Gynaecomastia – Excision

There are several techniques used for gynaecomastia excision, utilising a variety of incisions.

The type of surgery selected depends upon skin elasticity and the amount of breast tissue and fat to be removed.

It is difficult to hide scars on a man’s chest and the scar can be just as obvious as the gynaecomastia itself. To optimise the cosmetic result, I have modified some of these techniques by minimising the scars and hiding them within the areolar (the pigmented area).

Liposuction is used to remove fatty tissue through several stab incisions, hidden within the areolae. These scars are almost unnoticeable.

If there is still a glandular element remaining behind the nipples, this can be removed via the same incisions used for liposuction, without creating additional scars.

Most patients require a combination of liposuction and removal of the gland to achieve optimal results.

In patients who have lost a significant amount of weight or have large gynaecomastia, there is likely to be excess skin, which will require additional surgery to tighten or move the nipple, thus resulting in additional scars.

A gynaecomastia excision is usually performed under a general anaesthetic (you will be fully unconscious). I use a long-acting local anaesthetic block during the surgery, which reduces post-operative pain so you should only need simple painkillers, such as aspirin, for the first few weeks post-operatively.

The surgery takes about 1½ hours to complete, and you can go home the same day.

Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about cosmetic surgery should never be rushed.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare.
• Dizziness and nausea.
• Sore throat.
• Damage to teeth or mouth.
• Nerve injury due to body positioning.
• Allergic reaction or anaphylaxis.
• Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: These are hidden in the areolae, and normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with noticeable thickened, thin or stretched scars.

Bruising and swelling: This is normal, and this may take approximately 3 weeks to settle.

Haematoma: This is clotted blood that collects in the breast. It occurs in less than 1.3% of men who have open gynaecomastia excision, and the risk is lower with my technique. A haematoma often occurs within 4 to 6 hours post-surgery. Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure, albeit very uncommon in elective breast procedures. Antibiotics are administered during surgery and for 7 days after surgery to minimise the risks. Less than 1% of patients develop an infection post-operatively and rarely require any intervention, apart from further antibiotic treatment.

Numbness, reduced sensation or oversensitivity:  A reduction in nipple sensation may occur temporarily but normally resolves in the fullness of time.

Wound healing problems: These are rare but can happen around the nipple or where the skin has been excised in select patients. These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery. Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Asymmetry: Each breast is slightly different and will continue to be following surgery; remembers, “they are sisters and not twins”. However, if you have noticeable asymmetry before your surgery then this will be corrected as part of the surgery and will be discussed with you.

Fat necrosis: Sometimes areas of fat within the breast scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over a 12-month period.

Recurrence: It is possible for gynaecomastia to recur. This is very uncommon, unless there is a specific factor that continues to cause glandular tissue to grow, for example certain medications or use of anabolic steroids.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with me. Decisions about cosmetic surgery must never be rushed and requires personal research.

Your incisions will be closed with dissolvable sutures that do not need to be removed. I use a waterproof plaster to cover the incisions. You can shower as soon as you like after surgery and the dressing will be removed in the clinic after a week.

I will also apply a supportive compression corset around your chest in theatre to reduce post-operative swelling. This should stay in place and needs to be worn day and night, for the first 4 weeks. It can be removed for washing, showering and for short periods during the day.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me in 2 weeks. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for advice.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from Silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you get home, you should take things easy for the first week or so. Most people take 1 to 2 weeks off from work and gradually increase activity over the next few weeks. You can return to exercise at the gym after 4 weeks.

For self-funding patients, surgical fees are a combination of the Hospital costs, surgeon fee, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the planned surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

Gynaecomastia - Nicotine and Surgery

Gynaecomastia - Compression Garments

Gynaecomastia - Pre-Op Instructions

Gynaecomastia - Post-Op Instructions