DETAILED GYNAECOMASTIA INFORMATION

Gynaecomastia is a condition in some males, which creates the appearance of female breasts. These ‘breasts’ can be composed of excess fat, breast tissue or both.

Using surgical techniques for the removal of breast tissue, and liposuction to reduce fatty deposits, Dr Harper can create a more masculine appearance.

Men with gynaecomastia are often self-conscious about their chest and after surgery, many experience enhanced confidence and have a new appreciation for their physical appearance.

Four presentations occur

  1. At puberty – about 1 in 10 young men. However 90% settle without surgery by 17 years of age. If enlargement remains at the age and patient is self conscious, then surgery is performed. Gland excision only.
  2. Steriod hormone and other drug ingestion. This does not settle when drugs stopped and surgery is required. Recurrence rate of 1% if steriods continued after surgery. Gland excision only.
  3. Middle age onset. Mild enlargement of gland from puberty and/or drugs, then fat deposition/infiltration occursto produce obvious breast enlargement. Needs gland excision then liposuction to chest wall so that pinch testwall = pinch test abdomen.
  4. Older men: fatty breasts develop, no gland enlargement. Liposuction is needed and that is all.

Corrective Surgery

  1. Gland Excision: “W” incision around lower half of nipple to remove all gland behind nipple.
  2. Liposuction: special technique of ultrasonic liposuction to remove all fat till pinch test of chest fat = pinch test of abdomen.

Surgery

Performed under local anaesthetic/sedation in the Day Surgery Centre or a general anaesthetic at Manly Waters Private Hospital. 11/2 hours surgery, then 2 days quiet resting at home, then shower, returning to work/driving by 1 week.

  1. Correction Gland excision: nipple incision around lower part of nipple.
  2. Liposuction: till pinch test, chest fat = abdomen fat.

GYNAECOMASTICA PRESENTATIONS

At puberty:

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19 year old patient. Solid small gland containing no fat, however patient himself is

overweight. Small procedure, und lA or G.A. gland only removed no liposuction.

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Post operative: 4/12: Incisional lines cannot be seen Patient still overweight – this

extra fat must not be removed by liposuction but by diet.

GYNAECOMASTIA AFTER STEROID USE

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Incision around nipple.

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Glandular excision only.

Breast size did not decrease after steroids stopped. Glandular resection only (very large gland)

and no fat removal by liposuction 2½-3 hour procedure. GA – Day only drains removed next day.

GYNAECOMASTIA OF MIDDLE AGE

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Showing glandular excision and extent of liposuction.

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Post op results.

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Postoperative showing elastic girdle and drains (24 hours).

Fat has been deposited with the gland, now a very extensive size. Gland with its contained fat must be removed no fat outside gland otherwise a hollow will remain. Pinch test of gland equals pinch test of abdomen at end of procedure. 3½ hours and a general anaesthetie. No liposuction to chest wall. Drains remain 2-4 days depending on drainage, avoiding a serona.

GYNAECOMASTIA OF OLDER MEN

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Fat only in breasts, no gland, no resection only liposuction GA or lA – 1½ hours.

Some loose skin will remain, but patients have an improved chest contour.

INCISION LINE AROUND NIPPLE

All patients have been happy, no complaints, with all incisional line white and flat by 4-6 months.

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W shape nipple incision & large gland excision which heals inconspicuously.

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At 3/12 incisional lines just visible, slightly red with be white by 4-6 months, totally inconspicuous.

POSSIBLE COMPLICATIONS

All surgial procedures have complications. Complications in this surgery are unfrequent and minor. The only complications Dr Harper has had over last 100 procedures for gynaecomastia is 1 Post operative bleeding (taking back to theatre, 1 Serona development requireing insertion of drains, 2 recurrences as patients went back on steroids

GENERAL RISKS WITH ANY SURGERY

  • Wound infection — not common; treatment with antibiotics may be needed, or even removal of the implant.
  • Bruising and swelling — usually sub- sides in one or two weeks but some- times can take up to a month or more.
  • Bleeding from the wound.
  • Poor or slow healing of the skin and breast tissue, even possible wound breakdown.
  • A chest infection may develop after a general anaesthetic.
  • Heart and circulation problems — a blood clot (thrombosis), heart attack or stroke; a blood clot can move to the lung and cause a pulmonary embolism, which can be life threatening.
  • Breathing difficulties — due to the general anaesthetic or the endotracheal tube, which can cause swelling. noisy breathing and discomfort.
  • Abnormal scarring from the incision — if the scar is unattractive and too big, additional surgery may be needed to try to improve it, though no guarantees can be given.
  • Keloid lumpy scar tissue which is pink, raised and irregularly shaped; it may be itchy and tender for many months but will usually fade and settle over the following 18 to 24 months.

SPECIFIC Risks FOR GYNAECOMASTIA SURGERY

  • Slightly mismatched breasts or nipples. If this is a significant problem, a second surgical procedure may be needed to correct the imbalance in size or position.
  • Numbness or loss of breast sensation is a temporary side effect and may last for up to a year.
  • Recurrence of breast growth after surgery can occur if the breasts had not finished growing when the surgery was done. This is an important reason why it may be preferable to wait until growth has stabilised before having surgery.
  • Another procedure may be needed to remove excess skin if large amounts of mammary gland or fatty tissue have been removed and the overlying skin has not adjusted to the new breast size.
  • Permanent pigment changes in the breast area may occur.
  • A keloid scar and hypertrophic scar are surgical scars that become inflamed, raised and itchy. People with a history of developing these types of scars are more at risk. Keloids and hypertrophic scars can be annoying but are not a threat to health.