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GYNAECOMASTIA

Gynaecomastia is the over-development of breast tissue in male patients. It is also unkindly known as "man-boobs". Patients can find this extremely socially embarrassing and depressing with loss of self-confidence. It is often most noticeable in the summer months when people wish to wear T -shirts or go swimming on holiday. Patients find that no matter how much they go to the gym or lose weight they cannot shift the breast tissue and alter their appearance satisfactorily.

In most cases the cause of the gynaecomastia is unknown (i.e. it just happens). Other causes include obesity, puberty, drugs (steroids, diuretics, excessive alcohol intake, recreational drugs), and hormone imbalance. It is important to exclude any of these causes of gynaecomastia as these may be reversible without surgery. However, for the vast majority of cases no identifiable cause is found, and patients proceed to surgery to correct the shape of their chest.

Before the operation

There is nothing special or complicated to be done by the patient. If you smoke it would be a good ideal to try to stop for a month before and two weeks after as this will significantly improve wound healing and your post-operative recovery. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before the operation.

The surgery

Patients come into the hospital on the morning of surgery. The operation is performed under general anaesthetic and takes about two hours. The excess breast tissue is a mixture of fat tissue and true breast tissue. There are two surgical options. The first is a "closed" technique which leaves tiny scars and which involves liposuction alone. This is good for patients where the majority of the enlargement is due to excess fat deposition. The second is an operation which involves a cut below or around the nipple and excision of the breast tissue. This is known as the "open" operation. The "closed" technique (liposuction) is a day case operation, with no overnight stay. The longer "open" procedure requires an overnight stay and surgical drains which are removed the following day.

Post-operative follow-up and after care.

If you have had the "closed" liposuction technique you will usually be discharged on the day of surgery. "Open" procedures necessitate an overnight stay in hospital. All being well, you will be discharged home the following day with some painkillers after the drains have been removed. You will be provided with an elasticated chest-binder. It is import to leave the dressing alone and wear the chest binder 24 hours a day. At home you should take life easy for the first few days. At between 5 and 7 days you will be seen in the clinic and the dressings removed and the wounds checked. You would be advised to take 1 to 2 weeks off work and it is essential to avoid all strenuous activity during this period. The binder needs to be worn day and night for a month to give the best results. Vigorous sport such as jogging or the gym should be avoided for 4 weeks. A check up clinic appointment at 3 months after the surgery will be arranged for you. The final result of the gynaecomastia correction is best viewed 3 months after the surgery.

Possible complications

All operations carry a risk of complications, and gynaecomastia surgery is no exception. The risk of infection is less than 5% and precautions are taken to avoid this. The most significant problem particularly after the open operation is a haematoma (a collection of blood under the skin), on the first night after the operation. This is easily detected and requires a trip back to the operating theatre to have this removed. This occurs in less than 10% of cases, and is the reason for staying overnight in hospital after the surgery. In virtually all patients with "open" procedures drains are inserted at the time of surgery. These drains are removed on the ward the following day. In a small group of patients, typically less than 5 %, a collection of fluid persists and this is called a "seroma". It is completely harmless and does not affect the final outcome. This can easily be removed in the clinic with a syringe. It is impossible to perform any gynaecomastia operation without a scar. Occasionally, scars may be red and thickened for a few months but they usually settle down by themselves without any treatment. Unevenness between the two sides or areas of lumpiness may occur. However, most settle with time following the resolution of any tissue swelling post-operatively. Exceptionally, areas of unevenness may require further surgery. Occasionally the nipple can become scarred down to the chest wall giving a displeasing inverted appearance to the nipple.

Correction of gynaecomastia can be performed by "open" or "closed" techniques. Not all patients are suitable for the simpler "closed" technique. Patients are usually very happy with the outcome of the surgery allowing them to wear T-shirts without worry, and to go swimming without embarrassment.

Plastic & Reconstructive Surgery

FACTS AT A GLANCE

SURGERY TIME
2 hours

HOSPITAL STAY
Day case – Closed, 1 night – Open

ANAESTHETIC ASSESSMENT
Possibly

PRE ADMISSION TESTS
Possibly

SLEEPING POSITION
No restriction

REASONABLY MOBILE
1 day

WASHING
Shower after 1 day. Bath only after 2 weeks.

DRIVING
5-7 Days

SPORT & EXERCISE
4-6 weeks

SEXUAL ACTIVITY
2 weeks

FULL RECOVERY
6 weeks

TIME OFF WORK
1-2 weeks (longer for open)

BRAS & GARMENTS
Elasticated chest garment for 1 month