Gynecomastia Surgery ( Breast Reduction For Men)

Gynecomastia is the medical term for the development of female-like breasts in men.  It occurs in approximately 50% of all men in different forms, ranging from excess breast or fat tissue to the development of female glands.

Gynecomastia can develop in adolescents as early as age twelve as a result of hormonal changes, and can also be caused by drug, diet, and lifestyle induced hormonal shifts.  Men taking anabolic steroids often suffer from gynecomastia as testosterone levels in the body rise dramatically, causing the body to respond by producing enzymes that turn excess testosterone into estrogen.  Increased age and weight can also contribute to the development of excess breast and fat tissue.

About half of all men today have excess localized fat and/or excess glandular tissue in one or both breasts. Gynecomastia accounts for more than 65 percent of all male breast disorders.

 

Am I A Candidate?

Men who have developed larger, female-like breasts and have not been able to alter this problem with diet and lifestyle changes can be candidates for surgery.

 

How It's Done?

In some cases, changes in lifestyle or diet can reverse gynecomastia, and in 90% of adolescents the condition disappears within a month or two.  For all others surgery is the only option for correction.  Usually performed in a doctor's office or surgical suite as an outpatient procedure, gynecomastia surgery can be done with the use of a local or general anesthetic.

Once the patient is properly anesthetized, the surgeon makes a small incision just below the areola.  Excess breast tissue is surgically excised from the area and fat is removed with the use of liposuction.  The incision is then closed and the patient is detained until the effects of the anesthesia wear off.

 

Recovery / Post Op Expectations

After surgery you will be fitted with a compression garment or ace bandages to support the breasts while they heal.  The recovery process is usually not a short one.  Patients should take their time when thinking about returning to normal activity, and are usually told to ease back into their daily routine gradually.  In many instances patients will wait between one and three weeks before returning to work.

 

Complications

Most instances of complications stem from surgeon error and patients trying to do too much after surgery.  The most serious complications include hematoma, asymmetry, infection, change in position or shape of the nipple, and wound separation.  More common complications include numbness, swelling, bruising, and scarring.

                                                    

 

 

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Breast Implant (Breast Augmentation)

Women’s desire for an enhanced self-image and more feminine appearance makes breast augmentation one of the most commonly performed plastic surgery procedure. Breast implant manufacturers have developed many styles, shapes and sizes of breast implants to fulfill different needs and indications.

 

 

What are the indications of breast augmentation ?

Small sized breasts are the most common indications followed by breast atrophy and redundancy after having children or significant weight loss. Asymmetric breasts is another mandatory indication either congenital or after certain mastectomy operations .

 

Are there any contraindications of breast augmentation ? ?

If you are planning to loose a significant amount of weight, it is recommended to stabilize your weight prior to undergoing surgery. Also, if planning soon pregnancy, better to postpone the surgery. Positive family history of breast cancer is not a contraindication, but you have to select the radiology technician who is experienced in taking x-rays of augmented breasts for your periodic check up. Breast augmentation can be done at any age after the breasts are fully developed .

About risks of breast augmentation :
There is always an argue about the relation between breast implant and breast cancer. It is well settled that there is no scientific evidence that breast augmentation increases the risk of breast cancer .

 

Where are the incisions placed ?

There are 4 different incision sites. The inframammary incision is made in the skin fold below the breast. The peri areola incision is made around the edge of the areola (colored area around the nipple). The Transaxillary incision is made in the armpit. The transumbilical incision is made in the umbilicus and the implant is inserted by the aid of an endoscope. Through either of these incisions the implant can be inserted behind the gland and above the muscle or behind the muscle and above the chest wall .
The choice of the incision site is a decision made by the doctor guided by the patient’s preference .

 

Types of implants

There are 2 main types of implants: The saline filled implant which carries the advantage of possibility of smaller incision as the implant is inserted empty and filled inside its pocket. Also, saline filled implant permits better asymmetry adjustment Silicone filled implant carries the advantage of more natural texture and feeling .

 

Are there any side effects to breast augmentation ?

Breast augmentation procedure is one of the most pleasing operations in cosmetic surgery field. However, infection blood collections are rare and controllable possible complications. Capsular contraction is a unique complication of breast implant augmentation. It is a tightening of the naturally produced scar capsule around the implant resulting in pain and distortion of breast contour. The incidence of capsular contracture is significantly decreased with improved implant quality, more experienced surgeons and post operative massaging .

 

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Breast Reduction

Breast reduction surgery, also known as reduction mammaplasty, is a procedure used to remove excess fat, glandular tissue and skin from the breasts. If you have large breasts, you may choose to have breast reduction surgery to alleviate discomfort or to achieve a breast size in proportion with your body. Breast reduction surgery may also help improve your self-image and self-confidence, as well as your ability to participate in physical activities.

How It's Done?

Depending on your personal situation, the procedure can be performed in an outpatient facility or you may have to stay at least one night in the hospital. In either case, you will be given general anesthesia, which means you will be  put  to  sleep  for  the  procedure. It's important to have someone with you who can drive you home and stay with you at least the first night if you're not staying in the hospital.

The surgery itself will take about three to five hours. Your surgeon will make an incision around your nipple, then downward on the breast, in a keyhole form. The excess skin, tissue and fat are removed and your nipple is relocated for cosmetic purposes. Your surgeon may use drainage tubes and the incision site is then sutured. Your breasts will be wrapped in special gauze. If required, you may also wear a surgical bra.

Recovery and Follow-Up Care

You will need to take at least one week off from work or school. Some patients require two weeks, but each situation varies. Your surgeon will instruct you on follow up appointments to remove bandages and sutures.

If you are a physically active person, you will not be able to resume your activity for at least one month after surgery. It's very important that you realize the emotional impact of surgery: a lot of people  experience  depression  ,   but this is normal! Make sure you communicate with your doctor about all your concerns.

Complications and Side Effects

You should expect to feel tired and you will have breast pain. This is normal!
Your surgeon will give you a prescription antibiotic ointment and oral painkiller to ease you through the first few days after surgery. You should avoid heavy lifting at all costs, as this can promote scarring.

It's important to note that a breast reduction will cause  scars   as a normal side effect. However, the  scars  can be made worse if you lift heavy objects prematurely. Though they are rare, some people may experience certain complications such as inadequate healing of the nipple area, which may require a skin graft.

 

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Breast Lifting

Breast lift surgery or ‘mastopexy’ is the name given to the procedure which lifts and firms the breasts. It does NOT increase the size of the breasts.

This is usually performed to correct sagging or drooping breasts: this can happen as a result of childbirth which causes a loss in breast size as well as stretching the skin. The breasts will also start to droop due to the effects of gravity and the ageing process. Over time they lose their tone and elasticity.

This procedure usually takes around two to two and a half hours and is performed under a general anaesthetic. You will experience some bruising and slight swelling afterwards but this will ease. You will be prescribed painkillers to control any discomfort

Who is a good candidate for breast lift surgery?

Women with small, sagging breasts are ideal candidates for breast lifts. Women with larger breasts can also be good candidates for breast lifts; however, the results may not last as long after the surgery.

What should I expect during the surgery?

Breast lifts are usually performed under general anesthesia. During the breast lift surgery, the doctor will make an incision in each breast. the size and shape of your breasts, as well as your surgeon’s preference, will determine what type of incision is made. After making an incision, your surgeon will relocate the nipple and areola to a higher position on the breast, remove some skin and tissue, and close the incision with sutures.

How long is the recovery period?

Women typically recover from breast lifts within a matter of days,  although bending and lifting may be difficult. You should be able to return to work after about a week, depending on how you feel. You will also be wearing a surgical bra for the first few days, followed by a support bra for a few weeks after surgery. Breast lifts generally leave some bruising along the incisions, which will diminish in seven to ten days. Breast lift scars will be prominent for at least three months following your surgery. Although the scarring will always be visible, it will fade over time.

 

What are the risks of breast lift surgery?

Breast uplift surgery is a safe procedure but like all forms of surgery does have a small amount of risk. A common side effect is feeling sick after a general anaesthetic and soreness and bruising.
This surgery is performed on a regular basis and by highly qualified surgeons. Complications are rare but they can happen and it is as well to be aware of them.

Complications include the following

• Infection
• Excessive bleeding
• Severe pain
• Bad reaction to anaesthesia
• Undersensitive or oversensitive nipples
• Internal bruising or haematoma
• Protracted healing
• Slight risk of deep vein thrombosis
• May need a second or third procedure
• Keloids – thickened, angry red scars

Complications differ from side-effects. Side effects are temporary and relatively mild effects of a procedure. These include nausea following anaesthesia, scarring, burning sensation in the nipples and soreness and bruising.

Complications are defined as those which can occur during or just after surgery. These include the development of a blood clot and a loss of nipple and skin sensation. There is also the chance that you may not be able to breastfeed because most of the milk ducts which lead to the nipple are removed.

 

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Breast Reconstruction after Mastectomy

Breast reconstruction is a type of surgery for women who have had a breast removed (mastectomy). The surgery rebuilds the breast so that it is about the same size and shape as it was before. The nipple and the darker area around the nipple (areola) can also be added. Most women who have had a mastectomy can have reconstruction. Women who have had only the part of the breast around the cancer removed (lumpectomy) may not need reconstruction. Breast reconstruction is done by a plastic surgeon.

Why have breast reconstruction?

Women choose breast reconstruction for many reasons:

You will be able to see the difference between the reconstructed breast and the remaining breast when you are nude. But when you are wearing a bra, the breasts should be alike enough in size and shape that you will feel comfortable about how you look in most types of clothes.

 

Types of breast reconstruction

Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. (A tissue flap is a section of your own skin, fat, and muscle which is moved from your tummy, back, or other area of your body to the chest area.)

 

Implant procedures

The most common implant is a saline-filled implant. It is a silicone shell filled with salt water (sterile saline). Silicone gel-filled implants are another option for breast reconstruction. They are not used as often as they were in the past because of concerns that silicone leakage might cause immune system diseases. But most of the recent studies show that silicone implants do not increase the risk of immune system problems. Also, alternative breast implants that have different shells and are filled with different materials are being studied, but you can only get them in clinical trials.

One-stage immediate breast reconstruction may be done at the same time as mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.

Two-stage reconstruction or two-stage delayed reconstruction is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander, which is like a balloon, is put under the skin and chest muscle. Through a tiny valve under the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time (about 4 to 6 months). After the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant. Some expanders are left in place as the final implant.

The two-stage reconstruction is sometimes called delayed-immediate reconstruction because it allows options. If the surgical biopsies show that radiation is needed, the next steps may be delayed until after radiation treatment is complete. If radiation is not needed, the surgeon can start right away with the tissue expander and second surgery.
There are some important factors for you to keep in mind if you are thinking about having implants:

Tissue flap procedures

These procedures use tissue from your tummy, back, thighs, or buttocks to rebuild the breast. The 2 most common types of tissue flap surgeries are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back.

These operations leave 2 surgical sites and scars -- one where the tissue was taken and one on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be problems at the donor sites, such as abdominal hernias and muscle damage or weakness. There can also be differences in the size and shape of the breasts. Because healthy blood vessels are needed for the tissue's blood supply, flap procedures are not usually offered to women with diabetes, connective tissue or vascular disease, or to smokers.

In general, flap procedures behave more like the rest of your body tissue. For instance, they may enlarge or shrink as you gain or lose weight. There is also no worry about replacement or rupture.

 

TRAM (transverse rectus abdominis muscle) flap

The TRAM flap procedure uses tissue and muscle from the tummy (the lower abdominal wall). The tissue from this area alone is often enough to shape the breast, and an implant may not be needed. The skin, fat, blood vessels, and at least one abdominal muscle are moved from the belly (abdomen) to the chest. The TRAM flap can decrease the strength in your belly, and may not be possible in women who have had abdominal tissue removed in previous surgeries. The procedure also results in a tightening of the lower belly, or a "tummy tuck."

 

Possible risks

Almost any woman who must have her breast removed because of cancer can have reconstructive surgery. Certain risks go along with any surgery, and reconstruction may have certain unique problems for some people.
Some risks of reconstruction surgery are:

After breast reconstruction surgery What to expect

You are likely to feel tired and sore for a week or 2 after implants, and longer after flap procedures. Your doctor can give you medicines to control pain and other discomfort.
Depending on the type of surgery, you should go home from the hospital in 1 to 6 days. You may be discharged with a drain in place. The drain is an open tube that is left in place to remove extra fluid from the surgery site while it heals. Follow your doctor’s instructions on wound and drain care. Also be sure to ask what kind of support garments you should wear. If you have any concerns or questions, call your doctor.

 

Getting back to normal

You should be up and around in 6 to 8 weeks. If implants are used without flaps, your recovery time may be shorter. Some things to keep in mind:

• Reconstruction does not restore normal feeling to your breast, but some feeling may return.
• It may take up to about 8 weeks for bruising and swelling to go away. Try to be patient as you wait to see the final result.
• It may take as long as 1 to 2 years for tissues to heal and scars to fade, but the scars never totally go away.
• Ask when you can go back to wearing regular bras. Underwires and lace may not be comfortable.
• Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a rule, you'll want to avoid any overhead lifting, strenuous sports, and sex for 4 to 6 weeks after reconstruction.
• Women who have reconstruction months or years after a mastectomy may go through a period of emotional readjustment once they have their breast reconstructed. Just as it takes time to get used to the loss of a breast, you may feel anxious and confused as you begin to think of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional may also help you sort out these feelings