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Gynecomastia or enlargement of the male breast is a sign of disorder in the ratio between the estrogens and androgens: the effect of estrogen is either too large or relatively too large. In case of teenagers gynecomastia is mostly connected with adolescence and its echoes; however, in case of older men it is usually connected with different diseases and the treatment thereof. In summary, gynecomastia is a very usual finding in case of healthy, especially obese men. It has a clinical meaning only in case the breasts grow quickly, they are sensitive or clearly large (diameter > 4 cm). It is complicated to find out the reason for gynecomastia, as the cause for the symptom of the disease has often already disappeared by the time of examination of the patient, only the symptom has remained and a considerable cosmetic problem has developed out of it.
It is always necessary to talk with the doctor of the clinic. The doctor introduces to you the gynecomastia surgery and the course thereof, the follow-up treatment and possible risks. In cooperation with the doctor an approach to best suit your needs is chosen. The doctor also collects information on your state of health. Do not forget to mention any of the problems related to your health. If everything is all right, the time for the planned surgery can be fixed. Gynecomastia surgery is usually performed using the liposuction method through some small skin incisions. If the breast tissue is too hard and “knotty", it has to be excised through a cut. In such a case a cut (of approximately 5 cm) is made below the areola.
ON THE DAY OF SURGERY
The surgeon offers you an overview on the gynecomastia surgery and you will be drawn a “surgery map" in the area to be operated. Due to painfulness local anesthesia is used during the surgery.
This surgery is performed under SPECIAL OR GENERAL ANAESTHETIC. We will check the sensitivity of the patient before choosing a method of anaesthesia. The physician-anaesthesiologist in our clinic will determine the most suitable method during your pre-surgery interview.
The following is required for submission to the anaesthesiologist:
In the event of general anaesthetic: ECG, venous blood and urine test results
In the event of special anaesthetic: results of urine test and blood test taken from the fingertip
If necessary, the tests will be organised by our clinic.
Your stomach must be empty when general anesthesia or combined anesthesia is applied. It is prohibited to eat at least six hours and to drink at least four hours before general surgery. Chewing gum fills the stomach with secretions and is therefore prohibited less than two hours before the start of surgery. Do not eat and drink at least three until four hours if local anesthesia is applied.
After the effect of anesthesia has begun, an incision the size of which is about 0.5 cm is made below the areola. Through the cut a slim hollow tube called a cannula is inserted below the skin and the soft fat tissue is sucked out. If the desired result is not achieved this way, the incision in the areola is extended and the gynecomastic tissue is removed surgically. The cut is closed and covered with dressing.
During the first hours after the surgery you are under the supervision of a doctor-anesthesiologist and a nurse-anesthesiologist. If necessary, you are given painkillers. During the first night you receive follow-up treatment in the clinic. The nurse is available throughout the night. The next day the doctor examines you and thereafter you may go home. Pain following the surgery is individual, but generally there exists relatively little pain. If necessary, painkillers are prescribed, although after the two first days these are not usually needed any more. There may be some swelling and hemorrhaging (bruises), which last for approximately two-three weeks. Most of the patients return to their work and social hobbies in a week. Heavy physical exercise has to be avoided during the first two weeks following the surgery, but light physical activity contributes significantly to healing. During the first two weeks following the surgery hobbies requiring exercise, e.g. aerobics, jogging, weight-lifting, swimming and tennis, as well as sauna have to be given up.
Keep the cut dry and dressed until the removal of stitches. If the dressing is dirty or wet, it has to be exchanged. The dressings have to be sterile. Sterile dressings can be bought in ready-made packages from pharmacies. The cut or the area surrounding it cannot be rubbed. Wet dressings have to be exchanged for dry and sterile ones. It is not recommended to go to sauna or take steam while you still have the stitches and two weeks after the removal of the stitches. Avoid any unnecessary moving of the cut area. If the pain in the cut becomes stronger, the temperature rises or the area becomes red or a lot of blood oozes constantly from the cut, moisture or a bad smell comes through the bandage, turn to the doctor. In case of gynecomastia surgery stitches are removed when 10 days have passed from the surgery. Smoking significantly hinders the cut’s healing.
The scar is formed in the surgical area after the removal of the stitches. Healing the scar can be affected by self-treatment. In order to quicken the scar’s becoming lighter and softer, for approximately four weeks and twice a day you may use a heparin preparation (Hepagel or Lioton 1000) available in pharmacies. Avoid rubbing the scar and keep it from the sun during three months; otherwise the scar may turn dark as a result of the skin’s pigmentation.
RISKS AND COMPLICATIONS
The risks and possible complications of gynecomastia surgery are minimal. Complications following surgeries performed by a surgery group of doctors and nurses who have received high-level training are very rare. However, in case of every surgery there exists a possibility
of bleeding, inflammation and creation of scar tissue following the surgery. There may also be problems related to anesthesia.
Accumulation of tissue fluids is also usual in case of the surgery. The fluid is removed by puncturing with a needle – usually two-three times is enough?
Inflammation may occur in case of any surgery. Following gynecomastia surgery an antibiotic cure is prescribed in order to prevent inflammation. In private surgeries built for cosmetic surgery and where no diseases are cured the risk of so-called hospital infection is practically nil. In general hospitals and other large surgery blocks the threat of hospital infection is manifold. Always check out where your surgery is performed, so you can avoid a severe hospital infection.
A hemorrhage (bruise) is usual in case of gynecomastia surgery. A bruise is a blood mass formed in your body, in this case under the skin and in the area of the surgical cut. Blood mass is usually formed soon after the surgery. Small masses of blood often disappear all by themselves.
The surface afferent nerve of the breast area may sometimes have a sensation disorder. Changes in sensation are temporary and heal in some time.
Swelling and bruises disappear in some weeks. The final result can be seen only after three to six months have passed from the surgery. Redness of the scars disappears within approximately half a year. The need for sick leave is for about a week.
It is possible to achieve the desired appearance through gynecomastia surgery. Improvement of mood and increase in faith in oneself is also important for a client.