MALE BREAST REDUCTION (GYNECOMASTIA SURGERY) CHENNAI
Gynecomastia (or) Gynaecomastia, most commonly referred to as ‘MALE BREASTS’ or “MALE CHEST ENLARGEMENT” is a common condition in more than 70% of men worldwide. Enlarged male chest results from hormonal imbalances at any age and steroid overuse, though other causes also do exist. There is an increase in the amount of breast gland tissue and / or fat resulting from any of the above factors.
Though not a serious medical problem, enlarged male breast are often abnormally prominent and may be tough to cope with emotionally for a few. Many teens who suffer with this condition are body shamed and eventually suffer a very low self-esteem in the later course of life.
Most common mannerisms of boys / men with male boobs or moobs :
Excessive stoop / hunchback
Avoid removing shirts in public
Avoid tight fitting T-shirts / shirts
Avoid socialising with female counterparts
Reluctance to participate in activities that involve revealing their upper bodies. Ex. swimming, pre-wedding rituals etc.
Most often, the breast swelling resulting from transient hormonal changes during puberty may go away on its own without treatment, usually within 6 months to 2 years of onset. If it persists, surgical correction is the most straightforward solution to correct the swollen breasts. Exercise and dieting are inadequate in addressing abnormally large male breasts. Also, certain drugs (e.g. marijuana, anabolic steroids) and medical conditions (e.g. liver disease) can aggravate gynecomastia – these should be dealt with before considering gynecomastia surgery.
The reality of the matter is that one does not have to live with Gynecomastia. The desire for a flatter, more masculine chest is achievable through male breast reduction surgery. Gynecomastia Correction is the only procedure permissible as early as 13 years of age to help avert deep rooted psychological issues in young adolescents.
These enlarged tissues are neither cancerous nor cause any health concerns. Many with man boobs experience pain in their breasts to varying degrees, most often referred to as “PAINFUL GYNECOMASTIA” and are ideal candidates for a surgical procedure.
Gynecomastia can affect one breast (Unilateral Gynecomastia) or both breasts (Bilateral Gynecomastia), sometimes unevenly. Occasionally, clients with one-sided Gynecomastia prefer to get operated only on the prominently enlarged side. It is advisable however, to get operated on both sides to achieve desired symmetrical results as per advice from your experienced Plastic Surgeon.
Grades of Gynecomastia
A common grading system for Gynecomastia used at our clinic is the Rohrich’s classification system.
Grade 1: Mild enlargement without sagging.
Grade 2: Moderate enlargement without sagging.
Grade 3: Severe enlargement with mild sagging.
Grade 4: Severe enlargement with excess sagging, mimicking female breasts.
Psychological preparedness is the key to a successful ‘Male Chest Correction’ surgery.
Never let anyone push you or force you into getting operated. It should be absolutely your choice.
Always remember that you are not alone. Almost 70% of the men across the globe suffer from Gynecomastia in varying degrees. Surgical removal of male breasts is equally common due to increased awareness and improved facilities.
Avoid googling unreliable sites for side effects or aftereffects of the surgery. Trust your surgeon and be willing to discuss your concerns with him / her well ahead of the procedure.
Gynecomastia Removal Surgery
You will receive your preoperative instructions well ahead of the surgery from our team. Though a minor surgery, it is mandatory to ensure all protocols are adhered to. Once you comply with the necessary pre-operative requirements such as medical test clearance, stoppage of smoking / alcohol consumption, modification / stoppage of earlier medications etc., you are all set for the surgery.
Male Breast Reduction surgery is usually performed under mild sedation / general anesthesia except in very rare cases, where it is done under local anesthesia. The surgery involves the removal of breast tissue and/or fat deposits, resulting in a chest that is flatter and better contoured. Incisions less than 1/4th of the areola circumference are made along the areola borders. Fat and glandular tissue is removed through these incisions using a combination of power assisted liposuction and gland excision. The results of the procedure are significant and permanent. The end result is a firmer, flatter and more contoured chest.
Day-care procedure
Almost painless
Minimally invasive
Minimal scars
Proven and gratifying results
Gynecomastia or Male Breast Reduction is a simple day care procedure.
If your procedure is scheduled in the morning, the same day evening you can return to your home/accommodation.
You will have to return to the clinic at the end of 48 hours for plaster removal.
On day 7, you can have your stitches removed at our clinic / in your hometown.
Complications
Though a relatively safe surgery, occasionally one might develop hematoma (internal bleeding) following the procedure. A follow up within 48 hours of surgery is strongly recommended and will help identify and promptly aspirate the hematoma if the need be. In most cases, it may self – heal. Swelling, bruising, discomfort and numbness are temporary and shall subside within a couple of weeks.
Post-operative instructions
No driving for 10 days post-surgery.
No cardio exercises for 15 days post-surgery.
No heavy body building exercises involving muscles for 45 days post-surgery. Start with mild workouts and then increase the intensity according to comfort level.
You are expected to wear a tight-fitting vest or compression garment for 30 days at all times, followed by 8 hours a day for 15 days to keep the swelling under control and enable adherence of the skin to the underlying muscle.
Expectations vs. Reality
Expecting a symmetrical chest post-surgery might end up disappointing you. Our body is built in such a way that the muscles on the left and right sides of the chest are asymmetrical. Hence, a slight difference between the two sides post-surgery is normal. The idea of the surgery is to give you a sculpted chest, not a perfectly symmetrical one.
Post Gynecomastia surgery results are more distinctly seen in men with average body weight and firm skin tone than in slightly overweight or obese individuals.
Surgery Estimate
The costs vary between 75000 – 180000 INR plus GST (18%) depending on the grade of the Gynecomastia and the technology employed. Quality surgeries, such as ours, generally involve slightly higher costs. This is to ensure that none of the components of the surgery are compromised. After all, your safety is our priority.
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i. newborns through the hormones that they get from the mother; the condition soon disappears.
ii. puberty – this is the commonest age group as the female hormones precedes the male hormones during the onset of puberty. This pattern settles in one or two years. Sometimes, the liver is not able to handle the excess testosterone (male hormones) and converts it into estrogen (female hormones) and leads to the condition.
iii. in the older age group (50 plus and above), when the testosterone level comes down. In this age group, testicular malignancy has to be ruled out.
Sometimes, liver failure, excess secretion of thyroid hormone, excess alcohol or drug intake can produce gynecomastia. Also, if you have not developed your secondary sexual characteristics, then you must consult a doctor.
As said earlier, usually gynecomastia is not harmful. However, in case of excessive pain, swelling or discharge from the breasts, a screening can be done to rule out the possibility of cancer. Remember that female breast cancer is different from male breast cancer.
There are various grading systems for gynecomastia. We use Rohrich’s Classification system. This system divides the condition into 4 different grades. Grade 1 – Men who fall in this grade have minimal hypertrophy (enlargement of organ or tissue) with no breast sagging. Grade 2 – Here men exhibit moderate hypertrophy with no breast sagging. Grade 3 – Men in this grade have severe hypertrophy with grade 1 sagging. Grade 4 – In this grade, men have severe hypertrophy with grade 2 or 3 sagging.
This is a very common question people ask doctors because no one wants to opt for surgery if it can be avoided. Even doctors want to avoid surgery as far as possible. Various drugs have been tried on gynecomastia patients, for example, anti-estrogens and danazol.
Most endocrinologists invariably agree that drugs might help in reducing the size of the breasts a little and people in the early stages of gynecomastia might be happy with the results. Also, these drugs do help in reducing the glandular pain that occurs as a result of gynecomastia. However, after six to twelve months, the rate of reduction might stop or the condition might recur. So drugs might not be the complete solution for gynecomastia. The main course of treatment worldwide for this condition is surgery only.
Not at all. It is an optional surgery, done only for cosmetic reasons. Many people are quite comfortable with their body and don’t opt for surgery. But if you find it difficult to remove your shirt in front of others or feel that you are always the object of ridicule because of your condition and want to correct it, then surgery is the only option.
To understand if you have got optimum results after surgery, you need to understand what the normal male chest should look like. In a normal chest, you have to focus on the pectoralis major muscle (chest muscle). Your nipple areola has to be one centimeter above and one centimeter from the sides of the chest muscle. The sides and below the muscle should be flat. Only the bulk of the muscle should be visible.
The major problem most surgeons face in gynecomastia is that the nipple areola is quite below the chest muscle area. Getting the areola back in the ideal position is, in my experience, the biggest challenge faced by plastic surgeons.
Placing a drainage tube is not at all harmful and many surgeons opt for it. The decision depends on each surgeon’s comfort level and experience. However, we at CPS do not place a drainage tube as our experience shows that it is not essential and does not make a big difference. Moreover, a drainage tube may be uncomfortable for the patients.
Seroma is a collection of clear fluid that sometimes develops in the body after surgery. The percentage is very rare (5-6 cases in 1,900 surgeries). For the 5-6 cases, there is no need of drainage tubes. Proper compression will help prevent accumulation of seroma and a simple needle aspiration will correct the issue.
If it is a minor bleeding, there is nothing to worry. A compression garment will help the body absorb the bleeding. However, in case of major bleeding, you have to come and meet us immediately.
Even after being discharged post-surgery, please stay in the city of surgery for two days so that you can immediately meet your surgeon in case of complications like major bleeding.
You could visit another doctor but they might not know your history or condition fully and therefore might be uncomfortable or hesitant operating on you in case of complications.
The black dots normally spread out and fade in five to six months so being patient is important. In rare cases, people do not get back the normal black colour. We advise them to go for tattooing the area black to blend with the surrounding area. The tattooing should be done after six months.
This so-called asymmetry is very normal. None of us have symmetrical body parts. There are always minor differences between the left and right sides, including in the chest area. After surgery, you will get a sculpted chest, yes, but expecting a perfect or symmetrical chest might lead to disappointment as asymmetry between the muscles of the left and right sides of the chest is inbuilt and a mild asymmetry is expected even after surgery.
The areola is initially big because it is pushed and stretched due to excess glandular activity in the area. Post-surgery, the areola will shrink and become almost normal. So we ask people to wait for some months post-surgery for the areola to shrink to normal. If it doesn’t, then it can be corrected surgically. Happily enough, no one has come back for the extra surgery as they are very happy with the surgery results.
The surgery is usually performed under general anesthesia as it is comfortable for you as a patient and for us as surgeons. Some people might insist on local anesthesia because of fear or affordability issues. We do give local anesthesia in rare cases, only in Grade 1, but it might be extremely uncomfortable for you, especially when liposuction is done over the ribcage area. In Grades 2 and above, general anesthesia is a must for surgery. Also, please be assured that these days due to medical advancement, general anesthesia is completely safe.
No heavy body building exercises involving muscles should be done for 45 days post-surgery. After 45 days, start with mild workouts and then increase the intensity according to comfort level. We perform the surgery between the skin and the muscles so the muscles are not disturbed at all.
As we said, the surgery is done between the skin and the muscles. We don’t make any changes internally. There is no relation between the surgery and your sex life. As long as your secondary sexual characteristics are normal, there is no problem.
Yes, there are chances if you gain a lot of weight (more than 10% of your normal body weight). It is vital to keep your weight in control and to get your hormone levels checked regularly. Avoid anabolic steroids as far as possible as they could lead to a recurrence. Also keep in mind that as your age advances (50 plus and above), testicular tumors may lead to gynecomastia. These instances have to be evaluated by the ultrasound of the scrotum.
Usually, we prescribe antibiotics and painkillers for 5 days as also medicines to protect the stomach from ulcers. Along with this, skin tightening medication and Vitamin C tablets might be prescribed for a month or so.
People with Grade 1 and 2 gynecomastia who take collagen containing skin tightening medication seem to have better results than people who do not take it. So, it is preferable in their cases although it is optional. In Grades 3 and 4, this kind of medication is mandatory. If they start taking the medication 10 days before the surgery and continue for 45 days post-surgery, results are much better.
Usually, the sensations that you feel pre-surgery are a result of glandular activity. You will probably feel no sensation for 3 to 4 months post-surgery as the nerve cells take time to regenerate. After this period, you will get back the sensation but its nature will be different from the one pre-surgery.
During the healing phase, the swelling will be soft. After 10 to 15 days, the swelling might harden and you might feel these hard nodules. A nice hard massage and a pressure garment will help reduce the hardness and any resultant pain. However, if the bulge persists longer, then the doctor might prescribe an injection for the hard tissues to reduce the hardness. In extremely rare cases, there might be internal scar tissue. Go for a surgery only if it is a major issue. For minor issues, let the body self-heal.
Lungs and hearts are internal organs, deeply embedded in the body and well-protected by the ribcage. Using a blunt canala, it is very difficult to go anywhere close to these organs so they are quite safe during the gynecomastia surgery.
Ideally, both sides should be corrected together for optimum results. In extremely rare cases, one side might show abnormal development compared to the other. In these cases, one-sided gynecomastia can be done. But the time taken and the surgery cost will be the same as for two-sided gynecomastia.
Any quality surgery will involve slightly higher costs. The costs vary between Rs 65,000 to Rs 90,000 plus GST (18%). If patients cannot afford the monetary aspect, we do provide help.
You must understand that every surgeon does their best to give you satisfactory results. If you are not happy, you must first approach your surgeon and express your views on this. If they do not give a satisfactory response, you may visit another surgeon. However, you must give the body at least six months post-surgery before planning the second surgery.
Sometimes, even after surgery for a Grade 1 gynecomastia, patients come back to the surgeon with concerns like, “When I walk on the road, everyone looks at my chest.” OR “In office, all the girls look at my chest and giggle.” These two sentences are sure signs of a psychological problem called body dysmorphic disorder. You have to consult a psychiatrist who might prescribe a mild anti-depressant or cognitive behavioural therapy. Do not obsess about this condition as it is easy to correct. Lead a happy and active life.
Usually, when all-round liposuction is not done and only the glandular excess is removed from a specific area, that particular area looks dented or like a crater. Sometimes, a composite liposuction will make the area even. Sometimes, the dented area is filled with fat from the other areas. Mild anesthesia is needed for this half-hour surgery. Go for the surgery only if it looks very odd. For mild or negligible deformities, don’t opt for surgery.
I personally feel liposuction is necessary for evenness. So from my experience, I advise all my patients to go for liposuction and gland excision together for the best results. The charges in both the cases are almost the same so it is better to go for both.
In some Western countries, surgeons prefer the double incision mastectomy and free nipple graft. However, if the nipple areola is up to three inches from the muscles, then that option is not necessary. Only liposuction and glandular incision is enough with some kind of a plastering technique added in. People in the West opt for double incision mastectomy mainly because with their skin type the scars fade and blend easily. However, with our skin type a large scar is very visible and people will feel uncomfortable removing their shirts in public even after surgery rendering the cosmetic surgery pointless. In extreme cases, however, you may have to go for it.
