Gynecomastia (Male Breast Reduction)

Dr. Capella will take a thorough medical history, including a history of obesity and weight loss and a history of alcohol or marijuana abuse, and a careful drug history. If there are signs of either liver or endocrine malfunction or if there are any signs of abnormal secondary sexual development, then a referral to a qualified medical specialist such as an endocrinologist may be warranted. In most cases involving adult males there is usually a history of obesity and weight loss or a history of anabolic steroid use or no cause at all. In most cases, surgery is the only effective form of therapy. The approach that Dr. Capella would advise will depend on the degree of breast enlargement, the ratio of fat to breast tissue that exists, and the amount and elastic quality of the skin. He will then determine and discuss with you what approach he feels is necessary to best manage your condition.

t is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen just prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Prophylactic antibiotics are given at the time of surgery and for 24 hours following the procedure to reduce the risk of surgical wound infection. A prescription for pain medication is also written, so that you have pain pills when you return home from the operation. Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3-6 months after your procedure.

You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation. You will need to arrange for an escort to drive you to and from the operating suite. Patients cannot operate motor vehicles after surgery and recently sedated patients will not be discharged to taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.

Depending on the degree of breast enlargement present in your case, Dr. Capella will review the exact surgical approach he would take to provide you with the best contour using the least-invasive operation. In the least invasive approach, and if most of the enlargement is fatty in nature, he may utilize liposuction to contour the breast area. Under a general anesthetic (completely asleep), or sometimes using local anesthesia with an intravenous sedative, he makes very small incisions through which he inserts a small tube. Vacuum suction applied to the tube then extracts the fat, leaving you with a smoother, flatter contour. The procedure usually takes about an hour, and is done as an outpatient.

If you have primarily a glandular accumulation causing your abnormal contour, he can usually remove this through a small incision at the lower half of the periphery of your areola (pigmented part of the nipple). The breast gland is then completely removed. Often a small drain tube is placed to assist the skin in conforming back to the underlying muscle. The procedure takes about sixty to ninety minutes, and is done as an outpatient. It can be done either under a general or local anesthetic. All stitching is done with self-absorbing type suture material, avoiding the need to remove stitches after surgery.

For many men following massive weight loss, there is a combination of excess fat and skin remaining at the breasts and often extending onto the sides and back. If this is the case, Dr. Capella may either suggest liposuction as a first stage and having you return in three months for breast reduction and removal of excess tissue at the sides and perhaps back. If however, you have mostly excess skin, Dr. Capella may suggest you a have a breast reduction with removal of excess tissue at the sides and back as an initial procedure.

At the conclusion of your procedure, sterile dressings and a garment will be placed over your chest. The breasts become bruised, swollen, and tender for a week or so, but the pain should not be severe, and is usually well controlled with the pain medication that is prescribed.

After two days, showering is permitted and the dressings may be removed. If drains have been placed, they most likely will be removed at this time during your follow-up office visit. Some patients feel more comfortable wearing the chest garment for the first two weeks. Though the skin of the breast may feel numb for a while, usually the feeling returns in 6-8 weeks, but can take up to a year to feel completely normal. Heavy exercise involving the upper body should be avoided for 3-6 weeks, and you should stay away from sporting activities or work that risks a blow to the chest for a similar period of time. Avoiding sun exposure to the incisions sites for six months or more reduces the risk of dark pigmentation of the scars; you may need to use a sunscreen for up to a year for this reason. It normally takes approximately 12 weeks for all of the initial swelling to subside, and it takes one to two years for the scars to mature and fade.

Complications from treatment of gynecomastia are infrequent and usually minor, though no surgical procedure is without some risk. These would include bleeding, infection, loss of sensation that may take up to a year to recover and could be permanent, visible irregularities in the skin, asymmetry, and fluid accumulations beneath the skin following the operation that may require drainage.