Gynaecomastia or ‘male breast enlargement’ is an uncommon condition, which can be corrected with surgery. This extra tissue is usually a combination of fat and glandular tissue. If mainly fatty tissue is present then liposuction alone can help, but often a cut around the nipple is needed to remove harder glandular tissue, which cannot be liposucked away. The surgery always leaves scars although these usually become inconspicuous with time. The larger the breasts, the more extensive the surgery. This procedure is safe, the results predictable and an immediately improved appearance is obvious to see. It does take about 12 months before the final appearance is evident as complete healing takes this long normally. The recovery is relatively pain free.
At your first visit, your suitability for the procedure and your fitness for surgery will be assessed. Your breasts will be examined. It is important to decide what is the cause for the gynaecomastia – usually hormonal alterations in puberty or middle age. Occasionally medication may cause it, and need to be changed. Rarely testicular tumours (different sized testes with a lump in one) or brain growths (visual disturbances) or other pathology can lead to hormonal changes and I may request blood or other tests to find help out the reason for your breast enlargement.
An operation plan will be made and an explanation given on anticipated recovery time and use of chest supportive garments.
You should be aware of the risks and complications. All your questions should be answered. A well-prepared patient will do better with surgery and will be more satisfied with the final result.
My usual method of gynaecomastia correction is described below. I will vary this surgery according to patient's individual requirements, but I find the method below provides me with excellent results in the majority of patients.
Surgery is usually performed under general anaesthetic. Either day case surgery or a one-night hospital stay is needed. On arrival on the morning of surgery, you will meet the anaesthetist who will explain the anaesthetic and risks. I will mark the incision lines and various other landmarks on your skin with a pen. I will also take pre-operative photographs at this stage.
After you are under anaesthetic, fluid is injected into the skin to give good pain relief – the fluid contains a local anaesthetic and vasoconstrictor to stop bleeding. The incisions for liposuction are usually 3 small (5mm) cuts around the breast mound. Then the fat is sucked out with a small blunt tipped cannula. If an open approach is required, then it will usually follow the edge of the nipple to hide the scar as best as possible. The firmer glandular tissue is removed through this cut. Sometimes the incision goes all round the nipple, and sometimes only part of the way around. Rarely the cut will need to extend onto the chest – if the breasts are very big. The surgery takes approximately one and a half hours. The wounds are closed with dissolvable stitches and covered with waterproof dressings to allow you to shower regularly. After surgery, you will be transferred to the recovery area and then back to the ward. You will have an elasticized support garment placed around your chest. This will need to be worn for 6-weeks continuously.
When you awake from surgery in the recovery area, you should be relatively pain free. As the local anaesthetic wears off, you may feel a little sore, but painkiller medication will be prescribed. On the first postoperative day you should be up and about, and shower. Your breasts will be a little swollen and bruised. Most of the swelling and bruising takes about 3-weeks to settle. However there still is some firmness and a little swelling that slowly improves over the next 12-months. It is only after a year that the final result is evident.
I will see you about 1-week post-operatively for your first visit. Following this, you should slowly get back to normal domestic activity. Massaging the scars with an aqueous cream helps them to settle, and should begin gently after the first dressing change. Firmer massage can start after 3-weeks.
Some numbness in the breast and particularly the nipple may be noticed for the first few months after surgery. Hypersensitivity can also occur. Both are usually transient.
With regards to driving, I usually advise a period of 1-week with no driving but again this is very personal and some people recover very quickly and can get back to driving in a short time. You should be able to return to work within a week to two, depending on the level of activity required by your job. Physical exercise can be begun when you feel ready, generally after 4-weeks.
Gynaecomastia correction is a relatively straightforward procedure. As with any surgery, however, there are certain risks and complications. It is important to understand what these are.
Telephone the ward of the hospital from which you have been discharged.
Telephone my secretary Angie during office hours – 07961221874
In an emergency (and you have failed to contact me by the above two methods) then please telephone St George’s Hospital (020 8672 1255) and ask them to either bleep me or the Resident Plastic Surgery doctor on call (Bleep 7050).
Appointment times vary, usually 30 minutes for a new patient and 15 minutes for a follow up appointment. Mr Soldin bills for his time. Angie Harrison PA to Mr Soldin - Tel: 07961 221874 would be happy to help you with any queries. Look forward to meeting you. MS