Gynecomastia comes from the Greek meaning “gyne” meaning woman and “mastos” meaning breasts. It refers to abnormal development of large mammary glands in males. The diagnosis can be made by physical examination where relatively firm tissue (breast gland tissue) can be differentiated from relatively soft tissue (adipose tissue). Breast prominence due to excessive adipose tissue is called pseudo-gynecomastia or lipomastia. The differentiation of true gynecomastia from adipose tissue is important because the surgical treatment may differ. Usually physical examination by a well experienced board-certified plastic surgeon is sufficient to make the diagnosis and to determine the best course of treatment.
Gynecomastia is defined as the visible or palpable development of breast tissue. Gynecomastia is a condition in which males develop enlargement of the breast and/or “puffy” areola. This is quite common in adolescents and is often first noted at the onset of puberty. Gynecomastia affects an estimated 40% to 60% of men. It may affect only one breast or both. When gynecomastia is severe, when it persists, and in those cases where there is suspicion of malignancy surgical treatment may be indicated. 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. In most cases, the incisions for this operation can be placed just inside the areolar border where they are less likely to be conspicuous. Gynecomastia is often best treated with partial excision of the prominent glandular tissue as well as liposuction surgery of the peripheral chest area. If the prominence of the chest wall is caused by adipose tissue, then liposculpture surgery alone may suffice.
It is always best to be at a long term stable weight prior to surgery. Accurate diagnosis would necessitate physical examination. It is important to differentiate gynecomastia (excess breast tissue) from lipomastia ( otherwise known as pseudo-gynecomastia or excess adipose tissue of chest wall). Pubertal gynecomastia often resolves within 1 to 3 years after onset. Adult onset gynecomastia however does not necessarily do so. Breast glandular tissue “can go away” without surgical intervention; this is most commonly seen in pubertal gynecomastia. Once gynecomastia has been present for longer than a year, it is unlikely to spontaneously resolve.
During the consultation process, a history and physical examination will likely be very helpful. Make sure you provide a list of all medications and/or drugs you use. Hormonal studies, although sometimes helpful, are not mandatory.
The Surgical Procedures
Treatment will differ depending on diagnosis. In most cases, gynecomastia is treated with resection of the excess breast tissue; peripheral chest liposuction surgery may also be helpful.
The glandular tissue must be removed. This firm fibrous tissue extends from the nipple areolar complex down to the surface of the pectoral muscle beneath. In some cases, it is helpful to use liposuction to remove some of the fatty tissue which always surrounds this ductal tissue. Without this liposuction some patients would have a “donut” shaped defect after removal of the ductal tissue.
The most common complication following surgical removal of the ductal tissue is hematoma. When severe this could lead to a second operation to drain the collection of blood. Some residual deformity of the nipple areolar area may remain despite the best efforts of the surgeon. As with any operation, a wound infection could occur. Inadvertent injury to the blood supply of the nipple areolar region could result in loss of skin in the nipple areolar area. There would be the usual anesthetic risks associated with any surgical procedure.
One other potential risk associated with gynecomastia surgery is contour deformity related to over resection of glandular tissue and/or adipose tissue. This is a risk that is explained to patients who are undergoing the procedure. Many patients who have gynecomastia are looking for the chest to be as flat as possible. Surgeons must balance their desire to achieve the patient’s goals with efforts to avoid over resection and contour deformity.These complications and other even rarer complications do not occur often and the vast majority of patients undergoing this operation are very pleased and adopt a more normal life style with regard to exposure of the chest in normal social situations such as the beach.
Mild swelling is to be expected after surgery, especially as you become more active. Compression garment will be worn for the first month after surgery. The degree of swelling that occurs after gynecomastia surgery will depend on the exact procedure performed. For example, swelling tends to be greater with larger areas treated, especially with liposuction surgery. Generally however, swelling tends be mild to moderate and well tolerated. Long-term you be able to return to all forms of exercises/activities after gynecomastia surgery.
Recovery after gynecomastia can vary for each patient depending on the severity and complexity of each case. Generally, patients are asked to avoid strenuous activity and heavy-lifting or about 4-6 weeks. This decreases risks of complications. However, patients can exercise within 2-4 weeks, focusing on other areas, like the lower extremities.
“Can’t say enough good things about Dr. Tom Pousti and his staff. I had suffered with gynecomastia since I was 12 years old and it took 26 years for me to finally do something about. Some of the reasons I waited so long : Fear of surgery, cost, and the guilt that I was uncomfortable with something so minor while other people suffer from “real” problems such as cancer. I finally came to the conclusion that I deserved to do something about it and made an appoint with Dr. Pousti’s office after carefully reviewing online reviews. I don’t regret it one bit and am glad I finally did something about a problem that caused me so much anxiety and personal pain for so long. I was feeling so uncomfortable in clothes that I lived for the times where I could wear zip up jackets or black shirts. The new style “moisture wicking” t-shirts from Under Armour and other makers became my worst enemy. Those thin fabrics accentuated every horrible curve of my breasts. It was humiliating and could not take it any longer and needed to act.
I wanted to outline the surgery process so those interested know what it is like. Again, it was totally worth it but it is a commitment and not something to enter into without careful analysis.
Step 1: An initial consultation and set-up for the surgical process – about 2 visits.
Step 2: Surgery day. The center where Dr. Pousti does his surgery was top notch and had the nicest people. I absolutely adored the prep nurse, surgical nurse and anesthesiologist – caring, calm people. Prep for surgery takes about an hour or so and Dr. Pousti came in one final time to make some markings. He had called me the night before and was his usual calm self with a dry sense of humor that I really like. I wasn’t scared hopping on the operating table and remember nothing until I slowly woke up in recovery. The actual surgery is the easiest part!
Step 3: Recovery (the first 3 weeks). You will be outfitted with a vest and padding during surgery that you cannot remove for a week. Forget about showering and get a sponge! I wasn’t in much pain and was eating soup that night and working on my e-mails for work the next morning. It was actually much easier than I thought. Again, pain wasn’t bad and I abandoned the Percocets after about a day and a half. The constipation is bad for about 3 days and the Percocets make it worse so I switched to Tylenol. The constipation was probably the worst part of the entire thing as laxatives didn’t even help.
Again, you can’t shower for a week and you get a bit stir crazy. I left the house and started my evening walks a couple days after surgery. I wore zip up hoodies because a normal shirt was out of the question. I could go back to work but luckily I worked from home as it would have looked weird if I walked into the office in a hoodie. There was some itching and it did get a bit uncomfortable from time to time but nothing too severe. The key is to keep pressure on the chest area and that is why the vest becomes your best friend.
After a week they take the padding out of the vest and you get to see the results for the first time. I was shocked at how good everything looked even though I was bruised. My breasts were already done to a normal size and I found it hard to believe it would eventually look even better! You continue to wear the vest for another 2 weeks 24/7 but at least you could take it off to shower!
An important note about showering: It’s not what you think! You can’t just hop in and get wet. You have to keep the tape that covers the incisions dry. I tried the Band Aid brand waterproof bandages. They don’t work well at all. Showers were essentially bobbing and weaving around to avoid getting my chest wet and then using a blow dryer to dry off any parts of the tape that got wet. Not fun at all but at least I could get somewhat clean.
Step 4: Four weeks and beyond. I am now 2 months out and feel totally normal. I’ve started going back to the gym to try to reduce some of the other fat in other parts of my body that I may need to see Dr. Pousti about! It feels so wonderful to wear t-shirts without suffering and ditching the vest was a real pleasure. The tape on the incision remains but you can now get it wet and they eventually fell off about 2 weeks after I started fully showering and not worrying about them getting wet.
Your body might feel a bit strange for a while as you sense part of you missing (fat and tissue!) when you are wearing clothes. That feeling took about a week to subside and any numbness was gone at that point. Once the tape is off and there are no scabs you use BioCorneum ointment to reduce the visibility of scars. You’ll use that for at least a couple months and I still have plenty left at this point.
It is amazing how invisible the scars are, particularly on the nipple. Dr. Pousti is a genius with a scalpel and it is almost impossible to see anything. I don’t know how he gets it so perfect as everything is perfectly aligned and looks natural There are two small scars to the right of my breasts on the side of my body but they are small and don’t bother me much. I assume they will fade more as time goes on and I use the BioCorneum.
Was it all worth it? Heck yeah! The joy of walking around in a t-shirt and not feeling like I need a bra is incredible. From the wonderful office staff, the nurse, anesthesiologist, to Dr. Pousti himself, everyone was delightful. Dr. Pousti is a hoot and I like his sense of humor. The man is clearly an incredible artist and knows what he is doing. He helped me ease 26 years of suffering and for that, I am forever grateful!”
I’m happy to have chosen Dr. Pousti to perform my gynecomastia surgery. He has an excellent staff, all whom were attentive at all times. Every day for a week after surgery I received check up calls to ensure my recovery was progressing smoothly. The doctor was also very straight forward about the risks of the procedure and provided me a realistic explanation of what results I could expect. I am about two weeks in recovery now and feeling great. I’m happy to have done the procedure and recommend to anyone thinking about gynecomastia surgery to consider Dr. Pousti.
Hey guys here to share my story with you all! I started doing research on Gynecomastia back in 09. After a long period of careful research I came across a few top names, and narrowed the list down to Dr Pousti. After seeing his credentials I knew I didn’t have to search further. I immediately called and scheduled an appointment at his beautiful office in San Diego. His staff was extremely kind and professional. After meeting with him and discussing surgery I was relieved that he was as kind, professional, and sharp as I had imagined he would be. I scheduled my surgery a month later, and soon after that I was under the knife. Then began the recovery process and things were looking good. It’s been almost 1 month since my surgery in April, and I can honestly say I’ve never been happier with my appearance.
What to Expect After Surgery
Whether you’ve had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by Dr. Pousti. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed.
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’ll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. 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. Any stitches will generally be removed about 1 to 2 weeks following the procedure.
Resumption of Physical Activities
You’ll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough–which could be as early as a day or two after surgery. Your surgeon may advise you to avoid sexual activity for a week or two, and heavy exercise for about three weeks. You’ll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you’re back to all of your normal activities.
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 sun block.
Click here to learn more about San Diego Cosmetic Surgeon, Dr. Tom Pousti. To schedule your cosmetic surgery consultation in our San Diego office, call (619) 466-8851 or email firstname.lastname@example.org.
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