How Is Breast Reduction Performed?
Print PageYou must stop smoking two weeks before surgery. You cannot take Vitamin E, herbs, aspirin, and anti-inflammatories for two weeks before the surgery because they increase bleeding.
Generally, men who desire breast reduction (mastectomy) book surgery with a qualified plastic surgeon or a general surgeon on an out-patient basis. If you have pre-existing medical conditions, then an in-patient stay will be required. Most men opt for general anesthetic (complete unconsciousness), but sedation with a local anesthetic can also be used. It takes about 60 to 90 minutes per side. Usually, a surgeon will not consider you for mastectomy until you have finished puberty (reached 18 to 20 years old).
Many health insurance plans do not provide gynecomastia reduction coverage because it is considered cosmetic surgery. The price for gynecomastia reduction surgery ranges from $5,000 in Australia up to $7,500 in the U.SA.
Mastectomy involves removal of breast glandular tissue with a scalpel. The surgeon makes a 1 centimeter incision as inconspicuously as possible, either in the armpit or through the areola. The surgeon shells out glandular tissue and fat from the sides of the breast, beneath the areola, and the base of the breast..
Surgeons tailor the incision to your particular case. A Webster incision is a half-circle through the areola. A transverse incision cuts right across the areola and nipple. The triple-V incision exposes a great deal of tissue when the overgrowth is advanced. If your nipple needs to be removed and repositioned, the surgeon uses a Letterman technique to fold the nipple back as a flap. If you have massive breasts, the surgeon makes an elliptical incision around the entire breast.
Liposuction may be necessary to contour the remaining fat. The liposuction tubing (cannula) is inserted through the same incisions made by the scalpel. Liposuction requires salt water (saline) and anesthetic to be injected into your breast (tumescence). The surgeon inserts an ultrasonic probe into the breast to liquefy fat and glandular tissue. The slurry is vacuumed out at high speed.
Skin removal may be necessary if the breasts were very large, to prevent sagging after the procedure. The red, raised scars will gradually fade and flatten over the next six months. Wear a silicone sheet over the scar for two months and avoid sun exposure for six months so the scar will not become darkly pigmented.
Your nurse will encourage you to get up and walk soon after the surgery to prevent pooling of body fluids and pneumonia. You can take a shower two days after your surgery. Barring complications, you probably can return to work in two days, but book the week off work as a precaution. You must return to have your surgeon remove your sutures in one or two weeks. Most men can resume exercising in three weeks.
Mastectomy always produces bruising, swelling and scarring to some degree. Hence, you may be disappointed if you expected an immediate flattening of your chest. Your chest may be numbed or you may have diminished sensation for up to a year because nerves are severed. You must wear absorbent dressings for the first 24 hours after surgery, because your wounds will drain a combination of blood, liquefied fat, and injection fluid. Expect to bandage your wounds for two weeks thereafter.
You will be required to wear an elastic pressure bandage or surgical garment for six weeks. You must wear it day and night for two weeks to reduce swelling and help prevent skin sagging. Then for the next four weeks, just wear it at night. Massage the area daily to prevent contour irregularities from developing. You will not know the final outcome of the procedure for three months to one year, as your chest reshapes itself. You will require follow-up examinations once per month for six consecutive months.
Every surgery entails risk. Possible complications of mastectomy include:
- Adverse reaction to the anesthetic
- Bleeding
- Infection
- Sloughed skin or nipple death (necrosis)
- Inverted nipple
- Fluid pocket formation
- Uneven pigmentation
- Noticeable asymmetry requiring a second procedure to correct it
If you are very obese, or use alcohol, anabolic steroids, or marijuana, then you are not a good candidate for surgery. The surgical team will most likely decline to perform the mastectomy until you lose weight and/or stop taking drugs. Gynecomastia improves spontaneously in 60% of men who stop taking the aggravating drugs.
If you have a pre-existing medical condition that contributed to the gynecomastia, such as diabetes, liver, heart, or lung disease, then you are not a good candidate for surgery. Your doctor will likely recommend conservative treatment because the benefits of surgery do not outweigh the risks.