Gynecomastia

Gynecomastia means a mammary gland hypertrophy in men, on one side or on both sides.
Gynecomastia can have a hormonal cause. It is often temporary in the adolescent and can be permanent in adults. In most cases, mammary hypertrophy in men is a combination of fat and hormonal disorder. A combined gynecomastia is carried out with liposuction and reduction of mammary volume by direct surgical resection (subcutaneous mastectomy).

Before the procedure

Two consultations with your plastic surgeon with at least 15 days between each are mandatory before the operation. Medical photographies are always taken during these consultations.

A preoperative mammogram is mandatory, as well as an endocrinal evaluation and a testicular echography.

A pressure garment such as a bolero is prescribed.

Stop smoking 2 months before the surgery to reduce the risks for skin necrosis.

Coverage by health insurance is possible only if the following conditions are filled: operation carried out after an endocrinal evaluation, after puberty, for proven gynecomastia which can cause a sexual or psychological problem (particularly asymmetrical gynecomastia, painful, with distension of the areola.

The procedure

The procedure is usually performed under general anaesthesia. An incision is placed on the inferior line of the areola. The surgeon extracts the mammary gland (subcutaneous mastectomy) and the excess fat through this incision. A liposuction is often associated to this procedure, at the edge of the gland excess in order to harmonize the global shape. In case of fat prevalence gynecomastia, the resection may be carried out by liposuction. In this case scars are very short and can be situated near the gynecomastia, under breast or in the axiliary area for example.

If gynecomastia and excess skin are very important, the incisions may be longer and more visible. They can be around the nipple (around the areola), horizontal and extend on both sides of the areola. In extreme cases, the surgeon may transplant the areola and the nipple. Other types of scars are possible (vertical, racket handle...), they depend on the patient. A drain may be placed during surgery according to the technique used and the surgeon's habits. It is used to evacuate blood and lymphatic residues which could build up in the operated area. At the end of the procedure, a shaping bandage is placed, usually with an elastic bandage. The procedure length varies depending on the surgeon and the technique used. It can last from a few minutes for an isolated liposuction to two hours for complex operations with a major reduction.

After the procedure

A suction drainage (redons) and a pressure bandage are placed at the end of the operation. No drain is placed if the operation consists in a liposuction.

The hospitalization usually lasts 24 hours.

Most of the time, pains after surgery are minor and well balanced by the usual pain-killers.

You will be asked to wear a pressure garment day and night during one or two months. It aims at applying detached skin on its base. Stitches are dissolvable. You will need to stop working during 5 to 10 days.

Sport, physical strain and heavy loads are prohibited during one or two months.

The result is immediate, breasts disappearance is visible as soon as the first bandage the day after surgery. The final result can be appreciated 6 months to 1 year after the operation because of progressive cutaneous retraction.

The final result concerning fat volume is visible 3 months after surgery. Usually, the scars around the areola are invisible. In some rare cases, when there was a major skin excess long chest scars are visible but can be hidden by thorax hairiness.

The scars will take their final appearance 12 months after the operation. Several follow-up consultations are realised: 1 month, 3 months, 6 months and 1 year after surgery.