Northern Virginia- Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
Gynecomastia is the condition of enlarged breasts in men. It can happen to men at any age and can cause a decrease in self confidence and avoidance of physical activities to hide their condition. The good news is that this problem is easy to fix. Gynecomastia can result from hormonal changes, certain diseases, or drugs. It can also occur in healthy normal men because of heredity. First, it is important to make sure that any drugs or diseases that may cause gynecomastia are treated. If no causes are found then surgery may be the answer to correct the gynecomastia permanently.
An initial consultation is set-up where we will discuss the gynecomastia correction procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The breasts of a man are similar to that of a woman in that they have both hard breast tissue and fat. In gynecomastia there may be an excess of both breast tissue and fat. The operation will depend on the severity of the gynecomastia:
- Minimal- gynecomastia is primarily the result of excess fat. The treatment is liposuction of the breast with a small incision at the lower aspect of the areola or arm pit region.
- Moderate- gynecomastia is a result of excess fat and breast tissue. Liposuction is performed to remove the excess fat, but the breast tissue cannot be liposuctioned. An incision at the lower aspect of the areola or arm pit is made and the breast tissue is directly excised.
- Severe- gynecomastia is a result of excess breast tissue, fat, and saggy skin. In this case a formal breast reduction, similar to the one performed on women, may need to be done. This will achieve the goal of removing breast tissue, fat, and skin, as well as providing a lift. This technique will leave the man with a breast lift incision. The specific incision will depend on the size and shape of the breast.
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding after a gynecomastia correction is rare. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. In our practice the rate of significant bleeding is less than 1%. Very rarely, we will put drainage tubes in the breasts during a procedure, if we feel there will be some bleeding after the surgery, so the blood will be drained into a plastic bulb that the patient can empty. Those drains are removed in the days after surgery.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after a gynecomastia correction is extremely rare. The scar usually heals very well.
In a gynecomastia correction, the incision is usually at the bottom pole of the areola and heals very nicely. We have not had any open wounds in our gynecomastia patients.
Loss of Nipple Sensation or nipple / Areolar skin
Loss of nipple sensation is a potential complication that may be due to the removal of breast tissue and fat from behind the nipple. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks. Loss of nipple skin has not been a problem.
The most accurate way to achieve the best symmetry is for equal amounts of fat and breast tissue to be removed from each breast. If the breasts are not symmetrical then more breast and fat tissue is removed from the bigger breast to achieve symmetry.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.