Gynecomastia is the enlargement of the male breast, often with a feminine appearance. The nipple and areola are only rarely enlarged. Gynecomastia can range from a small mass of tissue located behind the nipple to enlargement of the entire breast and can be composed of both fatty and fibrous breast tissue.

There are a myriad of clinical causes for gynecomastia including the hormonal changes that occur during puberty, various metabolic and endocrine disorders including thyroid, liver and kidney disease, and tumors and drugs including steroid, marijuana, finesteride and excessive alcohol use.

We recommend that all patients with gynecomastia consult their physician before seeking plastic surgical correction to exclude a serious cause for the condition. It is highly advisable to discontinue the use of these substances prior to surgery.

There is not a minimum age requirement for this, however many surgeons prefer to wait until the sufferer has completely finished puberty (18-20 years old). The reason for this being that for many teens who are still in their pubescent period, the gynecomastia they're experiencing can usually go away on its own. The surgeon will use his clinical judgment if the case is severe and causing severe social/psychological issues. This may encourage surgery at a younger age.

There is not an age limit for surgery, however if you have any medical conditions that could compromise your health during surgery, your surgeon may be hesitant to proceed or decline to perform the surgery altogether.

If the surgeon removes glandular tissue, he/she will make a small peri-areolar incision, a half-circle incision around the lower half of the areola. In most cases the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot distinguish them from your normal skin.

It is absolutely necessary to quit smoking starting at least 4 weeks prior and continuing until four weeks after your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote excessive bleeding. Herbal remedies such as St. John's Wort, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding. Bottom line is it is best to avoid all medications/vitamins/supplements such as these for four weeks prior and four weeks after your procedure.

The initial recovery period is the 7 to 10 days right after your procedure. Total recovery time can vary from patient to patient. Most patients can expect to be fully healed by 3-6 months. At this point most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. For the first 4 to 6 weeks after surgery, it is necessary to avoid all strenuous activities, especially those involving the upper body such as lifting weights or intense workouts at the gym. In addition I advise my patients to wear a compression garment for 6 weeks post-operatively.

This is a same-day outpatient surgical procedure. The actual surgery takes about 2½ to 3 hours. After your surgery, you will be taken into recovery for at least one to one and a half hours to be observed and attended to by a nurse. Once your surgeon feels you are in a stable enough condition, you are released to return home. It is necessary to have a family member or close friend escort you home and stay with you for at least the first 24 hours.

A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimum discomfort and most never complain of any severe pain, only soreness of the area. Regardless of you pain level after surgery, pain medication are prescribed for you to minimize any discomfort of surgery.

Early sun exposure to your incisions after surgery is not advisable. To avoid scar pigmentation, you should use sun-block cream on your scars for 3 to 6 months following surgery. I also recommend silicone sheeting to be placed directly on the incisions for 2 months after surgery. I find the silicone gel sheeting improves the appearance of the scars by flattening them and decreasing the pigment.

Usually patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity then it is easy to return shortly after the procedure. If you do physical labor then it is recommended to wait at least 4 to 6 weeks. .

Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication, this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood underneath the skin, made noticeable by excessive bruising, swelling and pain, typically of only one side of the chest. If this happens it is imperative to contact your surgeon immediately.

The complications and risks associated with gynecomastia surgery include-

Unfavorable scarring, Bleeding (hematoma), Blood clots, Infection, Poor wound healing, Changes in nipple or breast sensation may be temporary or permanent, Anesthesia risks, Breast contour and shape irregularities, Loose skin, if liposuction is used, Skin discoloration, swelling and bruising, Possibility of revision surgery.