Secondary corrections for gynecomastia

Secondary correction of gynecomastia

Secondary corrections refer to operations undertaken to improve the outcome after primary surgery. Secondary corrections for gynecomastia are done to improve the appearance of the operated site.

Some of the deformities that may be corrected with secondary surgery include the following: 

1. Asymmetry: Minor degrees of asymmetry can be seen in most cases of gynecomastia. They may arise as a result of the differences in the breast or the underlying muscles and skeleton. Surgery is useful in the former type. 
2. Residual gland: During gynecomastia correction, a disc of the gland is left underneath the areola. Complete removal of the gland can lead to other deformities. However, in a small number of some individuals, this may be associated with a recurrence of gland enlargement. Recurrence is more common among younger individuals. This can be corrected by secondary gland excision.   
3. Irregularities of the treated area. Some irregularities of the treated areas are common in the initial months following surgery. This is a result of scarring of the tissues following surgery. Such irregularities usually improve with time. Irregularities persisting beyond a year can be treated with the help of liposuction and fat grafting. 
4. Excess skin. Excess or redundant skin of the breasts is usually seen in two types of patients. One, in those, underwent massive weight loss. These patients may have lost more than 20 kg in a short period and have redundant ptosis or sagging of the breast during the presentation for primary correction. Two, in individuals with large breasts. This can cause a deflated appearance after liposuction and gland excision. After a gynecomastia correction, the skin recoils and adjusts to the new contours. However, this may be inadequate in some. Such patients can be treated with skin removal surgery. These corrections would involve long scars.  
5. Scar revision. The scars of a primary gynecomastia surgery usually settle without much deformity. However, the scars involving skin outside the areola may have pigmentation and texture abnormalities. In case of minor deformities, they are managed with medicines and topical applications. Some of the scars can be improved with surgical scar revisions. 

Timing of secondary corrections of gynecomastia. 
We usually wait for a year before undertaking secondary corrections. This has some advantages. They include the following,

1. Remodeling of the scar. In addition to the visible scar over the skin, gynecomastia surgery leads to scarring in the deeper tissue planes. These scars change with time. This phenomenon is known as remodeling. The operated areas can feel firm and nodular in the first few months following surgery. They soften with time and do need any particular treatment in most cases. 
2. Skin recoil. Skin recoil takes time. We tend to stage skin removal in those presenting with skin excess for two reasons. One, they may not be warranted since the skin recoil may be adequate at the end of a year. Two, removal of skin leads to lengthy scars. These may be easily noticeable. 

 Various procedures are undertaken during secondary gynecomastia corrections. These may be carried out in isolation or as a combination. They include, 

1. Liposuction. This can help treat any step deformity and persistent irregularities of the chest. 
2. Fat grafting. Fat grafting is useful to treat contour defects. The fat may be harvested from the adjacent regions or distant parts of the body. Fat grafting is usually not combined with open gland excisions. 
3. Gland excision. This is sometimes carried out when there is a residual gland or during a recurrence. The gland is usually removed by an areolar incision. 
4. Skin removal surgery. This is carried out when there is the persistence of skin excess beyond a year. The pattern of skin removal is determined by the severity of excess skin. The different patterns of the skin include those of a doughnut shape and ellipse. The resulting scar may be at the junction of the areola and surrounding skin or may extend downwards. 

A surgical plan is based on the appearance of the deformity and concerns of the patient. In other words, such plans are customized. Two patients with a similar-looking deformity may undergo different types of surgical correction. A realistic expectation is important since it is usually only possible to make some improvements in the appearance. Also, secondary corrections are usually taken after a year following the primary surgery. During this period patients can help optimize their appearance by the following activities. 

1. Healthy diet. Having a stable weight close to the ideal body weight helps in skin recoil. 
2. Avoid smoking. Smoking impairs skin recoil. 
3. Exercise. Weight training improves muscle volume and this additional volume can recruit excess skin. This lessens the sagging of the chest skin. 

Secondary corrections of gynecomastia can help improve the appearance of selected individuals. 

For more information about gynecomastia please visit: https://www.amicusclinic.in/gynecomastia