What is gynecomastia?
Gynecomastia is defined by an increase in the size of the breast in men. It can concern the mammary gland (glandular gynecomastia or true gynecomastia), fat (adipomastia) or both (mixed gynecomastia or adipo-gynecomastia). It can be unilateral or bilateral and in severe forms constitute a real breast.
The surgical procedure that corrects this increase in breast size is called gynecomastia correction, adipomastia liposuction or adipomastia treatment. It is a surgical intervention that is often overlooked but very frequently performed.
For men, an increase in breast volume is often a very negative experience, causing severe psychological problems and leading to real complexes. Gynecomastia treatment can give excellent results and help a man to regain self-confidence and a better self-image. The decrease in breast volume provides undeniable physical comfort, especially when dressing. Gone are the days of oversized tops or t-shirts and the summer beach complex. The result is almost always extremely beneficial on the psychological level.
As a cosmetic surgeon, Doctor Vincent Masson is available to listen to you and advise you on the best way to meet your expectations.
What are the causes of gynecomastia?
Generally there is no particular cause. We talk about idiopathic gynecomastia.
However, in some cases, gynecomastia may be related to abnormal hormone production or the taking of certain drugs. Gynecomastia is secondary to an endocrine pathology. A hormonal blood test is absolutely necessary in order to eliminate a possible secondary cause as is a radiological assessment. A mammogram or ultrasound is required to analyze the density of the glandular tissue. In these cases of gynecomastia secondary to a medical cause, there is often no surgical treatment. Treating the cause of gynecomastia will be enough to make it go away in the majority of cases. Hence the importance of the endocrine balance.
What does gynecomastia look like?
Many clinical forms can be seen. Sometimes a simple increase in volume is seen in the chest corresponding to an excess of fat. The increase in volume of the breast can be major, the breast then looks like a real breast with distention of the areola. This form is painless and on palpation the chest is soft. Sometimes the patient can simply palpate a nodule behind the areola, hard and painful, which corresponds to an isolated glandular nucleus. Flows are possible through the areola. All associations are possible in the context of mixed gynecomastia, symmetrically or not.
What are the principles of gynecomastia treatment?
The aim of this cosmetic surgery is to, as best as possible, restore the patient’s normal anatomy in order to eliminate complexes:
Reduce breast volume by direct surgical excision of the excess glandular tissue for glandular forms using a scar hidden under the areola, or by liposuction for fatty forms using micro-incisions under the breast. In the case of mixed forms the two techniques are combined.
Reduce excess skin: In some cases where there is considerable excess skin, reducing breast volume is not enough and you must also remove excess skin, most often using a scar that is around the areola. Sometimes the scar extends under the breast or on the sides in case of a major form of gynecomastia.
What happens before the gynecomastia treatment?
Two consultations with Doctor Masson are compulsory. The minimum period between the first consultation and the operation is 15 days (this is the legal reflection period). Medical photographs will be taken.
It is always necessary to carry out a preoperative, hormonal and radiological assessment in order to eliminate a secondary cause and not to rush into treatment, particular in an adolescent. In fact, at puberty, gynecomastia can be quite frequent (linked to hormonal surges) and often returns to normal spontaneously in the following two years. If there is a real need to operate, we will define together the type of intervention that is most appropriate for your case including the choice of the location of the scars and associated or non-associated liposuction.
A bolero style compression garment is prescribed. It should be worn day and night after the operation for 6 weeks.
The anesthetist will be seen in consultation at the latest 48 hours before the operation.
Quitting smoking is strongly recommended for at least one month before and after the operation (smoking increases post-operative complications and the risk of unsightly scarring). Use of aspirin and anti-inflammatory drugs should be stopped 10 days before the procedure for gynecomastia or adipomastia (they increase bleeding).
What type of anesthesia is used?
The procedure is most often performed under general anesthesia, during which you are completely asleep.
How long does the operation take?
Between 45 minutes and two hours depending on the surgical technique used.
How long does hospitalization last?
Outpatient surgery is possible in some cases (entering the hospital or clinic in the morning and leaving the same evening). Otherwise, hospitalization is 24 to 48 hours depending on the surgical technique used.
After male gynecomastia treatment: post-operative care and recovery
The dressing which was put in place in the operating room after the gynecomastia procedure is removed the next day. If a drainage system (redon drain) has been installed, it will be removed at this time. In case of isolated liposuction, no drain is put in place.
The chest is swollen and blue (bruising) for 5 to 15 days which is normal. Showering is allowed. After a shower a light bandage is placed on the scars which will have to be redone every day for 3 to 10 days. The compression garment is then put on and must be worn day and night for 6 weeks to reduce swelling and to help the skin to recover. The threads are absorbable: no sutures need to be removed.
The post-operative effects are therefore very simple and the care easy to do.
Sports, violent movements, or carrying heavy loads are not recommended for six weeks.
Time off work, ranging from 72 hours (simple liposuction) to 8 days is desirable (to be adapted according to your profession).
Does it hurt ?
The aftermath of a gynecomastia operation can be painful for the first few days. Aches are felt. An analgesic treatment adapted to the intensity of the pain will be prescribed. There is often discomfort in raising the arms for the first few days that will go away on its own.
Where is the scar located?
The scar is a compulsory sequel to surgery. It is often pink during the first 3 months and then begins to fade after the 3rd month, and this gradually continues for 1 to 3 years. It is extremely important to effectively protect scars from the sun during the first year after the operation. In all cases, the scar will be as discreet and hidden as possible. In the case of liposuction alone, it is located at the areola or at the level of the submammary groove and is 2 to 3 mm long. In larger forms of gynecomastia with the need to remove excess skin, the scar is most of the time placed around the areola and almost invisible because it is located at the junction of the dark and light skin. In major forms of gynecomastia, the scar may extend to the sides. As the torso is generally hairy, the hair growth itself hides the scar.
Gynecomastia and health insurance?
Health insurance participation for gynecomastia treatment is possible provided that the conditions defined by the social security system are met, namely that it is an intervention performed after endocrine assessment (and after puberty) for confirmed gynecomastia which may pose a sexual or psychological problem to the patient (in particular painful asymmetrical gynecomastia with areolar distension). A prior agreement with the social security system is essential before surgery.
It is largely therefore the surgeon who will decide if the motivations for the surgery meet the health insurance participation conditions. The rest of the fees can be covered by a complementary (mutual) health insurance company.
Otherwise, the gynecomastia correction is an aesthetic surgery intervention, which is not supported either by social security or by a mutual complementary health insurance scheme. The usual budgets is 4000 euros.
If the gynecomastia treatment is not covered by social security, plan a period of time off work of 5 to 10 days after the operation, as no work stoppage can be prescribed.
When is the result visible?
The improvement is often clear and immediate from the first few days.
However, the final result of a gynecomastia procedure requires a period of 2 to 6 months. It is the time necessary for the post-operative edema to disappear and the excess skin to shrink. It is necessary to wait at least 12 months to judge the final appearance of the scars (and longer for smokers). Several follow-up consultations are carried out approximately at 7 days, 1 month, 3 months, 6 months and 1 year after the gynecomastia operation.
Real complications are rare after a gynecomastia operation performed in accordance with the rules. Despite their rarity, however, you must be informed of the possible complications by your surgeon during your consultation appointments.
- Postoperative bleeding and hematoma: quite rare but may justify evacuation so as not to risk secondarily affecting the aesthetic quality of the result.
- Thromboembolic events: quite rare but justify preventive measures (compression stockings, early waking, anticoagulant treatment)
- Localized infection: antibiotic treatment may be sufficient, but it may require surgical drainage.
- Relatively frequent serous effusion, which may appear a few weeks after the intervention, and can lead to repeated punctures and / or re-intervention for drainage.
- A pneumothorax (collapsed lung): very rare, and needs a specific treatment.
- The scars can be large or hypertrophic (in relief) and unpredictabe. They can sometimes require surgical touch-up when they are large and / or corticosteroid injections when they are hypertrophic.
- Delayed healing
- Skin necrosis which extends the healing time by several weeks. It is clearly favored by smoking, diabetes, and obesity. The importance of this necrosis can be very variable.
- Alteration of skin sensitivity for the first few months: numbness, insensitivity or “bizarre” sensations, these changes are frequent and usually disappear, at least partially, over time (several months or years depending on the case).
- Subjectivity: as male gynecomastia treatment is motivated by aesthetic reasons, the results can only be assessed subjectively. It is therefore important to recognize that the results obtained may not correspond exactly to the expected results.
- Imperfection of results: residual asymmetry of volume, asymmetry of the height of the areolas and nipples, cutaneous excess, hollowed aspect to the areola, zone of hollow or small nodules under the skin.
These complications or imperfections of results can possibly be corrected by a surgical touch-up which, in general, is much simpler than the initial intervention both from the technical point of view and post-operatively, but not before the 6th post-operative month.
Before the gynecomastia surgery:
- Compulsory medical visits: two consultations with your plastic surgeon and a consultation with the anesthesiologist no later than 48 hours before the operation.
- Signature on the quote and informed consent form.
- Medical photographs: there is a systematic production of medical photographs.
- Reflection period: 15 days minimum reflection period between the first consultation with your cosmetic surgeon and the operation.
- Mandatory information: imperfection of results and possible complications.
- Pre-operative recommendations: smoking cessation recommended one month before and for one month after surgery to optimize healing, no medication containing aspirin should be taken 10 days before the surgery, anti-inflammatory drugs should be stopped, and fasting (do not eat or drink anything) for six hours before the operation is necessary.
Surgical intervention: Gynecomastia
- Type of anesthesia for gynecomastia: General anesthesia
- Duration of the gynecomastia treatment: 1 to 2 hours
- Hospitalization procedure: return home the same day if liposuction isolated from adipomastia, or the next day if subcutaneous mastectomy and skin resection.
Follow-up and results
- Special care after gynecomastia treatment: wearing a compression garment for 1 month night and day, rigorous pre and post-operative hygiene until complete healing, rest.
- Thread withdrawals: no suture is removed in general, they are absorbable in most cases.
- Social isolation after gynecomastia treatment: 1 to 3 days
- Resumption of physical activities after gynecomastia treatment: 6 weeks
- Resumption of professional activities: 3 to 7 days depending on the professional context
- Deadline for the final result after gynecomastia treatment: 3 to 6 months approximately, which is the time necessary for the post-operative swelling to disappear and the excess skin to shrink.