Gynecomastia in NYC with Local Anesthetic/Twilight Sedation?

Possible to perform Gynecomastia surgery under local anesthesia? It's a mild case. Slightly elevated breast+nipples. I know some doctors excuse is compromised results but it's just fat removal no sculpting involved

Doctor Answers 14

Gynecomastia Surgical Techniques

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There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case. 

The excision technique is used on cases of #gynecomastia where excess skin and glandular breast tissue must be removed and the areola or nipple needs reduction and repositioning to create a natural looking appearance. The incision patterns are determined by the specific condition of the patient. The doctor will recommend this procedure which combines the liposuction technique and excision technique to create a natural look. Patients are given specific instructions for the recovery period. 

Men who suffer from large #areolas may notice that after breast surgery, the skin of the chest muscles will tighten, causing the areolas to tighten and diminish in size. This is a result of the removal of glandular and/or adipose tissue.

It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with male breast #reduction. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your procedure. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision. 
Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

Gynecomastia Surgery with Local Anesthetic/Twilight Sedation

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Hi greeneyepeas,

Thanks for the post. The type of anesthesia used is based on several factors:

1. The magnitude of the surgery: the more extensive the surgery the higher the level of anesthesia
2. The disposition of the patient: patient anxiety levels at being awake
3. Surgeon preference: every surgeon has their preferred way of obtaining consistent predictable results.


Dr. Dadvand

Gynecomastia in NYC with Local Anesthetic/Twilight Sedation?

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I prefer to use general anesthesia for this type of surgery.  However, if the amount of tissue to be removed is very limited, I suppose it is possible.  Consult with a board certified plastic surgeon.  Good luck and be safe.

John T. Nguyen, MD, FACS, FICS
Double Board Certified Plastic Surgeon

Depends on the Doctor

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Doctors have different way of providing anesthesia.  Some use local,iv sedation or general.  I alway use general anesthesia to make the patient comfortable, control bleeding, and  provide easy adequate disection.  The extent of dissection is wider than you think, sort of the tip of the iceberg.  Your plastic surgeon will guide you well.

Some gynecomastia procedures can be done under twilight

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If your gynecomastia doesn't require extensive skin excision, you may be a great candidate to have your surgery done under twilight with local anesthesia.  In fact, this is very commonly done.

No problem with local anaesthesia

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I have performed gynecomatia surgery entirely under local anaesthesia without difficulty. If the skin is very loose, then a longer scar may be needed, but this is rare. Good luck, N. Huq

Local anesthesia is a great option

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Personally I perform more then 50% of the Gynecomastia Surgery under local anesthesia .More  people like it and prefer it over general anesthesia.I do perform more then 250 Gynecomastia Surgeries each year. y

Gynecomastia Surgery While Awake is Reasonable

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It seems from your query that you just have a small amount of gynecomastia - this is certainly correctable under local anesthesia.  Typically the male breast can be contoured to a degree with liposuction, but there is often a dense glandular component under the nipple/areola that requires direct excision via an incision around the areola.  There should be no issues with compromised results, or safer this or that, it typically has to do with the surgeon's (and your) comfort levels in performing work under local.  If you are awake, with or without some additional oral or IV sedation, you are going to feel things to a degree, including periods of discomfort.  This is typically noted during the phases of the operation where numbing medication is administered (ie injected).  You will also feel pressure during the operation, hear things, and even smell tissue being cauterized.  If any of these things bother you, then by all means, don't do it under local.  If you think you can tolerate it, then this should be a reasonable and less expensive option.

Gynecomastia under Local/Twilight Anesthesia

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Many patients with gynecomastia will have pseudogynecomastia, which means that it is only fatty and/or skin excess and not a true firm glandular component to their condition.  These cases are amenable to liposuction alone and can be performed well under Twilight anesthesia.  If there is a firm glandular component, we have to do something in addition to liposuction alone, using either an incision or more modern minimally invasive techniques for ablation of the glandular component.  Depending on your surgeon, these can also be performed under Twilight anesthesia.  For minimal deformities, these may be performed under local anesthesia alone depending on the severity.  Best wishes on achieving your goals.

Luis Zapiach, MD
Paramus Plastic Surgeon

Gynecomastia anesthesia

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I have performed gynecomastia under local anesthesia however it depends on the patients presentation. A small amount of tissue may be amenable to correction with local only but with larger volumes I prefer conscious sedation because of the increased patient comfort. I should note there are different levels of conscious sedation..

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.