Macromastia is a condition with disproportionately enlarged breasts in women. This can be a cause for significant emotional and physical distress in those affected by this condition. Reduction mammaplasty is a surgical condition to reduce the size of the breasts by making it more proportionate to the rest of the body.

The cause of macromastia is usually undetermined. It can be as a result of a change in levels of hormones and sensitivity of the tissues to hormones. There can be an enlargement of the gland, fat and excess skin in this condition. Medicines do not have a significant role in the treatment of macromastia. Surgery is the mainstay of treatment of this condition.

Macromastia can result in physical symptoms such as neck and backache, skin grooving and skin rashes over the folds below the breasts. Patients may find it difficult to perform strenuous exercise and other physical activity. Individuals with this condition also find it difficult to get appropriately sized clothing. Macromastia can result in emotional distress and a feeling of embarrassment and social inhibition.

Surgical correction is achieved by reduction mammaplasty. This is aimed at reduction of the size the breasts, and reshaping it to give a more pleasing appearance. The areola (pigmented skin around the nipple) is also reduced in diameter in case they are enlarged. The scars associated with this procedure are confined to the skin at the junction between the areola and breast and a vertical limb towards the undersurface of the breast. In most individuals, the scars settle well.

Reduction mammaplasty is carried out in the hospital setting under general anesthesia. Patients are admitted overnight after the procedure and discharged home the next day. Discomfort is controlled with the help of pain medications. Patients are not confined to bed and are able to carry out daily activities like showering from the next day. Most patients resume work in a week. Strenuous activities can be started after a month.

Benefits of reduction mammaplasty are physical, emotional and social. After reduction mammaplasty, individuals report the absence of back and skin symptoms. Patients find it easier to perform strenuous activities.  Patients have increased levels of self-confidence and are no longer embarrassed by this condition.

For more information, visit us at:
 https://www.amicusclinic.in/breast-reduction

No. It can't be.

Working out at the gym has health benefits. One of it would be to get a muscular and aesthetic chest. And for the same reason, it is hoped that lifting weights would help get rid of the excess breast tissue. The reason why it does not help has to do with the tissues which are responsible for gynecomastia.

Gynecomastia is comprised of glandular tissue, surrounded by varying amounts of fat. The muscle which gives definition to the chest is pectoralis major and is found behind the breast tissue. Working out at the gym and lifting weights can augment the size of the muscles. This can lead to a more anterior (forward) position of the overlying breast tissue. So paradoxically, lifting weights can make the deformity more obvious.

Losing weight can have beneficial effects on the appearance of gynecomastia. This acts by reduction of the fatty tissue. This will lead to an overall reduction in the size of the breast tissue. However, losing weight does not reduce the glandular tissue found beneath the nipple-areola. So there would be a persistence of the puffiness of the nipple region.

So what gets rid of gynecomastia?
In most cases, the answer would be surgery. Due to technical refinements, it is possible to treat this condition with very small incisions. Fat around the gland is treated with liposuction and the gland is removed with a small incision in the areola (the dark skin surrounding the nipple). In most individuals, these lead to very fine scars. The goal of gynecomastia correction is improved aesthetics of the chest. There is a role for medical intervention in cases of gynecomastia which are secondary to abnormal levels of certain hormones.

To conclude, cosmetic surgery offers a definitive cure for this condition which can't be attained by pumping weights at the gym. Otherwise, bodybuilders would have been immune to this condition.

For more information about gynecomastia, click here.

Scars are common. We start our lives with an umbilical stump that matures into a scar. But since everyone has one we do not seem to mind having it.

Scar looks and feels different because it is composed of tissues which are different. Due to this scar has different biomechanical and light reflecting properties. And at times it can lead to significant distress in those with these scars.

A scar is a living tissue that changes its composition over a period of time. We know this as scar remodeling. Many therapies exist to favorably alter the appearance of the scar. They vary in their simplicity and invasiveness. There are certain activities that can be done by anyone to make scars better. We commonly ask our patients to perform these to have a better-looking scar. These would be,

1. Massage: Gentle massage can be started approximately 2 weeks after surgery. Massage is done with fingertips along the line of the scars. It can be done with an emollient or moisturizer.
   
2. Sun protection: Dark skin individuals are prone to get changes in pigmentation of the scar. The scars in sun-exposed areas can end darker or lighter than the surrounding skin. Sun protection can be achieved by means of sunglasses, hats or simply taping the area when out in the sun.
   
3. Sunscreen: Use of sunscreen is beneficial in the reduction of pigmentation abnormalities. Sunscreen has to be applied regularly and daily. Sunscreen application should be used even if the individual is exposed to indirect (inside room or shade) sunlight. Its use should not be restricted to the time under direct sunlight. Both sun protection and application of sunscreen is applicable to scars found in exposed parts of the body.
   
4. Silicone sheet: Silicone sheet application has favorable effects on scar remodeling. These sheets are transparent and pliable and can be cut to overlap the scars. They have to be constantly used to obtain the benefits. Silicone sheets help in making the scars softer and more pliable. It also helps in reducing the symptoms associated with problem scars. Silicone sheets are especially useful in individuals prone to prominent scars. In individuals prone to hypertrophic (prominent) scars we routinely prescribe their use once the suture-line is left open.
   
5. Pressure application: Application of pressure most commonly done by a pressure garment favorably influences the appearance of a scar. Since this requires a lot of commitment and compliance we advise this modality for individuals prone to hypertrophic scarring.
   

In most instances, scar remodeling favorably affects the scar. Scar remodeling is greatest during the initial one to two years.  This usually leads to more supple and flattened scars. Because of this, we tend to postpone any surgical scar treatments until one to two years since we would like to reap the benefits of scar remodeling.  

To conclude, though one can't completely eliminate scars, it is possible to influence the outcome of scars by means of simple techniques that be done by the patient. With compliance, a patient can end up with more acceptable scars.

Gynecomastia correction is a commonly carried out procedure among men.

The aim of the surgery is an improved contour of the chest. This is accomplished with the help of minimal incisions such that patients do not have an operated look. Most of the patients undergoing correction have liposuction for removal of the fat surrounding the gland and in the lower part of the axilla (armpits). The incision is placed in the areola (pigmented skin around the nipple) for removal of the gland. The areolar incision usually settles very well and has a high patient satisfaction. We sometimes place small tubes (drains) to remove any fluids from the operated site. This is usually removed on the next day. Many of our patients do not have a drain.

Most of the cases of gynecomastia correction are performed under general anesthesia. We reserve treatment under local anesthesia for cases with minimal gynecomastia in slim individuals.

Patients are retained overnight after the procedure. Dressings are removed and operated area is inspected on the day after the surgery. Patients are instructed to wear pressure garment continuously for a month following the surgery. They are usually discharged home after an overnight stay. Due to liposuction and accompanying infiltration of the operated sites with local anesthetic most patients are comfortable on oral pain medications.

At home, patients can move about and carry light activities. We review our patients back in the clinic 2 to 3 days after the procedure. The dressings are removed and skin adhesive tapes are used to secure the suture line. Patients can shower with the skin adhesive tapes.

We review the patients after one week for removal of sutures after one week. Skin adhesive tapes are reapplied for 2 more weeks. Most patients usually return to work within a week. Heavy exertion such as weight lifting is restricted until one month following the procedure.

A normal recovery can involve the following,

1. Swelling. Postoperative swelling accompanies any surgical procedure. The swelling gradually resolves over the next few weeks. Most of the swelling is gone by one month. However, some residual swelling occurs till three to four months. In some individuals, it can last longer.
   
2. Seroma is not unusual following liposuction. In most cases, it subsides without any intervention. Uncommonly we may aspirate the collection under image guidance.
   
3.  Puffiness of the areola. This can be due to the swelling associated with the scar tissue under the areola. It may sometimes take a few months to soften. Puffiness of the areola can also be due to shortening of the areolar scar. The scar initially shortens over the first few months before it lengthens to its original dimensions. We reassure our patients to wait it out. Gentle massage along the scar helps in softening of the scar.  
   
4. Deflated appearance.  In longstanding gynecomastia, the skin over the chest becomes lax and saggy after removal of the underlying fat and gland.  This similar to the abdominal skin being lax after pregnancy. The skin adapts to the new shape of the chest over the next few months. An exception to this would be in individuals with significant obesity. However, we ask our patients to wait for at least 6 to 8 months before deciding on secondary procedures to address the laxity of the skin.
   

 
In most patients, gynecomastia correction is associated with a boost in self-confidence.

Learn more about gynecomastia here.

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An axillary breast is a common condition that affects women. It presents as a swelling over the axilla (armpits). The severity may vary from a mild bulge to a loose baggy fold. Those affected by this condition often view this as unsightly and avoid wearing clothes which reveal this condition.

This axillary swelling is usually an extension of the breast tissue from the outer and upper quadrant. This tissue is also prone to the same changes which occur in the rest of the breast. There may be accompanying pain and discomfort in certain phases of the menstrual cycle.

The axillary breast is usually removed as a daycare procedure. Patients are usually discharged home after a brief period of rest following the procedure. Liposuction and open removal (axilla-plasty) are two techniques that are combined to treat this condition. Liposuction is used to remove fat from the edges of the wound. It helps in the removal of the fat with short incisions.  Open removal of the breast tissue has the advantages in allowing better preservation of the nerves which travel through this space. It also helps get rid of the relatively non-retractile axillary skin. The removal of the excess skin gives a better contour to the axilla (armpit).  

Wounds are approximated with sutures and dressings are applied. Drains are sometimes placed to avoid any collection from occurring at the operated site. Patients are followed up as outpatients and sutures are removed at one week. The postoperative swelling usually resolves over the next few weeks. Patients are usually able to resume work after a few days. There are no restrictions on any activity after a month following the procedure.

Treatment of the axillary breast gives a better contour to the axilla (armpit). Liposuction and open removal when combined help women achieve better contours with short incisions. After the procedure patients usually feel more confident about their appearance.

You can learn more about female breast reduction here.

​The hymen is a diaphragm-like structure located at the external opening of the vagina. The aperture(s) in the hymen helps in the drainage of the menstrual blood. The hymen varies in appearance. Some individuals may have multiple apertures instead of a single aperture in the center. It can be either a thin or a relatively thick structure. 
The hymen gets disrupted following sexual intercourse. Following disruption, the hymenal remnants at the external vaginal opening are known as hymenal carunculae. The hymen can also get injured following clinical examination, strenuous physical exercise or disease. hence its appearance is not a definitive indicator of the virginity of a woman or a girl. The presence of an intact hymen in a bride is considered very important in some cultures. This probably arises from a correlation between an intact hymen and virginity. 
It is possible to repair a laceration of the hymen. This procedure is also known as hymenoplasty. Some also know this cosmetic surgery as 'revirginization'. It is a small procedure which does not require an overnight stay in the hospital. We usually perform this procedure under general anesthesia. The remnants of the hymen are carefully brought together in layers using fine absorbable stitches. Follow up is done after a few days as an outpatient. 
Patients should avoid strenuous activity for a few weeks following the procedure. The labial folds should not be stretched apart for a month following hymenoplasty. We recommend at least six weeks for the tissues to heal. There are no restrictions on any activity after this period. 
Hymenoplasty is a relatively new technique among other female genital cosmetic procedures. It may help some individuals cope with the stress arising as a result of the cultural taboos of our society. 

Lipomas are small soft swellings commonly found beneath the skin. Lipomas are usually painless. In most cases, they are accidentally detected while touching the area. In some individuals, they can be large and obvious from a distance. Some of us tend to get multiple lipoma over the body and face. This condition is known as lipomatosis. This may run in certain families. Lipomas are removed either to ascertain the diagnosis or because they are considered unsightly. Lipoma removal is usually an outpatient procedure. Patients can go back home after the surgery. 

The traditional technique of removal of a lipoma is with open surgery. An incision placed on the skin is used to dissect the lipoma away from the surrounding tissues. The disadvantage of this technique is the resulting lengthy scar. There is a newer technique which can minimize the length of the scars. This is achieved by means of liposuction. During liposuction, the fat in the lipoma is aspirated with a small tube (cannula) attached to a suction producing device. The tiny cannula is inserted with the help of a small incision. The residual lipoma which remains after liposuction can be removed with the help of a small incision. This technique has significant cosmetic benefits because it leads to a short scar. Thus all scar-related consequences such as hypertrophy, color and texture changes of the overlying skin are minimized. Patients are later reviewed in the clinic. It is usual to have some induration at the operated site. This gradually subsides over the next few weeks. The recovery following this procedure is similar if not faster when compared to the traditional technique for removal of lipomas.

Liposuction for the removal of lipoma is a good option for those who want to get it removed with the help of very small incisions. It is especially recommended for individuals with multiple lipoma as the resulting length of the scars are less compared to the traditional open technique. 

Gynecomastia correction is commonly performed for improvement in the aesthetics. It is done as an outpatient or short stay procedure. Which means that patients do not have to spend a long time at the hospital. 

Anesthesia: Depending on the severity of gynecomastia and patient preferences, the corrective surgery is carried out under local anesthesia or general anesthesia. In case of small enlargements carried out under local anesthesia patients are sent home the same day. In case of cases treated with general anesthesia, we opt to retain the patient overnight at the hospital. 

Returning home: Patients can go home the next day after the change of dressing. Patients are usually comfortable after the surgery and most report only minor discomfort and do not require multiple analgesics. Patients can shower next day onwards and are advised to apply a small pad over the suture line. Pressure garments have to be worn constantly for a month. 

Follow-up: We see patients in our outpatient set up after a few days to check on the healing. During this visit, most of the swelling has started to subside. Some of our patients resume light work after a few days. Sutures (stitches) placed on the areola (pigmented skin around the nipples) are removed at one week. 

Resuming work and exercise: After a week light exercise like running and walking can be resumed. We see our patients again at the end of a month. By this time, the improved contours of the chest are well made out. After a month there are no restrictions on any activity. We ask for a review at three months and one year after surgery. 

Most of the patients have an uneventful recovery. Some patients may get prolonged swelling due to postoperative collections. These are usually treated conservatively and settle after a period of time. The collection usually does not make any difference in the final outcome of the procedure. Gynecomastia surgery is associated with a high satisfaction rate and patients report an increase in self-confidence after the procedure.

For more information about gynecomastia, click here

Male breast enlargement or gynecomastia can be treated effectively with liposuction and direct removal of the gland. And a significant number of such patients can be treated under local anesthesia. With improvements in anesthesia techniques, it is possible to have a near pain free experience. There are certain advantages in undergoing the procedure under local anesthesia. These include:

1. Faster recovery:  Patients can return home soon after the procedure. The benefits also include the absence of general anesthesia associated effects like nausea and vomiting.
2. Improvement in safety: It is safer when the surgery is performed under local anesthesia. Liposuction under local anesthesia has been shown to result in far less number of adverse events when compared to general anesthesia.
3. Good pain relief in the postoperative period. Careful infiltration of local anesthetic solution is important for adequate pain relief during the procedure.This also has the added benefit of giving good pain relief for a long time after the surgery.

Some types of gynecomastia are particularly suitable for treatment under local anesthesia. These include:

1. Glandular enlargement confined to an area close to the nipple areola. These cases usually present with a bulge under the areola.
2. Milder forms of gynecomastia.  Even larger variants can be treated in a motivated patient these take longer to complete.

There are certain disadvantages when doing liposuction and excision under local anesthesia when compared to general anesthesia. Perhaps the most important would be the longer duration of the procedure. Local anesthesia should be allowed to act for a sufficient duration before liposuction is begun. Similarly, it is common to again inject the anesthetic solution and wait before resuming the procedure. The procedure takes longer to complete under local anesthesia. Individuals who are afraid of needles and do not want to be awake during the surgery may not be right candidates for the procedure.

To summarize, local anesthesia is a good option if you are adequately motivated and have one of the milder forms of gynecomastia. The advantages include faster recovery and improved safety profile of the procedure.




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