Frequently Asked Questions

Q1- What is gynecomastia?

A- Gynecomastia is the enlargement of the male breast, often with a feminine appearance. The nipple and areola are only rarely enlarged. The word gynecomastia literally means woman's breast and the enlargement can be in both projection and width. Gynecomastia can range from a small mass of tissue located behind the nipple to enlargement of the entire breast and can be composed of both fatty and fibrous breast tissue.

Q2- What causes gynecomastia?

A- There are a myriad of clinical causes for gynecomastia including the hormonal changes that occur during puberty, various metabolic and endocrine disorders including thyroid, liver and kidney disease, and tumors and drugs including steroid, marijuana, finesteride and excessive alcohol use.
We recommend that all patients with gynecomastia consult their physician before seeking plastic surgical correction to exclude a serious cause for the condition. It is highly advisable to discontinue the use of these substances prior to surgery.

Q3- What problems can gynecomastia cause?

A- While gynecomastia is persistently painful in a small number of patients; it is the alteration in body image and attendant anxiety and embarrassment that can prevent participation in some activities; that patients find most troubling.

Q4- What is the goal of surgical treatment of gynecomastia?

A- Our goal of surgery is to relieve the condition adequately so that our patient can participate more fully in activities where embarrassment and anxiety would otherwise occur. This can include sports and social activities where certain clothing styles would ordinarily be worn or where removal of one's shirt might occur.
It's important to note that the surgical goal may not necessarily involve removal of a shirt in public because skin removal, if necessary, may result in scarring.

Q5- Is there a minimum age requirement for patients interested in gynecomastia surgery?

A- There is not a minimum age requirement for this, however many surgeons prefer to wait until the sufferer has completely finished puberty (18-20 years old). The reason for this being that for many teens who are still in their pubescent period, the gynecomastia they're experiencing can usually go away on its own. The surgeon will use his clinical judgment if the case is severe and causing severe social/psychological issues. This may encourage surgery at a younger age.

Q6- Is there a maximum age limit for patients interested in gynecomastia surgery?

A- There is not an age limit for surgery, however if you have any medical conditions that could compromise your health during surgery, your surgeon may be hesitant to proceed or decline to perform the surgery altogether.

Q7- What type of anesthesia is used?

A- Liposuction-assisted mastectomy with or without gland excision for gynecomastia patients can be performed under local anesthesia, intravenousconscious sedation, or general anesthesia. The choice of sedation should be determined preoperatively by the physician and patient.

Q8- Will there be any scarring?

A- If the surgeon removes glandular tissue, he/she will make a small peri-areolar incision, a half-circle incision around the lower half of the areola. In most cases the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot distinguish them from your normal skin.

Q9- What is the most common technique for gynecomastia surgery?

A- The most common technique is where the surgeon makes a peri-areolar incision to remove glandular tissue and then performs liposuction of the area for definition. Some surgeons only use liposuction if it is pseudo-gynecomastia (all fat content).

Q10- What do I need to do in preparation for surgery?

A- It is absolutely necessary to quit smoking starting at least 4 weeks prior and continuing until four weeks after your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote excessive bleeding. Herbal remedies such as St. John's Wort, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding. Bottom line is it is best to avoid all medications/vitamins/supplements such as these for four weeks prior and four weeks after your procedure.

Q11- What is the recovery time following gynecomastia surgery?

A- The initial recovery period is the 7 to 10 days right after your procedure. If drains are used, they will typically remain in for about 2-3 days after which they will be removed. Total recovery time can vary from patient to patient. Most patients can expect to be fully healed by 3-6 months. At this point most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. Sometimes, it may take as long as a year to completely heal to the point where the scars are no longer visible. For the first 4 to 6 weeks after surgery, it is necessary to avoid all strenuous activities, especially those involving the upper body such as lifting weights or intense workouts at the gym. In addition I advise my patients to wear a compression garment for 6 weeks post-operatively.

Q12- How long will I be in the hospital? Will I have to stay overnight?

A- This is a same-day outpatient surgical procedure. The actual surgery takes about 2½ to 3 hours. After your surgery, you will be taken into recovery for at least one to one and a half hours to be observed and attended to by a nurse. Once your surgeon feels you are in a stable enough condition, you are released to return home. It is necessary to have a family member or close friend escort you home and stay with you for at least the first 24 hours.

Q13- How much pain will I be in post-surgery and for how long?

A- A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimum discomfort and most never complain of any severe pain, only soreness of the area. Regardless of you pain level after surgery, pain medication are prescribed for you to minimize any discomfort of surgery.

Q14- What kind of stitches do you use externally? How long will they be there?

A- I use very thin 6-0 nylon sutures that are removed 7 to 10 days after surgery.

Q15- Do I need to avoid exposing my scars to the sun after my procedure?

A- Early sun exposure to your incisions after surgery is not advisable. To avoid scar pigmentation, you should use sun-block cream on your scars for 3 to 6 months following surgery. I also recommend silicone sheeting to be placed directly on the incisions for 2 months after surgery. I find the silicone gel sheeting improves the appearance of the scars by flattening them and decreasing the pigment.

Q16- Do I need to wear a compression vest? What is it for? How long do I have to wear it?

A- It is necessary to wear a compression vest for about 4 to 6 weeks following the procedure. After the gland is excised and liposuction is performed, a large open space exists. The compression garment helps the tissue come together and close properly. The placement of the drains helps as well. Another function of the garment is to help reduce the initial swelling and contract the skin over the surgical site.

Q17- When can I return to work?

A- Usually patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity then it is easy to return shortly after the procedure. If you do physical labor then it is recommended to wait at least 10 to 14 days or whenever you feel you are ready. Listen to your body It will tell you when it is ready to return to your normal activities.

Q18- Are there any post-operative complications that I should be aware of?

A- Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication, this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood underneath the skin, made noticeable by excessive bruising, swelling and pain, typically of only one side of the chest. If this happens it is imperative to contact your surgeon immediately.

Q19- What are the complications & risks of gynecomastia surgery?

A- The complications and risks associated with gynecomastia surgery include-
  • Unfavorable scarring
  • Bleeding (hematoma)
  • Blood clots
  • Infection
  • Poor wound healing
  • Changes in nipple or breast sensation may be temporary or permanent
  • Anesthesia risks
  • Breast contour and shape irregularities
  • Loose skin, if liposuction is used
  • Skin discoloration, swelling and bruising
  • Possibility of revision surgery