The cause of the condition is usually unknown but gynecomastia can be associated with the ingestion of certain medications such as antidepressants, blood pressure medications, ulcer medications, and steroids. Sometimes, gynecomastia can be related to an imbalance of hormones, the smoking of marijuana, or the overconsumption of alcohol.
Every case of gynecomastia is unique to the patient experiencing it. There are various surgical options to treat gynecomastia, depending on the presentation and severity of gynecomastia. In some cases, it is possible to perform removal of excess fat using liposuction alone and wait/hope for the skin to retract on its own. Sometimes skin retraction can take a minimum of one year to see any significant progress. If the skin does not retract on its own, then an additional surgery to remove the skin may be warranted at that time. In very severe cases, the surgical incision may have to extend beyond the nipple incision. If your nipple/areola has changed in shape due to the excess fat/tissue, it is possible for your surgeon to perform a nipple revision during the surgery.
The decision to have plastic surgery is extremely personal, and you’ll have to decide if the benefits of the surgery outweigh the risks and potential complications of surgery.
You will be asked to sign consent forms, similar to the ones found here, to ensure that you fully understand the procedure and any risks. It is important that you address all your questions directly with your surgeon.
Gynecomastia surgery is often done under a general anesthetic. In very mild cases of gynecomastia, it is possible to perform the procedure under local anesthetic. The surgery requires an incision to be made around the lower portion of your nipple and requires a combination of direct surgical removal of the breast tissue with some possible liposuction to smooth the surrounding area.
During the surgery, your surgeon will weigh the risks and benefits of the placement of surgical drains and decide whether you will need them at that time. If so, two Jackson-Pratt drains will be placed along the opposing sides of your surgical incision or through two small stab incisions at the lower corner of your chest closest to the armpit. Dissolvable stitches will be used along the surgical incision, with exception to the two black stitches used to tether your drains. Surgical dressings will be applied and a compression vest will be used on top. Depending on your surgeon you may be fitted for the garment a week after surgery rather than going home with a garment the same day.
Following general anesthesia or intravenous sedation, it will take 24 to 36 hours for the full effects of the drugs to wear off. You must be accompanied by a responsible adult, who may either drive you home or take a taxi with you. You may feel a little sleepy or nauseous when you get home, you should quietly rest at home for the remainder of the day.
Remove all surgical dressings 48 hours after surgery, leave only the pink paper tape over the surgical incisions. At this time you can shower, but do not directly apply water pressure over any of the pink tape, only let the water run over it and pat gently to dry. The pink tape is waterproof and will start to peel off over the next 4 weeks, please cut off the portions that are no longer adhering to prevent the rest of the tape from falling off.
You may have two drainage tubes in place (one to each chest) after surgery to help reduce the amount of fluid buildup around the wound. You will be given instructions on how to care for the drain and when to arrange an appointment to have them removed. To make showering more comfortable, you can attach your drains to a lanyard around your neck. Please do not bathe or soak your incisions until all incisions have completely healed. Swelling and bruising is common following surgery and is to be expected. The bruising should subside within 2-4 weeks after surgery. It is essential to continue wearing the provided compression garment for 3 months for prevention of fluid buildup (even at night if comfortable). Additional garments are available for purchase through the clinic.
Patients are able to get up and walk around right after surgery. However, it is important to reduce tension to the chest and arms during recovery. Most patients are able to walk on a treadmill in about a month, and play tennis in about three months. Most patients who have sedentary jobs take about two weeks off work. If your job involves a lot of physical activity be sure to speak with your surgeon during your consultation with regards to how much time off you will need for your specific daily tasks. There should be no heavy lifting for 6 weeks following surgery. Most patients are comfortable driving in about two week's time. However, it is not uncommon for a spot along your surgical incisions to open up during the postoperative stages due to increased tension on the incisions with movement. This is not a serious complication, and can be remedied with daily dressings, but it does mean a delay in your expected recovery time. Sometimes if there are no drainage tubes used, there is a potential for you to develop a pocket of fluid in your chest that will require manual drainage requiring weekly visits. This is also not a serious complication, but it does mean a delay in your expected recovery time.
If you have any questions or concerns, feel free to give us a call at (403) 800-9157 and leave a message as necessary. If you are unable to reach us, and need medical advice please call 811 to speak to a nurse, the line is free of charge and available 24 hours a day. If it is a medical emergency please call 911 or go to your nearest hospital, or call the Peter Lougheed Centre Switchboard at (403) 943-4555 and ask to speak to the plastic surgeon on-call.
A good candidate for surgery is a patient who is relatively healthy and has realistic expectations for post-operative outcomes. It is also strongly advised that you be a non-smoker at the time of surgery. If you are a smoker we recommend you quit smoking at least 3 months prior to surgery as nicotine can interfere with blood supply and potentially cause complications with healing after surgery.