The male breast is less evident than the female one, although during puberty, adolescence or adulthood it can increase in volume causing what is known as gynaecomastia, which has three forms:
- true gynecomastia in which the increase in volume of the breast is caused by an increased gland component;
- adipose gynecomastia in which the increase in volume of the breast is caused by an increase in the adipose tissue of the mammary zone;
- mixed gynecomastia in which the increase in volume of the breast is caused by an increased gland component associated with an increase in the distribution of the mammary tissue. This happens very often in the formerly obese.
Why undergo this surgery?
Gynecomastia is often a cause of discomfort and embarrassment for patients and may even lead to issues in their social and sexual life. It is quite a big problem and, indeed, the number of men undergoing surgery has increased a lot in the last few years. The purpose of the surgery is to give a proportionate and male aspect to the chest area, bringing back the breast to its physiological volume.
What needs to be done before surgery?
Speaking to the plastic surgeon before surgery helps eliminate doubts and perplexities and understand exactly how the surgery will be made and all options suitable for one’s case. In order to achieve the best result, all possible variables to the surgery procedure will be taken into account depending on the patient’s physical characteristics and needs. The consultation is non- binding and gives one the possibility to have all the information regarding the surgical and post-surgery programme, the medicine to take, analyses and check-ups to do and costs.
How is the surgery performed?
There are two possibilities: - liposuction in cases of adipose gynecomastia; - gland removal in cases of true gynecomastia; - the two techniques combined in cases of mixed gynecomastia. The surgery is done under general anaesthesia (local anesthesia and minimum sedation) and lasts about 1 hour and 30 minutes. In the case of false gynecomastia, the choice will be liposuction: we will make small incisions of about 3-4 mm. From these points, we will insert cannulas for suction. In the case of true gynecomastia, a small incision is made at the lower edge of the areola to then proceed with the elimination of the gland tissue. We then apply a compressive dressing. Hospitalization is one day. In the case of a minor condition, the surgery is done under local anaesthesia and sedation and in Day Hospital.
What happens after the operation?
The compressive dressing is removed after 48 hours from the surgery. The wound is then medicated and a compression garment is applied. This must be worn for 30 days. Stitches are removed after about 15 days from the surgery; at this point, it is possible the wounds can be washed. Until then do not have a bath or shower. Rest and limited movements are advised in the days following the surgery, especially for the upper limbs. Return to work is after 7-10 days, whilst return to sport activity is after about 30 days.
Patients normally suffer pain, swelling, reddening and bruises in the treated area during the first days following the surgery. Post-surgery issues may be kept under control using normal painkillers or anti-inflammatory drugs.
Residual scars following liposuction are almost invisible as they are just few millimeters in size. In case of gland removal, the patient will have a lower periareolar scar that is almost invisible.
A good outcome of the surgery depends on the patient’s initial clinical conditions, his/her healing capacity and compliance with the doctor’s post-surgery indications, i.e. avoid sun exposure until complete healing of the scars, maintain a healthy lifestyle and avoid weight gain and loss.
What are the possible risks?
The complications linked to the surgery are rare, namely hematomas and bleeding, infections, delayed healing of the surgical wound, bad healing, change in skin sensitivity. Loss of sensitivity in the nipple may occur, but it is just a temporary issue.