures personally. He does not have any assistants or students assist with your surgery. Dr Lista is Chief of Plastic Surgery at the Trillium Health Center (The Mississauga Hospital) so your operation can also be performed at the hospital if you prefer. The operation is performed either at our clinic or in the hospital. At the Plastic Surgery Clinic anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes one to two hours. A friend or relative will need to come and pick you up and stay with you for 24 hours.
Preparing for your surgery
Dr Lista will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, and taking certain vitamins and medications.
Smokers should plan to stop smoking for a minimum of one or two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon's instructions.
If excess glandular tissue is the primary cause of the breast enlargement it will be surgically removed with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location--either on the edge of the areola or in the under arm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.
Glandular tissue must be cut out, usually through a small incision
near the edge of the areola.
If your gynecomastia consists primarily of excessive fatty tissue, Dr Lista will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola -the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula which is attached to a vacuum pump, is then inserted into the incision. The surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out.
Power Assisted Liposuction(PAL)) is the newest technique of liposuction and is extremely useful in gynecomastia surgery. Dr Lista is one of the first surgeons in Canada to utilize this method. In this technique a power source is used to rapidly oscillate the liposuction cannula 3 or 4 millimeters at a frequency of several hundred cycles per second. This allows fat and breast tissue to be removed with less force thus decreasing trauma to the patient. The fat is removed more quickly, more evenly and with less bleeding. This means that patients have less bruising and can recover more quickly following surgery.
In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly re-adjust to the new breast contour.
The standard technique for correction of gynecomastia involves a small incision around the nipple. The problem with this procedure is that it leaves a "tell-tale" scar which looks like a half moon around the lower half of the nipple. Usually this scar looks acceptable, but in some patients the scar is obvious and visible. Some men are disappointed that after surgery they are embarrased to expose their chests because of the nipple scar.
Because of these concerns, Dr Lista has developed a new technique which eliminates this embarrasing tell-tale scar. In Dr Lista's procedure he places the Power Assisted Liposuction scar in the outside area of the chest. This scar is about 3 mm (or a quarter of an inch) and looks just like a scar after the removal of a small mole. At the completion of the liposuction he inserts a specially designed instrument through the liposuction incision to remove glandular tissue. This revolutionary technique allows the removal of both fatty tissue and glandular tissue through the same small incision while avoiding the embarrasing incision around the nipple. In the photographs at the bottom of this web page, all of the patients have undergone this new procedure and therefore have no scar around the nipple. You can see a tiny scar on the outside lower part of the chest. Dr Lista is preparing to present this new technique to several national plastic surgery conferences.
Sometimes, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest will be wrapped to keep the skin firmly in place.
|| Fatty tissue can be removed by liposuction. A small, hollow tube is inserted through a tiny incision, leaving a nearly imperceptible scar.
After your surgery
You will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by Dr Lista. In any case, you should arrange to have someone drive you home after surgery and stay with you for 24 hours.
You'll be swollen and bruised for awhile--in fact, you may wonder if there's been any improvement at all. To help reduce swelling, you will be instructed to wear an elastic garment continuously for 6 weeks. This garment is like a lycra undershirt and is not visible under clothing. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.
In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can return to work in a week. Any stitches will generally be removed about 1 to 2 weeks following the procedure. You may resume gentle exercise in 2 weeks but it may take a month before you return to strenuous aerobic exercise or weight lifting. You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin's pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.
All surgery carries some uncertainty and risk
When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area , loss of breast sensation or numbness, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue.
Your new look
Gynecomastia surgery can enhance your appearance and self-confidence, but it won't necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.
The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you'll be very satisfied with your new look.