Gynecomastia Surgery under twilight or local anaesthetic - possible? (photos)

Thank-you for your question. It is certainly possible to have Gynecomastia surgery under local or twilight anesthesia , although general anesthesia will be more comfortable at your stage. Please discuss this with your Board certified Plastic surgeon who can help you with all your concerns and tell you about his protocol. All the best!

Dear fruit_rollup,
it is hard to tell for sure without an examination. Generally speaking, it is possible to remove gland under local anesthesia or twighlight. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question. Not only is this possible, this is how I routinely perform my gynecomastia surgeries. I generally use a little bit of sedation to make the numbing of the chest less painful and then let the tumescent solution sit before performing liposuction and gland excision. If you call around, you should hopefully be able to find a surgeon near you who performs the procedure similarly. All the best,

I prefer anesthesia when doing gynecomastia surgery . This will make you more comfortable and decrease bleeding risks.

But every surgeon is different. Best to see a board certified plastic surgeon.

Good luck.

Andrew Cohen, MD

I do not believe that general anesthesia is necessary to perform your gynecomastia surgery. From your photos it looks like you will need liposuction and some direct excision as well. Both procedures can be done under local or gentle sedation as long as you are a good candidate for that and your surgeon feels comfortable with that. In regards to the second part of your question, I do not think your case of gynecomastia is particularly severe. On the day of surgery your surgeon will meet with you and mark the surgical area pre-operatively. Then you will be brought to the OR and you will be prepped and draped. Then, depending on the anesthesia plan you will then be given some IV sedation or local anesthesia before beginning the liposuction. Once the liposuction is complete the direct excision will be performed through an areolar incision. After your surgery you will be placed in some sort of compression garment which you will need to wear for a few months and will need to perform some local wound care to the nipple incisions.Good luck with your surgery

There are three tissue variables determine what the male chest looks like. They are skin laxity, excess subcutaneous fat and glandular tissue.
Men who have good skin without skin laxity or loss of skin elasticity should get the best results.
In your case you have highly divergent nipples. we see this sometimes in women but it is not as usual in the male population regardless of having gynecomastia or not.
Recognize that removing glandular tissue and subcutaneous fat will not move your nipple/areola position.
Generally a combination of liposuction for subcutaneous fat with direct open excision of glandular tissue is the treatment of choice.
Need for open surgery with an incision around the bottom half of the areola depends on the extent of true gynecomastia or the presence of firm glandular tissue which cannot be removed with Liposuction.
One way to assess the amount of glandular tissue is to put the skin and pectoralis muscle under tension on one side of your chest at a time is.
Do this by putting one arm behind your neck like you’re scratching your upper back. at the same time have someone else take a picture or use the timer of your camera to take a picture. You could alternatively look in the mirror but getting photographs in the end it’s probably better.
What does skin and pectoralis muscle under tension will get a better idea of the amount of glandular tissue. This technique is particularly good to use after gynecomastia surgery especially on individuals have skin laxity and don’t feel like they got a sufficient outcome from the procedure.
Your skin looks good so you should get a good outcome however like I mentioned earlier the divergence will still be there.
Gynecomastia surgery is not always the easiest or straightforward. Results very quite a bit depending on who you choose as your surgeon.
In the end there are generally two variables to determine outcomes. Patient candidacy and the skill of the provider.
To find the best provider I recommend having multiple in person consultations with local board-certified plastic surgeons in your community who seem to do a lot of gynecomastia surgery.
I recommend bringing pictures of your old chest with you in printed format to use this reference during the consultation.
Ask each provider to open up their portfolio and show you their entire collection of before and after pictures. providers may be apprehensive to do this and will instead prefer to show you preselected images representing some of their best results of their career. Well these may be more impressive they do not however tell you what average results are going to look like nor do they tell you how many of these cases them actually performed.
Ask providers to show you only examples of previous patients who had similar chest characteristics to your own. note that nipple divergence in men is unusual so for that aspect you may not have a lot of other examples to look at.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped. Ask providers about revision rates and revision policy.
Revision surgery is quite common in gynecomastia surgery. A significant number of patients will wish they had a better outcome. At the same time being overly aggressive and removing too much glandular tissue can leave permanent indentations that cannot be corrected.
For reference and experience plastic surgeon should have no difficulty show me at least 50 that’s a before and after pictures of commonly performed procedures. While at gynecomastia surgery is not one of the most common procedures it is certainly not uncommon.
Providers showing you only limited numbers of before and after pictures should be a big red flag.
If in doubt continue scheduling more consultations until you feel very certain you are in the hands of the best provider.
The results of these procedures are permanent and irreversible.
You’ll be reminded of the outcome every day for the rest of your life. When in doubt slow down and schedule more consultations.
The procedure can quite easily be done using local anesthesia with sedation. It may be slightly uncomfortable and may be a little intense using local anesthesia alone.
That said you should go with the form of anesthesia the surgeon recommends.
General anesthesia is safe and there are advantages to having an anesthesiologist doing the anesthesia for you. from the patient’s perspective there is really no difference of having general anesthesia or having twilight sedation. You don’t remember the experience you simply come to in the recovery area and go home.
Personally I do these procedures using local anesthesia with mild sedation. I don’t use an anesthesiologist so I keep my patient alert and oriented and give them only enough sedation to be comfortable. Twilight sedation is a term used for conscious sedation which generally implies a deeper level of sedation which ideally includes using an anesthesiologist or staff that are properly trained to do conscious sedation.
What type of anesthesia is not nearly as important as choosing as efficiently skills and experience provider.
Find the right plastic surgeon and go with what they recommend.
It’s not like you’re gonna spend the rest of the day going back to the office.
If the surgeon does not have a lot of experience doing local anesthesia procedures then you don’t want to have the procedure done that way because it would be uncomfortable.
There’s a learning curve to doing surgery without general anesthesia.
Best,
Mats Hagstrom MD

i would do this case under general anesthesia and aggressively remove the glandular tissue with surgery and not liposuction. I would also place a drain for a few days - one on each side. I think if you do less than this, you will not be satisfied with the final result. See a board certified plastic surgeon with gynecomastia experience.

best of luck
david berman md, frcsc