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Gynecomastia refers to the development of male breast tissue. It comes from the Greek words: "gyne", which means women, and "mastos", which means breasts. This condition is quite common. However, it is rarely discussed, because of the stigma associated with the development of breasts in men. Men with this condition are usually very self-conscious. They often think that they could have a "glandular disorder", or even worse. They are worried about what other people may think. They frequently avoid socializing in the gym, in the locker room, and on the beach. In fact, though, gynecomastia is usually not associated with any underlying disorder or any medical problems.
In a very small number of patients, certain drugs and medical conditions can be associated with the development of this condition. However, in most cases of gynecomastia, there is no known cause. The condition is essentially a medical curiosity.
Temporary gynecomastia is very common during puberty. At that time, it likely develops because of the altered hormone levels associated with puberty. In 90% of these cases, the problem disappears within 6-24 months, as adolescence wanes. In the other 10%, the condition becomes permanent. Gynecomastia may affect one breast or both. It may be present in a minor form with "puffy nipples". It may occur as well-formed breasts, ranging from a small size to a larger size.
The tissue that develops in gynecomastia consists of fatty tissue and actual breast tissue. The only effective treatment is surgical removal of the tissue. Historically, the tissue was removed through rather large incisions on the chest. This would leave large tell-tale scars. Frequently, it would leave indentations on the chest surface. During the past 5-years, liposuction has played a major role to treat gynecomastia. However, liposuction addresses mainly the fatty component of gynecomastia. The breast component is quite fibrous, and is usually not removed by liposuction alone. It requires a different form of treatment - Power Assisted Liposuction - so that the breast tissue can be liquefied. Then it can be easily removed by liposuction. In addition, many patients require a direct excision of a small amount of glandular tissue directly behind the nipple. This is done through a very small keyhole incision.
Power Assisted Liposuction (PAL)
Power assisted liposuction is one of the newest and most helpful techniques available for liposuction and gynecomastia. A power source is used to oscillate the tip of the liposuction cannula 3-4 mm at a frequency of several hundred cycles per second. This breaks down the fat and breast tissue, so that they can be suctioned more easily. Less force and less trauma allow for the tissue to be removed more quickly, more evenly, and with less bleeding. This leads to a faster recovery.
Liposuction can be done under intravenous sedation ("twilight anaesthesia"), where you are very relaxed and sedated, or under general anaesthetic, where you are sound asleep. We prefer to use "twilight sedation", because there is much less bleeding and much less nausea after the procedure. It is done as a day-surgery procedure (you can return home the same day). Because of your sedation, you will need to arrange with a friend for a ride home after your surgery. Gynecomastia surgery usually takes about 2-hours. Small incisions are made, near the areas to be suctioned. Whenever possible, these incisions are placed within the natural folds or contour lines so that they are more inconspicuous.
Most forms of liposuction involve the tumescent technique. Large amounts of very dilute local anaesthetic solution containing adrenaline are injected into the tissues prior to liposuction. Enough fluid is injected so that the tissues become firm (tumescent). This causes the fatty layer to be magnified, which allows more precise removal of fatty tissue and minimizes surface irregularities. In addition, there is very little bleeding because of the adrenaline. There is also much more comfort after the surgery, because of the local anaesthetic, which remains in the tissues.
A cannula (hollow tube) is then introduced through the small incisions and is connected by tubing to a vacuum suction unit. The surgeon glides this cannula through the areas of the body to be suctioned.
You can usually return to office work in 3-4 days. You can return to full exercises such as aerobics, after 2-weeks.
The area suctioned will be quite numb initially. This may take 6-8 weeks until the feeling returns. Remember that the healing process is gradual. The final result will not be apparent until a full year after liposuction.
The cost of gynecomastia treatment with power-assisted liposuction is $4900 + HST. Your $100 consultation fee is deducted from your surgical fee.
After your liposuction, some of the residual fluid that has been injected may ooze from your incisions during the first 12 hours. Therefore, you should put a large sheet on your bed during the first night, to absorb this fluid. Our nursing staff will provide this sheet to you on the day of your surgery. On the day after your surgery, you should be walking around at least six times per day, to promote circulation. You should gradually increase your activities during the first week after surgery.
You can shower 2 days after your surgery (not counting the day of your surgery). Then, you can leave all your incisions open, without any dressings. Your Spandex garment can then be applied right over the sutures. This garment is worn day and night for 4-weeks. It can be taken off for an hour each day. Recovery time varies among individuals. You will be able to return to office work 3-4 days after your surgery. You will be seen in our office about 10 days after surgery for suture removal. Swelling and bruising will subside considerably by 2-3 weeks.
You can gradually increase your activities so that you can do full exercises such as aerobics, 2-weeks after surgery. The area that was suctioned will be quite numb initially and this may take 6-8 weeks until the feeling returns. In addition, you may feel small "bumps" under the skin. These are tiny collections of fluid. These will disappear in 6-8 weeks.
Remember that the healing process is gradual. The final result will not be apparent until about 6 months, or even a year, after surgery. At that time, you will notice that clothes fit more comfortably and you will feel more confident about your appearance. Remember that as long as you maintain your post-operative weight, your new, slimmer contour will be permanent.