Hello, is this the plastic surgery clinic?
Yes.
Do you perform rhinoplasty?
Yes, we do.
What is the cost of rhinoplasty?
We need to see you before we comment on the treatment plan or the cost.
Is it possible to give a rough estimate?
…….

We tend to have the above conversation multiple times. Sometimes rhinoplasty gets replaced by another procedure such as liposuction, fat grafting or something else. I thought of elaborating more about our resistance to comment on treatment costs before seeing the patient.

Imagine a person with a desire to build a home. Not an apartment in a high-rise, but someplace on a piece of land with a small garden. Such a person would have certain ideas about size, location, immediate vicinity, style, etc. And if there is a lack of clarity related to these aspects she would assume that she would be guided by an expert. Now let's imagine another conversation.

Hello, is this the builder's office?
Yes.
Do you build homes?
Yes, we do.
What is the cost of building a home?
……..

We find both these conversations very similar. Because we are dealing with situations in which making plans would not make sense without a good grasp of what the customer needs. In other words, both cosmetic surgery and building a home are highly customized endeavors. There are a lot of variables which need to be sorted out or understood before we finalize a plan. In both cases, the expert brings to the table his or her expertise. Once a plan is finalized it is reasonable to arrive at the cost.

 It is nearly impossible to follow a cookie cutter approach in cosmetic surgery. Let me give an example. Let us assume an individual seeking rhinoplasty. Following a clinical examination and discussion, we usually arrive at a treatment plan. A plan found suitable for one person may be quite different from a plan for another individual. One may require a short procedure lasting one hour whereas the other may require something much more complex lasting six hours. The cost, in turn, depends on the complexity and duration of a treatment procedure.

Like an architect who seeks input from her client, we give a lot of importance to input from our patients. This more so in cosmetic surgery when compared to other surgical specialties. Because of this, a similar looking deformity may get treated using different techniques. One individual may be satisfied with a simple correction whereas another may be keen on a more exacting remedy. This again reflects on the cost of the procedure. This sort of variability in treatment options applies to almost procedures in cosmetic surgery.

 Because of these reasons we hesitate to comment on any treatment plan when certain pictures or images are sent to us. We do get an approximate idea of the deformity with the images, but in the absence of a discussion with the patient, it does not make much sense to decide on a treatment plan. Also, a clinical examination gives a lot of important and useful information relating to the management of the condition. These are not otherwise apparent by inspecting images of the body part. To give an example, in rhinoplasty we get to assess aspects like the thickness of the skin and soft tissue, structural support, status of the nasal cavity as well as nasal obstruction with a clinical examination. These can't be inferred from the pictures.

It may sometimes be possible to give an estimate of the cost when a procedure is simple or straightforward. This applies to procedures like excision of a mole with a straight-line closure or repair of an earlobe cleft. This can also apply to procedures like hair transplant when the cost can be correlated in terms of a smaller unit say, cost per follicular unit.

All of the above reasons lead to a reluctance to comment on the cost of a procedure without a clinical examination and discussion. I suppose similar reasons would also apply to those who seek to get a home built somewhere.

Gynecomastia is an enlargement of the male breast tissue. This enlargement can be of one or both sides.  In cases of bilateral involvement, one side can be affected more than the other, leading to an asymmetrical appearance.

Mild cases of asymmetry are common. But in certain cases, the difference between the two sides can be readily noticeable. The asymmetry can be as a result of two causes, namely, a difference in the amount of breast tissue or changes as a result of the underlying chest wall and muscles. The treatment strategies for managing the asymmetry depends on the underlying cause. Usually, the reason is apparent during a clinical examination.

In the case of asymmetry arising due to the difference in the size of the breast tissue, the treatment involves liposuction and direct glandular excision. We take care to leave behind equal amounts of subcutaneous tissue at the end of the procedure. A more enlarged gland will require a longer time for adequate skin recoil. Such a gland may also have a longer duration of postoperative firmness. In most cases, adequate symmetry is achieved with the passage of time.

In cases of asymmetry due to underlying chest muscles, unfortunately, nothing much can be done to correct the difference at the time of surgery. We bring this to the notice of the patient during the consultation. Usually, such differences in chest muscles arise from altered posture and position during strength training exercises. It is recommended that individuals seek help and guidance from an expert physical trainer for the correction of the posture and technique.

Gynecomastia surgery is essentially a cosmetic procedure and the goal of undertaking a correction is to minimize the effect of the deformity. Wide variations occur in the presentation of this condition. Asymmetry is a commonly seen variant, even though severe asymmetry is uncommon. In cases of asymmetry, it is important that individuals understand the reason and the role of different treatment strategies to tackle the same.

For more information about gynecomastia and related topics, click here.

An individual with asymmetry due to difference in the size of the gland. The right side is bigger compared to the left.

Asymmetry due to the difference in the size of the underlying muscles. The left pectoralis major is more developed when compared to the right.

Gynecomastia correction is a commonly done cosmetic procedure. Surgery is indicated in case the affected individuals are bothered about the deformity. An effective correction is associated with improvement in self-confidence. 

Most cases are done under general anesthesia in a hospital setting. We reserve local anesthesia for the mild variants with only gland enlargement. 

Gynecomastia is usually associated with an increase in fatty and glandular tissues. The incisions and the resulting scars depend on the tissues being tackled during gynecomastia correction. Less commonly, there can be a significant excess of skin. 
​
1. Fat is removed with the help of liposuction. During liposuction small tubes are used to suck out fat. An advantage of liposuction includes the ability to treat large areas with the help of very small wounds. These incisions are usually not sutured and heal very rapidly. Liposuction also contributes to postoperative comfort during recovery. This is due to the infiltration of the anesthetic solution during the procedure.
2. The gland is removed with the help of an incision placed inside the areola. The areola is pigmented skin immediately surrounding the nipple. The wound is closed with sutures. These sutures are removed around 7 days following surgery. The areolar scar usually settle very well. The exceptions would be seen in certain patients prone to prominent scars. 
3. Skin is usually not removed during correction of gynecomastia. Skin excess can be seen in long-standing severe gynecomastia and those with massive weight loss. These individuals present with droopy or hanging breasts.   Removal of the underlying gland and fatty tissues helps the skin to recoil. This can take as long as one year. For this reason, we usually wait for a year before planning any skin tightening or removal procedure. Depending on the severity of excess skin, incisions may be confined to the junction between the areola and skin or may extend downwards and laterally towards the sides of the chest. 

In most cases presenting for gynecomastia, we do a combination of liposuction and gland removal with an areolar incision. These scars are associated with high patient satisfaction rates. Skin removal surgery is very uncommonly done in our practice. 

learn more about gynecomastia here.  

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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