Gynecomastia questions. Should I consult my physician? Is it ideal to get in shape first?

Great question. With almost all plastic surgeries it is safe to say that the better shape you are in before your surgery, the better you will look after. You would only need to consult your family doctor if you are concerned that the gynecomastia is due to a medical condition, in which case you would need to be worked up for that. If not, then it would be fine to go directly to a plastic surgeon for consultation. In terms of the type of anaesthetic, you should discuss that with the surgeon you choose as each will have different options and will have their own comfort level with varying degrees of anaesthesia. The only way to know for sure is to book a consultation with a board-certified plastic surgeon in your area to be examined. Best of Luck!  

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.There are three types of surgical treatment options available that treat gynecomastia. Your board-certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal candidate. Weight, and more specifically body mass index (BMI), need to be considered when deciding. For instance, studies have shown that patients with BMI > 30kg/m sq (placing them in the obese category) have a higher complication rate. Therefore, it is important for patients to be as close as possible to their normal body weight prior to surgery. Not only will this decrease risks of complications, but will also enhance the aesthetic results. Further, normal body weight is different from one patient to another.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.

Getting a check-up by your general physician is always a good start. Healthy patients have better recoveries. The difference from getting the surgery now or when being more in shape is that if you loose weight AFTER Gynecomastia surgery, there might be some sagging of the skin and therefore a new procedure might be necessary. General anesthesia is the most common type, but regional blocks and even local anesthesia (intercostal block) may be done with you wide awake and safely breathing on your own. Typical recovery time realistically speaking is three weeks. You are  most welcome for my response.

1) It is always recommended to see your primary doctor first for an overall health evaluation, especially if you haven't done so in the past year. 2) It's hard to answer this question without seeing pictures or knowing your height/weight/etc. Everyone's opinion of being out of shape varies. Your plastic surgeon will be able to tell you if he recommends losing weight before surgery or not. Obviously, being in ideal shape is beneficial for many reasons, however it's not always necessary in order to have a successful surgery. 3) I cannot answer this question without knowing how severe your gynecomastia is. If a more extensive surgery is needed, general anesthesia is recommended. If you have standard gynecomastia, most of my patients have surgery under local anesthesia w/ an oral sedative. 4) Recovery time applies to different things. Going back to work, being able to exercise, going in a pool or hot tub, etc.  Most stand gynecomastia patients can resume work within 3-5 days, however it will be longer if the job requires heaving lifting, rigorous activity, etc. The entire recovery period is about 4-6 weeks in total. This just means until incisions have closed up, swelling has subsided, full movement of your arms, you can work out, etc. The most important advice I can give you is to make sure you go to a plastic surgeon who is specialized in gynecomastia surgery. Ask how many surgeries he performs each year, make sure you have access to viewing a large photo library of before/after photos, ask to speak with former patients, etc. Best of Luck!

You should consult a specialist ,your physician probably not up to-date. As far as getting into shape the surgery is the best motivational  event,so after it, it will be easier. How should I choose a surgeon?Selecting a surgeon is as important a choice as the decision to undergo surgery. Choose carefully only a board certified PLASTIC SURGEON. The decision is yours. What follows is some advice to assist in making your selection.1. Experience matters. Choosing a surgeon who has performed over one thousand gynecomastia cases increases the likelihood that they have seen a case similar to yours in the past. Selecting a surgeon whose practice is focused on gynecomastia exclusively is also an indicator of experience.2. Results matter. The more before-and-after pictures a surgeon displays, the better. Pay attention not just to the number of pictures, but whether the surgeon is confident enough to show multiple angles of the same patient.3. Gynecomastia surgery Reviews matter. Have patients reviewed your surgeon? Did those patients undergo the surgery you are considering?4. Expertise matters. Is your surgeon recognized by the profession as an authority in the field? Are they certified by the American Board of Plastic Surgery? Have they authored books or medical journal articles regarding your surgery?We hope these guidelines are of assistance when you are selecting your surgeon. When undergoing surgery, it is very important to be realistic about your expectations. Past results are not a guarantee of future results. Also, revision surgery tends to be significantly more difficult than initial surgery.

Thank you for the question.   Yes, it is ideal to achieve your long-term stable weight prior to proceeding with  chest wall surgery. Exactly what operation you should undergo will depend on your physical examination and accurate diagnosis. It is important to differentiate gynecomastia ( excess breast tissue) from lipomastia ( otherwise known as pseudo-gynecomastia or excess adipose tissue of chest wall). Treatment will differ depending on diagnosis. In most cases, gynecomastia is treated with resection of the excess breast tissue; peripheral chest liposuction surgery may also be helpful.  Practices will vary, but I generally perform these operations under general anesthesia, under the supervision of board-certified anesthesiologists.  Recovery time will vary from one patient to another, depending mainly on exactly what procedure is performed.

My best suggestion: seek consultation with board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. You may find the attached link (dedicated to gynecomastia surgery concerns) helpful to you as you learn more. Best wishes.

Dear gynoremoval,

Thank you for your clinical post. Gynecomastia is a very common problem and in
answer to your questions seeing your family physician first would be wise if
you suffer from any sort of erectile dysfunction or low libido. Low libido and sexual dysfunction or
impotence may be a sign of underlying lack of testosterone production or
estrogen secreting tumours which should be investigated with a series of blood
tests and radiologic examinations prior to considering surgery. Assuming there is no endocrinologic
abnormality it is always best to get in shape first as a large part of
gynecomastia can be adipose tissue or fat and weight loss may shrink the breast
tissue and will require less contouring at the time of any operative
intervention. A significant weight loss
after a gynecomastia procedure may result in some chest contour irregularity as
you lose weight and fatty tissue is lost through metabolic reduction.

Once you’re in shape and have ruled out endocrinological
abnormalities the decision of full general anesthesia and oral sedation can be
made at the time with your surgeon. Some
surgeons do not feel comfortable performing lipo contouring under local anesthesia,
however, well over 60% of my advanced SmartLipo, BodyTite and Vaser Lipo cases
are performed under local anesthesia alone.
The technique of the gynecomastia reduction is important as the
glandular tissue does not respond well to traditional liposuction and some sort
of energy assisted procedures such as SmartLipo, which uses laser lipolysis or
BodyTite which uses radiofrequency lipolysis or even a Vaser Lipo which uses
ultrasound will be required to reduce the breast glandular tissue as well as
the adipose. Selecting a liposuction
physician with lots of experience will be important and usually it ends up with
an excellent result.

I have been performing advanced liposuction for over 15 years
and have found the use of energy sources such as SmartLipo and BodyTite to be a
very valuable part of the soft tissue contraction required after removing
breast gland and breast fat tissue.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below. Also
check out the liposuction sections at SpaMedica.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto