Bosom Buddies (Part 2)

Man boobs are the bane of the male species. Cosmetic Surgery & Beauty seeks professional advice on behalf of beleaguered gentlemen. (Part 2)

Dr. Somasundaram Sathappan - May 4, 12:15 PM

Part 2 (A continuation from Bosom Buddies - Part 1)

How are gynaecomastia surgeries performed?

Dr. Soma
: Gynaecomastia reductions depend on the condition’s grades. If patients present with Grade 1 gynaecomastia, simple liposuction should suffice. If conditions are moderate to severe, patients may be recommended surgical removal. A minimally-invasive approach, gynaecomastia surgery requires breast tissue removal through a small two to three centimetre periareolar incision. If breasts are saggy with excess skin, procedures involve dermal excisions too. Although a similar technique to female breast lifts, male breast surgery produces better cosmetic outcomes because scars are well-hidden within areolar pigments. Besides, incisions don’t normally travel beyond the areolar complex.

Dr. Yap: When pseudo gynaecomastia patients prefer surgical solutions, liposuction can be used to extract both fatty deposits and some breast tissue. What surgeons want to achieve are contoured corrections where skin is applied fairly close to the chest. Although most mild to moderate cases are easily resolved with liposuction alone, severe cases with additional skin laxity may necessitate supplementary skin reduction surgery or breast lifts. Male breast reductions are similar to their female counterparts. What we try to ensure however, is a circumareolar incision without resorting to lollipop or anchor scars. Nonetheless, surgeons may be compelled to conduct the standard lollipop or anchor incisions, depending on the amount of skin excess and on individual shape. Ultimately, where there’s skin laxity, there’s potential for skin reduction surgery.
     In some cases, there are possibilities for additional skin tightening with ultrasound or laser-based liposuction. Energy based treatments such as radiofrequency application and deep ultrasound application may provide a certain degree of skin tightening, which if sufficient, may help avoid surgery. However, results are often variable and depend on the extent of treatment and amount of response. For more severe cases, surgery is usually indicated.

Dr. Dilip: Gynaecomastia surgery is challenging because of its cosmetic implications. Simply removing breast tissue under the nipple may produce a ‘saucer’ deformity. Therefore, in my opinion, gynaecomastia surgery is best performed by trained professionals like plastic surgeons, as we’re better equipped to remove enlarged breast tissues and similarly achieve good chest contours with the assistance of liposuction. I personally utilise ‘SLIM-lipo’(Palomar.). SLIM-lipo is a laser liposculpture technique – with dual wavelength which helps dissolve fat, soften breast tissue and results in better skin tightening. However, lasers aren’t essential components as many plastic surgeons do achieve good results without energy-based solutions.
     I believe gynaecomastia surgery is best performed under general anaesthesia to allow better chest contouring. The procedure may take two hours or so – sometimes longer if there’s lots of breast tissue, fat and skin to deal with. Occasionally, individuals who’ve undergone massive weight loss may need additional skin reduction solutions to remove significant excess skin. This added technique may result in a more challenging procedure. 

What can patients expect after gynaecomastia surgery?

Dr. Soma:
Patients may have drainage tubes in situ for optimal fluid drainage. These tubes are removed after one or two days. Patients are also required to wear compression garments for three to six weeks. During this time, individuals may resume normal activity – even mild exercise – as long as compression garments are worn accordingly. While all complications are uncommon, there are always risks associated with surgery. In terms of gynaecomastia treatment, patients can experience bleeding, blood clots, insensate nipples, mild asymmetry, dimpling and infection. The worst possible complication is nipple areolar necrosis. 

Dr. Yap: Patients shouldn’t suffer many problems as techniques aren’t overly drastic or invasive. Recovery is quite individual, and pressure garments offer support during recovery and may help reduce swelling and recovery time. I advise against strenuous workouts for at least four to six weeks as this may increase the risks of bleeding, seroma and more bruising.

Dr. Dilip: Some surgeons use drains for a day or two. I don’t personally use drainage tubes with my patients because the SLIM lipo approach minimises bleeding and risks of fluid build-up. Like Dr. Soma and Dr. Yap, I advise strong compression binders or garments after surgery to reduce bruising and swelling as well as enhance better contouring. I suggest garment application for at least two weeks continuously and then for four more weeks when they are at home, or for as long as patients benefit from its supportive advantages. Like all surgical procedures, there are possible anaesthetic risks and deep vein thrombosis in the arms and legs. Along the operated region, there may be firm or lumpy nodules from fat necrosis or itchy lumpy scarring along the lower half of the areolar’s circumference. Finally, revisional surgeries are sometimes needed to tidy up scars or remove excess skin.

What results can patients expect after surgery?

Dr. Soma:
Patients can expect fabulous flat chests after surgery. While most outcomes are generally favourable, some men have complained of unsatisfactory results due to insufficient tissue removal. This, to me, is a commoner complaint among overweight men. If fatter men don’t watch what they eat, adipose tissue may reaccumulate along the chest. If these problems arise, individuals can always undergo secondary liposuctions to flatten chests once more.

Dr. Yap: Patients are usually very happy with the produced results. In fact, with liposuction alone, surgeons can normally achieve flat chests which are applied closely to the chests’ contours. According to individual needs, I may even aim for slight depressions along the periareolar region as these concavities are sometimes considered manly. Along the sides, I also try to ensure seamless transitions between the pectoral muscles and the chests’ overlying skin, to maintain favourable aesthetic outcomes

Dr. Dilip: From personal experience, male breast reduction surgery is often rewarding as it restores self-confidence and self-image. These individuals may also enjoy better social interaction and better participation in sporting activities especially topless sports like swimming, surfing, gym and athletics. 

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Man boobs are the bane of the male species. Cosmetic Surgery & Beauty (CS&B) seeks professional advice on behalf of beleaguered gentlemen (PART 1). Part 1 talks about what is Gynaecomastia and who are the ideal candidates to receive this treatment. Part 2 will talk about how is the Gynaecomastia surgery performed and what can a patient expect post treatment