Purpose: To reduce the size of the male breast
Length of operation: 1-2 hour
Anaesthesia: General anaesthetic
Inpatient stay: 1 day or day case
Followup: 1 week 3 months 6 months 1 year
Time off work: 2 week
Recovery: 2-3 weeks
Risks: Bleeding Dish Deformity Asymmetry Need of Further Surgery for Skin Excess
Gynaecomastia or male breasts is a common condition. Plastic surgery intervention is generally requested for large or asymmetrical male breasts. The procedure involves surgery with or without liposuction. The results are generally excellent with high satisfaction rates. In this information system I am going to go through the whole procedure giving you a view of what gynaecomastia surgery involves in terms of the operation hospital stay recovery and the complications. I am quite happy to see you again for a second consultation so that you can clarify any of your doubts.
Procedure / Hospital Stay
It is advisable to stop smoking for 4 weeks and prior to the procedure. On the day of the operation the surgeon with do skin markings over the breasts. Photographs for documentation and teaching purposes are standard and will be discussed. The procedure is done under general anaesthetic and takes about 1-2 hours to perform. If the breast is predominantly fatty then liposuction is done first. This is done by using small skin crease incisions which are barely visible. If there is a disc of tissue left behind the nipple then an incision is made at the border of the areola with the breast skin. The disc is then removed and a drain is placed in wound before it is closed. Some local pressure with a garment or dressings is useful straight after the procedure as it reduces discomfort and also helps skin to attach to the chest wall. Occasionally for large breasts with skin excess a formal breast reduction approach is necessary. This procedure for breast reduction can be done by either using an anchor shaped scar or a vertical scar. The vertical scar tends to have a curtain top appearance but settles in the longer term. Rarely a mastectomy may be necessary but Dr Sanjay Azad will discuss all aspects in great detail.
While you are in hospital you will have blood tests fluids through a drip and pain killers. The stitches are all dissolving in nature. At the end there is a bulky dressing on the breasts and a drain in each side. You will feel quite bruised and swollen after the operation and this settles in due course. We take precautions to prevent clots in your calves by putting on stockings and giving you a blood thinning injection. The hospital stay is conventionally 1-2 days and depends on your recovery and drain removal.
Recovery After Surgery
At discharge the dressing stays on and you need to attend the dressing clinic in a week time. The dressing is taken down and you should wear a support garment day and night for 2 months. You will be given some pain killers to take home. Further dressings may or may not be required depending on the wound. You will be seen again in 3 months time. Photographs will be taken at this stage.
You should avoid smoking for 4 weeks after the procedure. Recovery is individual but most patients get back to work and driving in 2-3 weeks time. Swimming is usually possible at about 8-10 weeks time. The breast size and shape is best assessed at 6 months after surgery. Occasionally further procedures may be necessary to get the desired result.
Overall results are excellent but there are some well known limitations risks and complications which you should be aware about:
- Scars hypertrophic scars keloids
- Both breasts tend to be asymmetrical and this will persist after surgery.
- Breasts are never static and will change with age and weight changes .
- Haematomas (blood clot which may need evacuation in theatre).
- Seromas (collection of body fluid)
- Skin necrosis
- Dish like deformity at the edge of the male breast
- Loss of nipple (complete or partial)
- Inadequate reduction
- Tissue taken from the breast is weighed and sent off for testing under the microscope.
- Further surgery may be occasionally necessary to achieve the desired result.
- Ensure that you wash your hair and shave your armpit the night before or morning of surgery.
- Simple pain like a combination of codeine and paracetamol are best. Avoid using ibuprofen or diclofenac, because they thin the blood and can cause more bleeding and bruising after surgery.
- Any bleeding, discharge, undue pain or unusual breast hardness after surgery; please contact the team or contact numbers given straightaway.
- During the first week after surgery keep your wound dry as water can seep below the dressing and cause maceration. It is a good idea to make a bra from cling film and then take a shower.
- It is common to have swelling and bruising after any form of breast surgery. This will settle in due course.
- It is quite important to use and move your shoulder after breast surgery. The anticipation of discomfort can make one stiffen at the shoulder and for this reason gentle shoulder movements should be started straight away.
- Do not drive during the first couple of weeks after surgery.
- It is advisable to avoid unnecessary activity, stretching or any strenuous exercise for at least the first few weeks. Aerobics and swimming can be done at 3 months post surgery.
- For sedentary occupations, you can return to work in 2-3 weeks. You will know when you are ready and do listen to your body which will tell you what to do.
- Massage with a good bland moisturizing cream (E45/Doublebase/Diprobase) helps the scars to settle down. This should be started about 2 weeks after surgery.
- Protect the scars from the sun by using sunblock for at least 2 years. This prevents them from getting pigmented.
- If the scars are getting lumpy they may need additional treatment. Please contact Dr Sanjay Azad.