is the development of female breasts in male patients. It is also unkindly
known as "man-boobs". Many patients find this extremely socially
embarrassing and very depressing with loss of self-confidence. It is often
most noticeable in the summer months when people wish to wear T -shirts
or go swimming on holiday. Patients find that no matter how much they
go to the gym they cannot shift the breast tissue and alter their appearance
In most cases
the cause of the gynaecomastia is unknown (i.e. it just happens). Other
causes include obesity, puberty, drugs (steroids, diuretics, recreational
drugs), and hormone imbalance. It is important to exclude any of these
causes of gynaecomastia as these may be reversible without surgery. However,
the vast majority of cases no identifiable cause is found, and patients
proceed to surgery to correct the shape of their chest.
Before the operation
There is nothing
special or complicated to be done by the patient. If you smoke it would
be a good ideal to try to stop for a month before and two weeks after
as this will significantly improve wound healing and your post-operative
recovery. It would be advisable to stop any herbal medicines and avoid
aspirin or ibuprofen-like drugs for 2 weeks before the operation.
The operation itself
into the hospital on the morning of surgery. The operation is performed
under general anaesthetic and takes about two hours. The excess breast
tissue is a mixture of fat tissue and true breast tissue, often in differing
proportions. There are two surgical options. The first is liposuction
alone, and this is called a "closed" procedure, which leaves
tiny scars. This is good for breast enlargement due to excess fat deposition.
The second is an operation which involves a cut below or around the nipple
and excision of the breast tissue, is known as the "open" operation.
The "closed" technique (liposuction) is a day case operation,
with no overnight stay. The longer "open" procedure requires
an overnight stay and surgical drains which are removed the following
day. In both operations an elastic compression binder is fitted routinely
around the chest -this is a tight elastic garment with a velcro zip.
Post-operative follow-up and after care.
If you have
had the "closed" liposuction technique you will be discharged
later that day. "Open" procedures necessitate an overnight stay
in hospital. All being well, you will be discharged home the following
day with some painkillers, after the drains have been removed. It is import
to leave the dressing alone and wear the chest binder 24 hours a day.
At home you should take life easy for the first few days. At between 5
and 7 days you will be seen in the clinic and the dressings removed and
the wounds checked. You wound be advised to take to 1 to 2 weeks off work
and it is essential to avoid all strenuous activity during this period.
The binder needs to be worn day and night for a month to give the best
result possible, and failure to wear it without doubt diminishes the final
appearance. Vigorous sport such as jogging or the gym should be avoided
for 4 weeks. A check up clinic appointment at 3 months after the surgery
will be arranged for you. The final result of the gynaecomastia correction
is best viewed 3 months after the surgery.
carry a risk of complications, and gynaecomastia surgery is no exception.
The risk of infection is less than 5% and precautions are taken to avoid
this with antibiotics. The most significant problem is a haematoma - a
collection of blood under the skin, on the first night after the operation.
This is easily detected and requires a trip back to the operating theatre
to have this removed. This occurs in less than 10% of cases, and is the
reason for staying overnight in hospital after the surgery. In virtually
all patients with "open" procedures drains are inserted at the
time of surgery. These drains are removed on the ward the following day
and their function is to remove any excess fluid that has accumulated
under the skin. In a small group of patients, typically less than 5 %,
a collection of fluid persists and this is called a "seroma".
It is completely harmless and does not affect the final outcome. This
"seroma" is easily treated in the clinic with a syringe. It
is impossible to perform any gynaecomastia operation with out a scar.
Occasionally, scars may be red and thickened for a few months but they
usually settle down by themselves without any treatment. Keloid scars
may occur in predisposed individuals. Unevenness between the two sides
or areas of lumpiness may occur. This is unusual, and most settle with
time following the resolution of any tissue swelling post-operatively.
Exceptionally, areas of unevenness may require revisional surgery.
of gynaecomastia can be performed by "open" or "closed"
techniques. Not all patients are suitable for the simpler "closed" technique. Both operations have low complication rates. Patients are usually
very happy with the outcome of the surgery allowing them to wear T-shirts
without worry, and to go swimming on holiday without embarrassment.
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