Gynecomastia under analysis by Dra. Luísa Magalhães Ramos - SIC Notícias
WHAT IS GYNECOMASTIA?
Gynecomastia is a unilateral or bilateral excess of skin, fat and mammary gland, in men. It appears in adolescence or adulthood, with an incidence of about 32% of men. About 65% of teenage boys are affected and it is bilateral in 75% of the cases.
In most cases, it is an idiopathic problem (meaning, with an unknown cause), but in many other cases there are multiple associated factors, namely physiological (decreased levels of testosterone in the neonatal period, adolescence or old age), pathological (cirrhosis, adrenal tumors, hyperthyroidism, hypogonadism, testicular tumors) and pharmacological (consumption of marijuana and steroids or drugs such as calcium channel blockers, spirinolactone, cimetidine and ketoconazole).
Gynecomastia is not associated with an increased risk of breast cancer in men.
GYNECOMASTIA
DIAGNOSIS
To diagnose gynecomastia, we have to observe a predominantly glandular or adipose (fat) increase, the presence or not of masses, the quality of the skin, the degree of ptosis (whether or not the breast is sagging), the positioning and size of the nipples and areola and existing asymmetries. Typically, a four degree classification is considered, ranging from the 1st (lighter, with minimal hypertrophy and without ptosis) to the 4th degree (more severe, with a volume greater than 500gr and with accentuated ptosis).
CHARACTERISTICS OF THE IDEAL CANDIDATES
FOR A MALE BREAST REDUCTION SURGERY
Ideal candidates for gynecomastia treatment usually exhibit the following characteristics:
- Increased breast volume;
- Excess skin (breast ptosis);
- Increased areolas;
- Patients without possible adjacent causes (e.g. tumors, drugs, consumption of some substances such as hormones or cannabis).
- Overall healthy;
- Non-smokers;
- Not overweight / with a stable weight;
- Emotionally mature;
- Realistic expectations.
GYNECOMASTIA SURGERY
PROCEDURE
GYNECOMASTIA MEDICAL APPOINTMENT
Consultation
The first step in your gynecomastia medical appointment is a detailed assessment of your breasts, health and lifestyle. The surgical plan will be outlined after the medical diagnosis, which is confirmed with a breast ultrasound;
Simulation with Vectra 3D
Vectra 3D XT creates a simulation for you to have an idea of the possible outcome of the surgery;
Detailed explanation
During your gynecomastia medical appointment, a personalized treatment plan will be presented and you will understand the risks of the procedure, pre- and postoperative care, and the results you can expect;
Quote
After the medical appointment, you will be presented with an exact price for your gynecomastia treatment. This price will depend on whether it is a case of excess fat, excess mammary gland or both.
WHAT RESULTS CAN I EXPECT
AFTER SURGERY?
Treating gynecomastia has a major impact on the patient’s quality of life and self-esteem. The final result is different for every patient as it depends on individual anatomical characteristics, density of the existing breast tissue and elasticity of the skin surrounding the breast. The result of the treatment is usually pretty evident. The chest becomes flatter, unnoticeable through clothing to the naked eye. Patients undergoing treatment report a significant improvement in confidence, self-esteem, and social activity. The result of the surgery is definitive, but it can be affected by weight fluctuations, hormonal problems, medication, supplements and the natural aging process.
TYPE OF ANESTHESIA
Surgery to treat gynecomastia is usually performed with sedation and local anesthesia. The type of anesthesia is always defined by the anesthesiologist according to the combination of procedures to be performed and the clinical history of each patient. Sedation is administered intravenously so that the patient falls asleep and is unaware of anything during the entire surgery. Then, when the patient is asleep, local anesthetics are administered so that he does not feel any pain during the surgery. The anesthesiologist will be present throughout the intervention for greater patient comfort and safety.
TYPE OF INCISION – SCAR
One of the issues that concerns patients the most is how scars will look. If only a liposuction is to be performed, the scars are very small, practically imperceptible (just enough for the insertion of a very thin cannula). If excess mammary gland and/or ptosis is to be treated, the scar will be in the transition zone of the areola and breast skin (the size will depend on the amount of tissue / skin to be removed).
GYNECOMASTIA TREATMENT
Treating gynecomastia involves reducing the size and reshaping the male breast. When breast enlargement results from an unknown cause, they often revert after 3 to 18 months. In cases where the swelling has been present for over 12 months, it hardly ever will regress and treatment is required. In obese patients, weight reduction is advised before surgery. Other patients can be treated with surgery after proper exclusion of possible underlying causes (e.g. tumors, medication, or consumption of substances such as hormones or cannabis).
Surgical treatment of gynecomastia can be performed using two techniques, either individually or combined: liposuction and reduction surgery.
Liposuction
When the abnormal breast volume is due to adipose tissue (fat). Through a practically invisible incision, liposuction allows the removal of accumulated fat in the breast and, thus removing the unwanted volume.
Reduction surgery
In cases where there is an excess of mammary gland, the breast tissue is removed through an incision in the areola, thus reducing the volume and correcting an eventual ptosis.
GYNECOMASTIA 3D SIMULATION
We were the first clinic in Portugal to provide real-time simulation to our patients.
In the Gynecomastia medical appointment, VECTRA 3D XT is used to simulate, in real time, the “before and after” your surgery:
- Vectra XT 3D system has 12 digital cameras;
- It captures images at 180º and at different angles;
- Builds a 3D model of the patient “before surgery”;
- Enables image manipulation to simulate the possible result of the surgery;
- Enables clear communication between the plastic surgeon and the patient.
GYNECOMASTIA STEP-BY-STEP
MARKING PATIENTS WHILE STANDING
The markings are made with the patient standing so that the areas to be treated can be correctly visualized;
SEDATION
Sedation is administered intravenously by the anesthesiologist who will be present throughout the surgery;
LOCAL ANESTHESIA
The local anesthetic or epidural is injected into the area to be treated with the patient already asleep;
DISINFECTION
The area to be treated is cleansed and disinfected to reduce the risk of infection. Operative fields are placed in order to isolate the treated area from the external environment;
LIPOSUCTION
In cases of excess fat, a cannula is inserted into the breasts to aspirate the fat, through a vacuum suction system;
EXCISION
In cases where there is an excess of mammary gland or skin, or there is a need to reduce the size of the areolas or to reposition the nipple, an incision needs to be done;
INCISIONS CLOSING
The incisions are closed with small stitches that are usually removed 7 days past;
SURGICAL GLUE
The glue is applied over the scars (in the case the excision technique is performed), isolating the skin from the external environment. The glue does not require dressings and falls off gradually after 15 days;
POST-ANESTHESIA CARE
Before being transported to a recovery room, the paient is provided with a compression vest that must be worn, day and night, for 30 days. The patient is awakened by the anesthesiologist and transported to the recovery room where he will remain under medical observation before being discharged.
PREPARATION FOR GYNECOMASTIA SURGERY
Before surgery
- Perform all preoperative exams requested by the medical team and send them as early as possible.
- Do not take anti-inflammatory drugs or aspirin in the 10 days prior to the surgery to reduce the risk of bleeding. You must inform the medical team of any medication you are on or any medical condition you suffer from;
- Do not take weight loss medication the month before surgery;
- Do not smoke the month before surgery, neither after surgery, while healing is in progress. Smokers have a higher risk of complications, namely healing difficulties and tissue vascularization.
- Carefully read the documentation provided before the surgery, as doubts may arise;
- If you get sick or feel ill in the days leading up to the surgery, you must immediately inform the medical team;
- If you have small children, organize your routines in advance. You should have help at home mainly during the first week;
- Do you have questions about the surgery preparation or postoperative care? Do not wait for the day of surgery and ask all your questions beforehand.
Surgery day
- On the day before surgery, you should have light meals only, in order to avoid indigestion. On surgery day, you must be fasting since midnight - do not eat or drink any liquids including water.
- Shower with the prescribed antiseptic shower gel the day before and the day of surgery, to prevent infections.
- Bring comfortable / loose clothing to wear when you are discharged (preferably with a zipper or buttons);
- After discharge, you can neither drive nor go home unaccompanied. If you have no one to take you home and help you there for the first few days, you must inform us before the day of the surgery. You must be permanently accompanied for the first 48 hours
- You must plan your social and professional life in order to guarantee complete rest in the days following the surgery.
Recovery and postoperative care
- The recovery period is different for every person, but on average it takes between 2 and 3 weeks.
- Take all the prescribed medication on time;
- Rest as much as possible, especially during the first week, and gradually return to your routine. Don’t lie down all the time and don’t stay too long in the same position. Take short walks to promote circulation;
- Wear the compression vest all day long, during the first month;
- Avoid moving your arms too much;
- Avoid any kind of effort for the first 8 days. Up until week 4 you should limit your physical activity;
- Continuously apply ice in the treated areas for the first 72 hours after surgery. This is the most important action to avoid bruising and reduce edema;
- Avoid direct sun exposure;
- Do not smoke;
- Have a balanced and healthy diet and keep hydrated with frequent liquid intake;
- After 5 days, you should start getting lymphatic drainage massages, as these are essential for edema control and adequate tissue healing.
BENEFITS OF MALE BREAST REDUCTION SURGERY
Treating gynecomastia has a major impact on the patient’s quality of life and self-esteem. The final result is different for every patient as it depends on individual anatomical characteristics, density of the existing breast tissue and elasticity of the skin surrounding the breast. The result of the treatment is usually pretty evident. The chest becomes flatter, unnoticeable through clothing to the naked eye. Patients undergoing treatment report a significant improvement in confidence, self-esteem, and social activity. The result of the surgery is definitive, but it can be affected by weight fluctuations, hormonal problems, medication, supplements and the natural aging process.
Male breast reduction surgery offers patients several benefits. The advantages include:
- More masculine and harmonious body contour;
- Better posture;
- Increased confidence and self-esteem;
- Better quality of life;
- Performing physical activity in a more comfortable way;
Specialist Doctors
About
Dr. Alice Varanda Pereira / Plastic Surgery
Member of The Portuguese Medical Association, Nr. 47051
Graduated by the Faculty of Medicine of the University of Lisbon, she completed her master’s degree in human sexuality and is currently developing her PhD at this same institution.
She joined the University faculty academic staff in 2008 as a lecturer of the Institute of Anatomy. It is in this unit that she produces most of her research projects, mainly in the area of surgical anatomy, whilst also supervising master’s thesis for undergraduate students.
About
Dr. Mariana da Rocha Martins / Plastic Surgery
Member of The Portuguese Medical Association – Nr. 55124
Graduated by the Abel Salazar Institute of Biomedical Sciences at the University of Porto and specialized in reconstructive and aesthetic plastic surgery at Hospital de São José, in Lisbon.
Throughout her specific training in plastic surgery, she worked in internationally renowned institutions such as Institut Kaplan (Barcelona), La Clinic (Montreux) and Great Ormond Street Hospital (London).
About
Dr. Marta Gouveia Duarte / Plastic Surgery
Member of The Portuguese Medical Association, Nº 57817
Graduated in Medicine from the School of Health Sciences of the University of Minho, where she completed her Master’s thesis in Human Aging.
She concluded her specialty in Plastic, Reconstructive, and Aesthetic Surgery at the Centro Hospitalar de Lisboa Central – Hospital de São José.
Collaborates in several research projects at NOVA Medical School.
About
Dr. Filipa Oliveira/ Plastic Surgery
PORTUGUESE MEDICAL ASSOCIATION: registration Nº. 59147, specialist in Reconstructive and Aesthetic Plastic Surgery.
Graduated in Medicine from the Faculty of Medicine of the University of Porto, where she completed her Master’s thesis on pediatric scars.
PhD in Medicine from the University of Münster in Germany.
After completing her specialty, she became a Senior Graduate Assistant (Oberärztin) at the Fachklinik Hornheide and the University of Münster. She is currently involved in various research projects at the University of Münster, where she is supervising doctoral students. She is also a regular correspondent for scientific and leisure magazines in Germany.
FAQ about
Male Breast / Gynecomastia
IS GYNECOMASTIA SURGERY SAFE?
Yes. The surgery is safe as long as it is performed in an accredited clinic and by a reconstructive and aesthetic plastic surgeon, registered in the Portuguese Medical Association and with several years of experience in this type of interventions. It is just as important to perform all the prescribed medical exams and to strictly follow the recommended pre and post-operative care.
HOW MUCH DOES A GYNECOMASTIA SURGERY COST IN LISBON?
Regarding gynecomastia, each case is different. The price of the surgery will depend on whether the cause for gynecomastia is excess fat, excess mammary gland, or both. The exact price for your gynecomastia surgery will be disclosed after the diagnostic medical appointment.
AT WHAT AGE DOES GYNECOMASTIA USUALLY MANIFEST ITSELF?
Male breast enlargement is more frequent at certain stages of life. The majority of gynecomastia cases occur during adolescence, with an incidence of 65% in boys aged between 14 and 15 years old. However, it can occur at any age, as it can have multiple causes.
DOES GYNECOMASTIA HAVE A CURE?
Since most cases of gynecomastia are of unknown origin, surgery presents itself as the best treatment option, and in these cases it can be regarded as a cure. In general cases, treating the underlying cause itself can also be considered a cure for the gynecomastia.
DO SCARS DISAPPEAR?
The scars from gynecomastia surgery are permanent, but they are so small they hardly noticeable. Over time, they become thinner and lighter. The final appearance of the scars is variable and will depend on the genetic characteristics of each patient and on postoperative care. The scars’ final appearance is expected 12 to 18 months after the procedure.
WILL I NEED DRAINS?
Usually, when only liposuction is performed, no drains are used. In the remaining cases, drains will be placed whenever necessary, and they will be removed after 48 hours.
HOW PAINFUL IS THE RECOVERY?
Recovery from gynecomastia surgery can take about 2 weeks. In the first few days, it is normal to experience tiredness, discomfort and moderate pain. It is important to strictly follow all medical recommendations, respect the rest time and take the prescribed medication to relieve the pain and enjoy a more peaceful recovery.
WHEN CAN I RESUME PHYSICAL ACTIVITY?
You should not exercise or make any kind of effort for 30 day, after which you can gradually resume physical activity. You must be extremely careful at this stage, as this not only warrants a quicker recovery, as it also contributes to obtaining better results.
IS THE RESULT NOTICEABLE IMMEDIATELY AFTER THE SURGERY?
The result of gynecomastia surgery is visible immediately after the surgery. However, for some time, the swelling will distort the end result. After three months you may have a very real idea of the result, but the final appearance is usually expected after 6 to 12 months.
CAN GYNECOMASTIA REAPPEAR AFTER SURGERY?
The results of gynecomastia surgery are long-lasting and permanent if there are no underlying untreated causes. On the other hand, if after the surgery, the patient gains weight or develops any health issue that originates gynecomastia, the surgery results will be compromised.
WHAT ARE THE RISKS AND COMPLICATIONS OF THE SURGERY?
Like any other surgical intervention, gynecomastia surgery is not free from risks and complications, (e.g. reaction to anesthesia, infection, hematoma, changes in skin sensitivity, asymmetry, prolonged and unsightly scarring, etc.). The possible risks and complications of gynecomastia surgery will be explained in detail during your medical appointment.
