Gynecomastia

WHAT IS GYNECOMASTIA?

Enlargement of the male chest - gynecomastia – is very common and distressing. The size of the enlargement may vary from a very small amount of breast tissue that grows behind the nipple areola, to a full sized breast which mimics a large female breast. Dr. Giuffre is highly experienced at fixing this frustrating problem.

WHAT CAUSES GYNECOMASTIA?

The vast majority of Gynecomastia has no definite cause (idiopathic).  The most common time for this development is during the peri pubertal development stage in a male.  The majority of this developmental Gynecomastia resolves by the age of 19 years.  For a small percentage of males, it does not resolve and may become problematic producing a cosmetic disability.  Gynecomastia may run in families, which predisposes the male children to develop Gynecomastia, if the father of the male child also has Gynecomastia.  Those males predisposed, who are overweight, are more likely to develop Gynecomastia. 

There are certain medications and drugs that predispose a male to develop Gynecomastia.  There are many, but the more common drugs are, Androgenic Steroids, used by recreational and professional athletes, certain diuretics, hair preserving products, and chronic use of cannabis.  Men being treated medically for prostate cancer with estrogen based medication are also predisposed.

There are certain medical conditions that can produce Gynecomastia.  A full medical workup, for men with Gynecomastia, by a Family Physician is recommended.

AM I A CANDIDATE FOR MALE BREAST REDUCTION SURGERY?

A peri pubertal male (the time around puberty), with rapid and large breast development, which produces a significant cosmetic deformity, with psychological and social impact, may be a candidate for the surgical treatment of the Gynecomastia before the age of 19 years.

After puberty, if the Gynecomastia did not resolve, and the non-surgical options have not reduced or eliminated the Gynecomastia, surgical treatment may be a consideration.

MALE BREAST REDUCTION CONSULTATION

Whatever your reasons for male breast reduction surgery, Dr. Giuffre personalizes the procedure according to your needs and treatment goals to enhance your natural silhouette.

Prior to your procedure, Dr. Giuffre will meet with you to discuss your goals and expectations for surgery. He will also review the details of your chosen procedure, the associated risks, and welcome any questions or concerns that you may have. This discussion is important,  helping you to communicate your vision with your surgeon in order to achieve the results you desire.  All post surgical results vary from patient to patient, as no two bodies respond to and heal from surgery identically.

Dr Giuffre will examine your breasts while assessing:

  • Chest wall symmetry

  • Breast symmetry

  • Nipple height symmetry

  • Breast shape differences

  • Exam for any masses or pathology

Each consultation is completely customized and designed with the individual patients goals in mind. 

MALE BREAST REDUCTION PROCEDURE

The surgical techniques used to treat Gynecomastia, depends on how large the male breast is, as well as, its shape:

Grade I: This is a firm, often painful disc of breast tissue directly under the nipple areola.  This can be treated surgically by removing this breast tissue, through an incision from the 3 o’clock to 9 o’clock, in the lower half of the areola, at the junction of the dark areola and the normal skin.  This can be done under Local (freezing) with, or without, sedation or General Anesthesia (the patient is completely asleep).

Grade IIA: In addition to the breast tissue, there is a substantial amount of adipose tissue, mixed with the breast tissue, that creates a moderately large breast mound.  The nipple areola are in the correct position on the chest wall, and there is no excess redundant skin.  This can be treated surgically, by removing this breast tissue through an incision from the 3 o’clock to 9 o’clock, in the lower half of the areola, at the junction of the dark areola and the normal skin. Liposuction is used at the same time, to reduce the adipose tissue, and feather the edges of the resection margin, to produce a flat male chest.  This is done under General Anaesthesia.

Grade IIB: This Gynecomastia takes the form of a full female breast, with excess breast and adipose tissue, skin redundancy (excess skin), and an abnormally low nipple areola, similar to a breast ptosis seen in a female breast.  *See Breast Lift 

This can be surgically treated by the removal of breast  and adipose tissue, removal of excess skin, reducing the size, and, relocating the nipple areola.

The male breast reduction procedure lasts one to two hours and is performed in a private surgical suite, adjacent to his Meadowlark Health Centre Office (#176) for his cosmetic procedures. The incision is made around the lower half of the nipple areolar complex, for both Grade I, and Grade IIA cases. For Grade IIB cases, there is an incision around the circumference of the areola, and in the breast crease, where it meets the chest wall. With any incision in the skin, regardless of where on the body, will heal with a scar.  The scar will mature, (the scar colour goes from red, to pink, to white, and the scar then softens and becomes pliable) which can take 1-2 years.  Medical paper tape placed directly over the incision, and changed weekly for 3 months, will help speed up the process of scar maturation.

BREAST SURGERY RECOVERY

Before waking from the surgery, Dr Giuffre will inject a long acting local anesthetic into the breast area to decrease any immediate breast discomfort from the surgery. The discomfort typically subsides after the first two days following the surgery, this will be treated with post operative analgesic medication (pain killers) for up to a week. Patients taking prescription pain medication should not drive a car or operate machinery or sign significant documents while taking this medication.

Patients will have to arrange a ride and aftercare with a responsible adult. Patients are not permitted to leave unaccompanied or in a taxi. Patients driving a distance from Edmonton that exceeds 90 minutes, should make arrangements to stay overnight in Edmonton. The surgical centre does not have an overnight care facility. 

Dr. Giuffre provides his home phone number to his cosmetic patients in case there is a patient concern.  In the rare instance that a patient requires hospitalization, Dr. Giuffre has admitting privileges to all of the major hospitals in Edmonton.

You will be seen the day following surgery by Dr.Giuffre and/or his nursing staff, and again within the week following your surgery by Dr Giuffre. After the 6 week visit, if there are any future requests for an appointment, they are made directly with Dr. Giuffre's office and an expedited visit is arranged.

Most patients feel tired and sore after breast reduction surgery, but this usually passes in a day or two. Many patients return to work within the week. Any postoperative pain, swelling and sensitivity will diminish over the first few weeks. Scars from breast reduction incisions will begin to fade in a few months, and will continue to fade for months or years.

BREAST REDUCTION RESULTS

Summary of generalized results a patient can expect. Would be good to circle this back to the customization of the treatment and expected results that Dr. G would discuss in a consult.

RISKS OF BREAST REDUCTION

With any surgical procedure, there are some risks. The risks related to a breast augmentation with implants include:

  • Scarring

  • Infection (If this occurs, removal of the implant may be necessary)

  • Extrusion 

  • Capsular Contracture

  • Sensation change to the breast or nipple

  • Discomfort

  • Time off of work and exercise

  • Implant failure or rejection 

  • Excess scarring around the implant 

  • Asymmetry

  • Bleeding (hematoma)

Please note that this list is not complete.  During the consultation with the patient, Dr. Giuffre will outline and explain each of the risks in detail.

FAQS

Is the procedure painful?

Before waking from the surgery, Dr. Giuffre will inject a long acting local anesthetic, into the breast area, to decrease any immediate breast discomfort from the surgery. When the freezing wears off, you will require postoperative analgesic medication, (pain killers) for up to a week. The discomfort typically subsides after the first two days following the surgery.

Patients taking prescription pain killers, should not drive a car or operate machinery, or sign significant documents, while taking this medication.

Do I go home the same day as Surgery?

Yes. You will have to arrange a ride, and aftercare, with a responsible adult. You are NOT permitted to leave unaccompanied, or in a taxi, if you have had a General Anaesthetic or Sedation.

I live out of town. Should I stay overnight?

If your driving distance from Edmonton exceeds 90 minutes, you should make arrangements to stay overnight in Edmonton. The surgical centre does not have an overnight care facility. You will be seen, the following day, for dressing removal and assessment by Dr Giuffre and his staff.