Male Chest Reduction Surgery - Gynaecomastia

Before & After Male Chest Reduction Surgery

Male Chest Reduction FAQs

What exactly is GYNAECOMASTIA (male breast enlargement)?

The breast, whether male or female, is made up of basically two components. These are the glandular tissue component (firm and dense) and the  fatty tissue component (softer tissue). The ratio of glandular to fatty tissue  in any breast varies from individual to individual. Although strictly speaking gynaecomastia refers to enlargement of the glandular component of the breast, in reality for most patients there is both an excess of fat and glandular tissue.

The term gynaecomastia (pronounced guy-nee-co-mastia) is greek for woman's breast and it was first coined by Galen a second century AD physician. A description of a surgical procedure to cure this condition was subsequently first documented during the 7th century AD by Paulis of Aegina, a Greek physician, who described it as an effeminacy of men.

Although sometimes this condition appears at birth the main cause is puberty. Some studies suggest that as many as 65% of boys in the 14-15 year age group encounter this. Within 2-3 years the incidence drops radically so that the condition affects only about 8% of males of 18 years of age. However the incidence rises again with progressive age reaching an incidence of about 30% in older men. Although the cause of male breast enlargement is not as yet entirely clear, there can be no doubt that it is basically a result of the actions of circulating hormones on specific cells in the breast area. Some researchers feel an imbalance in the male to female hormone ratio of the male body(yes, males do have quantities of female hormones circulating in their bodies!) rather than the absolute level of these hormones is significant in the development of this condition. Predictably therefore there are large variations between the degrees of breast enlargement encountered.

What's important to remember is that the condition is mainly and largely a normal finding, although very rarely it can be associated with drugs(marijuana in large quantities) or organ disease. This will be ascertained at the initial consultation.

How do you treat Gynaecomastia?

As mentioned above the problem of gynaecomastia is a dual component problem, due to an excess of both breast gland and fat. As such a combined approach is necessary in order to achieve the flat chest that most men desire. With the fatty component liposuction is used.  In fact the introduction of liposuction has truly revolutionised the treatment of gynaecomastia. In the past the only way to treat this condition was by creating large surgical incisions either around nipple or lower edge of the breast, and scooping out the excess tissue. Now with liposuction this can effectively be done usually through a single 3- 4mm incision placed in the armpit. More recently, a newer instrument has been developed called the Micro-Aire power handle which has significantly increased our capability of reducing the enlarged male breast(see Liposuction notes). As a result Mr. Karidis is pleased to be able to offer this latest technology for the benefit of his patients.

Nonetheless, it is also  important to remember however that despite the advent of the power handle most patients will require, an additional surgical incision, usually around the nipples to deal with the other component of the problem, the excess gland which is situated just beneath the nipples. Mr. Karidis has developed his own pull-through technique which only requires a small 7-9 mm incision under the nipple, from which he is able to remove the excess glandular component of the problem. By utilising this dual approach, Mr. Karidis ensures that you will achieve the flat chest you desire.

In very rare cases where patients have undergone large weight fluctuations or reductions, such patients also experience sagging of the skin in addition to the fullness of the chest. In these rarer situations, some form of skin removal and tightening will also be required. Obviously in these situations the scars will be significantly longer and more visible, and the healing time will also be prolonged. Of course this will be determined and explained to you at the time of your consultation.

Am I a suitable Candidate?

Only a consultation will be able to determine if you are an acceptable candidate for a combined liposuction/gland removal procedure. A consultation preoperatively accomplishes several objectives. A thorough medical history and appropriate physical examination will be taken to ascertain your health status. If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing.  Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you must avoid these.

Determining your suitability will partly be defined by the quality of your skin. In most cases the skin being a dynamic organ, it is able to shrink and reaccomodate to the new body contour after liposuction and gland removal. In the some cases however, patients may have decreased skin elasticity as witnessed by loose, hanging, or crepey skin in the affected area. In these cases liposuction alone will not produce the desired result and you may therefore require some form of skin removal/reduction instead  or perhaps in combination with liposuction.

The best patients for liposuction are those individuals who are active and healthy, of average or near average weight (within 12-15% of their ideal weight), and have reasonably good skin tone and elasticity. Age by itself is not a significant factor and in fact patients from age 16 -65 have benefited from liposuction.

What does the Operation entail?

The following description below pertains to gynecomastia correction using liposuction and gland removal with no skin excision necessary.

To begin the operation a tiny incision (about 3-4mm) is made in the skin in each armpit area. Subsequently the chest areas are injected with the tumescent solution mentioned in the Liposuction section. This solution is then allowed to diffuse and take effect (about 10-15mins) throughout the target fat. As mentioned previously the solution will numb the areas as well as reduce bleeding by temporarily closing down the regional blood vessels. The appropriate cannulaes are inserted into the fat, then through backward and forward stroking motions, along with the help of the power assisted liposuction handle, the fat is loosened and drawn off by a strong vacuum pump.

You'll lose some  fluid along with the fat during liposuction, therefore during the procedure it is normal practise for the anaesthetist to give intravenous fluids to replace those lost in the procedure.

Throughout this procedure Mr. Karidis is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimise the possibility of any irregularities or rippling of the skin. Once the required amount of fat is suctioned from around the breast gland, the gland is then more easily accessible and can be “pulled through” more readily with a small, usually about 7-8 mm, incision at the bottom part of the areola(red area around the nipple) and is usually removed piecemeal. This piecemeal removal avoids the need for a larger incision which would have been required to remove the whole gland in one piece. During the removal of the breast gland, Mr. Karidis ensures that he removes about 95% of the gland. A small amount of breast gland must be maintained in order to support the areola and to avoid unsightly dips and irregularities in the region. As the incisions are tiny, they do not require sutures and are left to heal on their own. A compression vest is then supplied for you in order to apply some pressure to the region for about 10 days.

When skin excision is also required, due to excessive sagging, the ensuing scar size and positioning will be explained to you at the time of the consultation. In these situations the operation details are more along the lines of female breast reduction (see breast reduction section).

Watch the procedure in Virtual 3d

What type of anaesthesia is used?

Gynecomastia correction can be performed successfully either with a local anaesthetic alone, local anaesthesia with mild sedation (twilight anaesthesia) or with a General anaesthetic(completely asleep). If you decide to have it done with a local anaesthetic, you will probably feel some vibration and friction during the procedure. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle. Obviously if you are put to sleep then you will not be aware of anything.

The decision very much depends on patients individual circumstances and desires.
Such decisions are best made after a thorough consultation and discussion with Mr. Karidis.

How long does the surgery take?

Gynecomastia correction using liposuction and gland removal takes approximately 30-40 minutes. In the event that skin removal is necessary then procedure can take up to 90 minutes.

Do I need to stay in overnight?

The vast majority of patients can have the operation performed as a day case and therefore leave the same day.
The decision for this can be made at the time of the consultation visit.

Is it Painful?

There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of gynecomastia correction with liposuction and gland removal, the degrees of pain vary from patient to patient, but this can be controlled by pain killers, which will be prescribed. The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness you may experience some stiffness which usually abates as your mobility increases.

Will the Fat or gland come back?

The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site. It is important therefore to maintain your weight afterwards by sensible eating and regular exercise.

However if you do put on excess calories after surgery, you will notice that other areas of your body may be then be affected.  The only exception to this rule is if there is a massive weight gain. In this case new fat cells can be seen in the previously treated area.

As Mr. Karidis removes about 95% of the gland volume very little remains to enlarge and therefore it is exceedingly rare for the condition or gland to reappear.

What happens immediately after the Operation?

After your surgery, you will find that a snug elastic compression sleeveless vest  will be in place.  This must be worn over the chest area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You will need to wear this compression garment continuously for ten days (apart from taking it off for a shower) after surgery. After this time, you may wear the garment, if you feel the need for only a few hours in the day to help support the area in the last few weeks of  the healing process which can last 2-3 months.

Post Operative Instructions

What kind of effects can I expect after  Surgery

After the surgery you will notice that you will be draining some fluid from your tiny incisions. This is because there is almost always some fluid build up (usually bloody) that develops in the treated area in the first 24-36 hours postoperatively. Your incision sites therefore will act as"drainage holes" in this instance and are therefore invaluable in reducing overall post operative swelling and bruising.

Drainage of the fluid is possible because, unlike traditional teaching, Mr. Karidis does not use stitches to close the small incisions. As the incisions are very small, these seal off and heal quite quickly on their own and the ensuing scar is no different, if not better, compared to the use of stitches. There is also the obvious advantage in that it negates the need for stitch removal.  The down side of this practise is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes. Thankfully all this usually stops by the end of the first 48 hours after surgery.

Despite wound drainage, you are still likely to experience swelling and bruising to varying degrees. Sometimes this bruising is quite spectacular. Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment. Tissue swelling, while expected, can last up to 4 weeks.

At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to "heal" itself. This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an "orange skin" appearance. Thankfully the scar build up ceases and eventually resolves completely, along with its manifestation. However this period of hardening and irregularity can take up to 4 months to resolve.

You will also experience sensory changes in the area treated. This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this is usually temporary and returns to normal in about 6-8 weeks.

Overall because of these effects, it's not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better.

Are there Scars?

Scars are not a complication but a normal event after any surgery. As described, tiny scars from about 3-8 mm in length will form. Thankfully the scars in Liposuction and gland removal  generally heal quite well, gradually  fading with time. However it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type however, then expect your scars to be darkly colored for a longer period of time (about 3 years). Daily massage of the scars during this time period is advised to expedite and facilitate this process. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance.

What can go wrong?

All surgery carries some uncertainty and risk. When  gynecomastia is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Thus complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections. In extremely rare cases, skin loss resulting in permanent scarring has been reported.

Despite any surgeons best efforts, it is possible that a small number of patients  may require a  secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks.

You can reduce your risks by closely following your surgeon's advice both before and after surgery.

How long before I get back to normal ?

The recovery time varies with every patient and the type of activity the patient intends to resume. It is important to realise that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required. However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 3-7 days. However because of variations in swelling and bruising, sometimes this may be delayed up to 10 days. Exercise is usually recommenced at about 10 -14 days.  Don't be depressed however if it takes you longer to resume your full activities. Remember every individual is different and great variations occur.

How many gynecomastia correction procedures does Mr. Karidis perform?

According to his annual audit figures submitted to the Hospital of St.John and St. Elizabeth last year Mr. Karidis performed 90 gynecomastia correction procedures in 2006. In the last 10 years he has performed over 800 gynecomastia correction procedures.

Summary

Gynecomastia is relatively common condition which affects a large proportion of the male population to varying degrees. Thankfully however with todays newer techniques and technology, patients can liberate themselves of this unwanted appearance both safely and effectively. The chances are excellent that you'll be happy with your surgery, especially if you realise that the results may not be immediately apparent. Ultimately however most patients are very satisfied with the results of their gynecomastia reduction - they feel more comfortable in a wide variety of clothes and more at ease with their bodies. As long as your expectations are realistic, you should be happy with your new flatter chest.

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