I will take a full medical history followed by an examination of your chest wall and the breast enlargement. I will advise you as to whether it is appropriate to arrange for several blood tests to be taken to rule out medical causes. Furthermore, you may be advised to undergo imaging of your breast enlargement with an ultrasound or mammogram to rule out a breast cancer. We will then discuss the various treatment options and I will advise as to which treatment I would recommend.
If you decide to proceed to surgery, you will be offered a second free consultation in which the type of operation will be finalised and where we will discuss in detail the potential complications that can occur with surgery. Any further questions that you may have will be answered at this point before consenting to surgery. I will advise you to buy a tight fitting supportive vest to wear home from the hospital and for 6 weeks thereafter.
An appointment to come in for an anaesthetic assessment prior to your operation will be arranged.
It may be appropriate to perform liposuction on your breast enlargement if there is a significant fatty component to your breast. This is normally done through two small scars on each side of your chest wall.
If your gynaecomastia contains dense breast tissue, liposuction alone will not remove all of the enlaged area. You may then need to have a scar placed around your nipple and the breast tissue removed through the scar.
If the breast tissue overgrowth is accompanied by excess skin (resembling a female breast) you may need to have a formal breast reduction in which the breast tissue and excess skin is removed through more extensive scars. These scars will extend all the way around your nipple and down to the bottom of your breast in a vertical line (shaped like a Lollipop). If there is a lot of excess skin you may also need a horizontal scar at the bottom of your breast resulting in an anchor shaped scar.
You will be admitted to the ward on the day that your surgery is scheduled. The operation is carried out under General Anaesthetic, given by a Consultant Anaesthetist, and usually takes one to two hours to perform. The wounds are closed with dissolvable stitches and dressings will be placed over the wounds. I may place a drain into the breast at the end of the operation if you have had any surgery other than liposuction. As long as no complications develop, you can expect to go home the following day.
Any drain you have will usually be removed before you leave hospital. On going home, you will be advised to wear your supportive vest for six weeks. You will need to arrange someone to drive you home the day after the operation.
Your dressings will be removed at 7-10 days and you will be followed up by me in clinic 10 days after surgery and again after six weeks.
You will need to take one week off work if having liposuction alone. You will need two weeks off if you have the breast tissue removed through a cut around your nipple as well as the liposuction or if you have a breast reduction. The swelling in your breasts will gradually lessen over 4 - 6 weeks and any shooting pains that you experience should settle down in this time.
Although you can start driving a car after 48 hours, most people feel comfortable starting to drive again after two weeks.
You should not exercise (other than walking) for the first two weeks and gently re-introduce exercise after that. Full exercise can be resumed at six weeks.
All operations carry some element of risk. Common side effects can include nausea and vomiting following general anaesthesia. As mentioned earlier, your breasts will be uncomfortable, and may be swollen and bruised following your operation.
Specific complications
Haematoma - This is bleeding under your nipple following your operation. It can occasionally lead to patients having to return to theatre to stop the bleeding and remove the blood clot.
Wound infection - Infection following this type of surgery occurs 1-2% of the time.
Deep vein thrombosis - This can happen following any operation. It is unlikely, but the risks are increased with smoking.
Nipple complications - Sensation of the nipples may be altered temporarily or permanently following all types of surgery for gynaecomastia. There is also a very small risk of nipple loss (death), particularly if you have undergone a breast reduction.
Nipple saucering - If too much breast tissue is removed from directly behind the nipple, it is possible for the nipple to have an indented appearance following the surgery.
Gynaecomastia regrowth - If not enough breast tissue is removed from behind the nipple, it is possible for the remaining breast tissue to regrow. This may require you to have further surgery to remove the new breast tissue.
Scarring - All scars can heal either as a thickened scar (hypertrophic) or with overgrowth of the scar tissue (keloid scar). The scars following gynaecomastia surgery will always be visible but will be less noticable if you need to have liposuction alone.
