Gynecomastia Orange County Gynecomastia
Gynecomastia is a benign enlargement of breast tissue in males. It occurs transiently in newborns, in one half of adolescent boys, and as a result of decreased testosterone in older males. It may rarely arise as an abnormal condition associated with metabolic or endocrine disorders. One of the more common causes seen in our practice relate to excess marihuana use or illegal steroid use in athletes. The following information has been prepared to familiarize you with facts about the surgical procedure known as gynecomastia correction ("male breast reduction"). You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to proceed with this procedure. Gynecomastia is a common, benign condition, which is
characterized by enlargement of the male breast. It usually begins in adolescence as a result of normal hormonal changes and will resolve within two years. If it does not resolve within several years many males choose surgical correction and obtain excellent results. Small incisions may be made beneath the breast around the areola (the dark skin surrounding the nipples) or in skin folds beneath the breasts or in the axilla (arm pit area). Excess fat and glandular tissue are removed, directly by liposuction techniques if possible or adding a surgical excision if necessary. The result is a flatter, firmer and more normally contoured chest. It should be noted that the fatty layer over the chest wall will be about a half inch thick after the procedure, a normal thickness for someone without gynecomastia.
With both hands lifted into the air, the chest wall should look flat! But with the arms down, particularly in more mature males, some skin folding will occur and this is normal for people of this age! Likewise, some young adults who lift weights and have very well developed pectoralis major muscles – in such patients, even if the excess breast tissue has been removed and the fatty layer is half an inch thick or less, chest protrusion can be caused by normal muscle development! This procedure can be done alone or in combination with other plastic surgery procedures such as a rhinoplasty, face lift, tummy tuck or liposuction of the love handles, tummy or neck.
This procedure takes about an hour and a half and is done under deep IV sedation or a light general anesthetic to supplement the local anesthesia injected by your surgeon. Swelling and bruising are to be expected. Medication will control the minimal pain and discomfort that patients usually experience. You may drive one or two days after surgery, as long as you are not taking pain pills or sedatives. A tight ACE wrap around the chest is worn for the first few days. Plan on being off work for just a few days but give yourself two weeks before you resume heavy exercising.
The operation is directed toward an improvement and does not in any way guarantee complete obliteration of all breast tissue. You must accept the judgment of your plastic surgeon and realize that he will remove as much as is safe and suitable.
It is common to be left with visible surface irregularities. The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the result include age at the time of operation, physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat this procedure to maintain the optimal result. It would be rare for gynecomastia to return after surgery, unless massive weight gain or continued marihuana or steroid use is encountered. However, it is not uncommon for a patient to see asymmetry or feel a persistent mass under the nipple that is significant enough to request a secondary procedure.
Should the patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, and each patient will be responsible for the cost of a subsequent procedure.
GYNECOMASTIA PREOPERATIVE PREPARATION
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit, which will take at least an hour, your final questions will be answered and you will confirm that you understand the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. All ibuprofen (Advil®) and Aspirin® products are to be avoided 2 weeks. You will be given prescriptions for surgical soap (Hibiclens®) that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Preoperative photos will be taken. Certain laboratory tests will also be required within two weeks of surgery.
If you are over the age of 50 or have had any prior cardiac problems, you will have to obtain a cardiogram at your doctor’s office or any state licensed laboratory. You may have blood drawn at your family doctor’s office or any laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.
It will be necessary to scrub the chest for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery.
Your anesthesiologist may call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center prior to your procedure (Orange County Surgery Center in Newport Beach). You must make arrangements to have someone drive you to and from the Surgery Center and stay with you at home for the first day or two afterwards.
The operation will be performed in an outpatient facility under deep sedation or a light general anesthetic to supplement the local anesthetics injected by your surgeon. A small incision may be made beneath each areola (the dark skin surrounding the nipples). Occasionally, if liposuction alone will be utilized to remove the excess tissue, more distant incisions will be made in the fold by the arm pit or under the breast tissue. Excess fat and glandular tissue can be removed, depending of the firmness of the tissue, either with direct surgical excision or with liposuction.
GYNECOMASTIA POST-OPERATIVE CARE
Adequate pain medication will also be prescribed. Wounds are generally closed with buried sutures. The incisions are covered with surgical glue and dry dressings, which are to stay in place for the first few days. This glue will generally peel off as you shower over the first few weeks. It is recommended that patients begin applying MD Performance® Ultimate Scar Formula to the incision as the adhesive begins to peel off about two weeks after surgery. The silicone Ultimate Scar Formula should be applied twice daily until the scar has finished healing and no longer contains any hint of pink or purple. The skin may itch after any surgical procedure.
After the first week, the skin can be moisturized with the MD Performance® Avocado CoQ-10 Body Balm – this will relieve the dryness and itchiness and help any crusts fall off the suture lines quicker.
Your first post-operative visit will generally be scheduled four to five days after surgery at which time the wound will be examined and dressing changed if needed.
Social activity should be limited while the patient is uncomfortable. Lifting heavy weights should be limited for approximately 2 weeks to allow the wound to heal properly. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away.
GYNECOMASTIA POSSIBLE COMPLICATIONS
Serious complications after treatment for gynecomastia are relatively uncommon. There will be small incisions which have to heal. The scars may remain itchy, painful, thick, or otherwise unsightly, but this is very rare. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for some time. Every patient undergoing tissue removal for gynecomastia will experience some degree of surface irregularities or visible indented folds, due to the skin healing down to the underlying muscle after breast tissue removal! One of the possible problems after surgical treatment for gynecomastia is a persistent collection of serous fluid or blood under your skin. Should this occur, this fluid will be aspirated by your surgeon with a needle during your post-operative visits.
Such drainage always stops eventually (but may persist for more than a month and require insertion of a drain) but usually does not affect the final results.
It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.
This procedure is rarely covered by insurance; the office staff will help you determine if your insurance can be helpful.Payment of all fees, however, is the patient's responsibility; all fees are due prior to surgery. The office staff can refer you to a professional billing service if you wish to attempt to use your insurance. If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. They can also assist you with financing if desired – various financing plans are available. In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation
and can afford the surgery, thus creating a better patient/ physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.