In our practice we frequently come across concerns about the pain associated with gynecomastia surgery both during and after the procedure. Thoughts about the pain can lead to a lot of anxiety in those affected by this condition. It may even prevent some individuals from seeking treatment.
Pain is subjective. Pain is a protective sensation that helps animals avoid injury. Postoperative pain is due to the stimulation of the nerve endings at the operated site. The use of pain medications help reduce the discomfort. Modifications in the surgical technique can contribute to less pain. Gynecomastia surgery is a short stay procedure. Patients can go home without a prolonged inpatient stay. This is made possible due to adequate pain relief with oral medicines.
There are a few reasons for less pain following a gynecomastia correction whn compared to other surgical procedures. These include,
Most patients do not require more than oral medications for postoperative comfort. This is more so among individuals treated under local anaesthesia. Local anaesthesia helps identify nerve sparing and address it before the completion of the procedure. Nerve sparing my occur when the procedure is performed under general anesthesia.
Fear about pain can discourage many from getting surgery. But the improvements in anaesthesia and newer surgical technique, lead to a comfortable postoperative period in most individuals. They usually do not require more than a few oral pain medicines in the initial few days following surgery.
To learn more about gynecomastia, click here.
Liposuction is a part of the treatment of gynecomastia correction in most of our patients. It is relatively uncommon to do a gynecomastia correction without accompanying liposuction. Why so?
Liposuction has many advantages. They include the following:
There are instances when we may not do liposuction during gynecomastia surgery. But these are relatively uncommon. Liposuction is sometimes not done in thin individuals with less breast fat. Such individuals usually present with a gland enlargement confined to the area under the areola. They also have a very thin skin pinch. In such situations, we proceed with a gland excision through an areolar incision after local anesthetic infiltration.
Liposuction has many benefits when done in gynecomastia treatment. It is usually done in almost all cases of gynecomastia surgery in our practice.
To learn more about gynecomastia, please click here.
Gynecomastia is excess breast tissue in men. In a subset of individuals with gynecomastia, there can be redundant or excess skin. The excess skin affects the outcomes following a gynecomastia corrective surgery. It can mean a longer duration to achieve an acceptable outcome. In some cases, we may do additional surgery to take care of excess skin.
How does skin redundancy present in gynecomastia?
Redundant skin is usually apparent with a clinical examination. The breast tissue tends to sag in such individuals. The breasts appear deflated. There can be visible folds on the lower part, and lateral areas of the chest. The presence of ptosis or sagging gives an aged appearance to the chest.
Who are the individuals prone to get skin redundancy associated with gynecomastia?
The risk factors associated with excess skin in gynecomastia include:
What are the treatment strategies that can be adopted in case of skin excess?
hereAmong individuals with excess body weight, it is always recommended to lose weight before undergoing a surgical correction. Optimizing the body weight before surgery has certain advantages. It is easier to assess the extent of excess skin before surgery. This makes the surgical outcome more predictable. In some cases, we may opt to undertake skin reduction during the time of gynecomastia correction. With weight loss, patients can benefit from the skin recoil beforehand.
In an individual, with excess skin, gynecomastia correction can be done in two different ways. It can be done either with skin excision or without skin excess. Both strategies lead to different outcomes.
When the correction is carried out without a skin excision there may be a postoperative course with an increase in the deflated appearance. This usually improves with time due to the skin recoil. It may take many months before the full extent of skin recoil is appreciated. We usually advise our patients to wait as much as 8 months before deciding on an additional surgery to remove the skin excess. Many patients are usually satisfied with the skin recoil and choose not to have any skin excision procedures. This has the advantage of an initial simpler procedure with shorter scars. Skin excisional procedures are associated with longer and more visible scars.
The second strategy would include gynecomastia correction carried out with simultaneous skin excision. The pattern of the excision can vary depending on the extent of skin excess. Patients with more excess tend to have a greater amount of skin removed. With this technique, the excess skin is addressed in a single procedure. However, it carries the disadvantage of longer scars. In our practice, this approach is less commonly used. We tend to choose individuals with severe excess for this approach.
What are the steps that can be taken by an individual to address excess skin?
The excess skin is usually seen to accompany increased body weight. Individuals should try to maintain their weight close to ideal. This is usually achieved with the help of dietary modifications such as diet and exercise. Weight training helps recruit the excess skin and contributes to reduced sagging over the lower part of the chest. Weight training and accompanying muscle hypertrophy also bring along aesthetic benefits.
Excess skin is seen in some individuals presenting with gynecomastia. This is more commonly seen in those with excess body weight. The skin excess can be tackled with surgery in a staged or simultaneous way. Both strategies have their advantages and disadvantages. A treatment plan is chosen based on individual preferences and extent of excess skin. Individuals with skin excess can help improve this condition with appropriate dietary modifications and exercise.
Learn more about gynecomastia here.
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:
Timing of secondary corrections of gynecomastia.
We usually wait for a year before undertaking secondary corrections. This has some advantages. They include the following,
Various procedures are undertaken during secondary gynecomastia corrections. These may be carried out in isolation or as a combination. They include,
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.
Secondary corrections of gynecomastia can help improve the appearance of selected individuals.
For more information about gynecomastia please visit: https://www.amicusclinic.in/gynecomastia
I could also have gone for a title called ‘why am I fond of syringe liposuction?’. Liposuction is a technique in cosmetic surgery for removing fat cells from certain parts of the body. The fat cells amenable to liposuction are between the skin and muscles. We do not perform liposuction on fat deeper than the muscles. Liposuction may be part of another procedure like abdominoplasty or gynecomastia correction.
Liposuction involves the creation of a vacuum. This vacuum helps remove fat cells with small cannulas. Such cannulas are called liposuction cannulas. Cannulas vary depending on their diameter, length, and shape of openings near the end. We use different types of cannulas based on the area treated.
During liposuction, a vacuum is obtained by a machine or a syringe. Syringe liposuction employs a syringe for generating liposuction. A cannula is attached to one end of the syringe. After insertion of the cannula inside the body, the surgeon pulls back the piston and locks it in place. The vacuum created inside the syringe helps move the fat cells into the syringe during to and fro movement. Once the syringe gets filled, the cannula is disconnected and the fat is emptied. The same process gets repeated till the desired endpoint is reached. This constitutes syringe liposuction.
Syringe liposuction is a simple technique with a lot of benefits. This makes it popular among many practitioners. Some of the benefits include the following,
Syringe liposuction was introduced by Toledo in 1989. The advantages of this technique make it very endearing to some practitioners of liposuction. One of them includes me.
For more information about liposuction, please click here.
For more information about gynecomastia, please click here.
Do I have gynecomastia?
'I don't know if I have gynecomastia. Maybe it is fat. So, I came.'
I hear this often in my practice. Gynecomastia is male breast enlargement. It can be diagnosed easily because of its appearance. But sometimes, the presentation can be a bit confusing.
The breast tissue is seen under the nipple and areola. The areola is the pigmented skin immediately surrounding the nipple. Depending on the severity of enlargement, gynecomastia can present as puffiness of the nipple and areola, or it can extend towards the sides of the chest. It can affect one side or both sides. Both sides can look different. In other words, there can be asymmetry.
The word, ‘gynecomastia’ comes from ‘gyneco’ and 'mastia'. 'Gyneco' means female, and ‘mastia’ means breast. Thus gynecomastia translates into the female-looking breast. This occurs due to an enlargement of the breast tissue. Compared to female breasts, male breasts are positioned more laterally (meaning to the side of the chest). Hence, the deformity of gynecomastia is also especially pronounced when viewed from the side.
Hypertrophy of the underlying muscle (pectoralis major) looks different from that of the breast. The muscle animates (moves) in certain maneuvers. This means the muscle contracts during certain activities like flexing the arm against resistance. Also, the lower border of the muscle usually stops at the level of the nipple. Any enlargement that significantly extends below the level of the areola is usually due to breast tissue. The lower border of the muscle is straight or flat. This is easily made out in men who perform weight training. The presence of breast tissue tends to make the inferior border curved. The curved lower part of the breast gives it a feminine appearance.
It is also possible to pinch the breast tissue separately from the underlying tissues. We usually carry this out during a clinical examination of an individual presenting with gynecomastia. Puffiness of the nipple and areola is also associated with enlargement of the breast tissue. It is not associated with hypertrophy of the underlying muscle.
There is an entity called pseudogynecomastia. ‘Pseudo’ means false. This is due to increased fat deposits in the chest. There is no glandular enlargement in pseudogynecomastia. It is usually seen in the setting of obesity with fat deposits that mimic the appearance of male breast enlargement. Losing weight will lead to an improvement in the deformity associated with pseudogynecomastia.
It is usually simple to diagnose a case of gynecomastia during a clinical examination. We sometimes request additional investigations to look for any underlying cause for gynecomastia. Imaging can help us to confirm the condition. Most cases of gynecomastia are benign and are self-limiting. Surgery is undertaken when gynecomastia results in significant distress in the affected individual.
To learn more about gynecomastia, please visit, https://www.amicusclinic.in/gynecomastia
Beauty is associated with proportions. A body part that is disproportionate to the rest of the body can impair appearance. An example would be women with arms that are large when compared to the torso. It is a common aesthetic concern in plastic surgery practice.
Arms are tubular structures. They consist of soft tissues around a bone. The soft tissues are made up of structures like fat, muscles, and vessels. It is surrounded by skin. Large arms usually involve a relative excess of fat and skin. The fat occupies the layer deeper to the skin. As the volume of fat increases, the overlying skin stretches to adjust to the increased volume. Hence, a reduction in the size of the arms involves a reduction in the size of the fat and skin excess. We can achieve this through surgical, and non-surgical techniques.
Why do some individuals get big arms?
The increase in the size of the arms is associated with excess weight. This excess fat gets deposited in various areas of the body. Some of us tend to deposit this fat more in our arms. This intrinsic tendency varies from one individual to another.
Other conditions can be associated with an increased size of the arms, lymphedema, soft tissue swellings, etc. But they are relatively less common causes of big arms. This article deals with the management of the arms as a result of excess fatty tissue.
What can be done to improve the appearance?
A reduction in the size of arms has to address the two types of tissues involved, namely fatty tissue and skin.
First, the fat. Fat occupies the area between the muscles and skin. The amount of fatty tissue correlates with the amount that can be rolled between two fingers. Fat is amenable to dietary modifications. A reduction in body weight usually leads to a reduction in the amount of fatty tissue and a resulting in a decrease in the size of arms.
Liposuction is a surgical technique to remove the fatty tissue with the help of small tubes (cannula). It is useful for individuals with fatty tissue that is resistant to dietary modifications. A good candidate for liposuction is someone with close to ideal body weight. Liposuction does not directly address the excess skin.
Next, the skin. The skin stretches to accommodate the excess fatty tissue. Once there is a reduction in the fatty tissue with diet or liposuction, there is a recoil of this skin. Recoil is the shrinking of the skin to a smaller area. However, this recoil of the skin takes time. It can take as much as a year for the skin to maximally recoil. In cases of massive weight loss, the recoil can be incomplete. This is seen as a persistent loose fold(s) of the skin. It is usually seen on the undersurface of the arms. Skin recoil is also reduced with advancing age and in smoking. Brachioplasty is a surgical procedure to remove excess skin. During brachioplasty, skin is removed as an ellipse from the medial surface (inside) of the arm. This is the part of the skin that abuts the torso. The decision to undertake a brachioplasty is taken after waiting for the skin to maximally recoil. Hence, it is usually not carried out during liposuction. The extent of skin removal is customized depending upon the extent of skin excess. Brachioplasty helps in improving the contour by removing the loose skin folds.
What are the advantages of the management of this condition?
It helps in improving the appearance of the arms in individuals with disproportionately large arms. The role of diet and exercise play a very important role in the appearance of the arms. Liposuction and brachioplasty are two surgical procedures that help to further optimize the appearance of arms.
Gynecomastia is an enlargement of the male breast. It is a common condition. Surgical correction of gynecomastia achieves a reduction in the excess breast tissue. A reduction in the breast tissue helps improve the aesthetics of the male chest. In most cases, surgery involves liposuction and gland excision. Liposuction addresses fat, and direct removal addresses the gland. These two steps are usually adequate for most individuals with gynecomastia. However, this may be insufficient to restore the aesthetics in those with excess skin. They may require additional treatments.
The stretched-out skin usually recoils adequately after reduction in most of the individual. The problem relating to excess skin is observed commonly in two subsets of patients. They are,
How do we manage excess skin while treating gynecomastia?
The treatment approach depends on the presentation. We tend to follow a conservative wait and watch in younger individuals, and those with a less severe presentation. This is because of better skin recoil in younger individuals. Also, the removal of the gland will reduce the effect of the weight on the skin. This helps the skin to recoil better. It is common practice to wait for more than ten months to assess the full extent of skin recoil. Any secondary corrections are done after this period.
The conservative approach may not help in older individuals and those with severe forms of excess. In such cases, we may opt to add a skin removal procedure during the management of gynecomastia. Good candidates for primary correction of the skin would include nonsmokers. They must have a stable weight. Skin removal procedures in those with unstable weight may result in suboptimal outcomes.
The design of the skin excess is variable. This is based on the extent of skin excess and patient preferences. A circumareolar (around the areola) approach is preferred in milder cases. In individuals with severe excess, we prefer extensile (long) incisions with the grafting of the nipple and areola. Needless to say, individuals with longer incisions have longer scars.
What is the advantage of staging a skin removal procedure?
In other words, why wait between a gynecomastia correction and a skin excisional procedure.
Skin can recoil significantly with time. It may not be able to predict the full extent. Adequately recoiled skin results in acceptable aesthetics. The full extent of skin recoil after gynecomastia correction takes time. Avoiding a skin removal procedure means lesser scars. However, this approach may not be suitable in those with severe forms of skin excess.
Are there any approaches to prevent this issue with excess skin?
They would include the following.
Avoiding excess body weight. The excess skin problem is not common in individuals with normal or ideal body weight.
Early treatment of gynecomastia. The ability of the skin to recoil reduces with age.
Smoking is bad for skin recoil. Nonsmokers tend to have better outcomes when compared to smokers.
What is the advantage of managing the excess skin in individuals with gynecomastia?
It leads to better aesthetic outcomes.
For more information about gynecomastia please visit here.
Should one lose excess weight before a body contouring surgery? Or should it be postponed to sometime after the surgery? Many of the patients I come across seem to have this dilemma. It is common for individuals to delay losing any excess weight until after the surgery.
Does it make any difference if the excess weight is reduced before or after liposuction? It does make a difference. It is better to lose excess weight before rather than after the surgery. This is best achieved with a healthy lifestyle. Both exercise and adequate diet play an important role.
What are the reasons? A few of them would be as follows,
Hence, it is better to bring the bodyweight close to ideal before undergoing a fat reduction procedure. Liposuction or lipoplasty can then help target resistant fat.
To summarise, should one lose excess weight before a body contouring procedure? Yes. It has its benefits. Ideally, weight loss is attained using sustainable lifestyle modifications. It is associated with better outcomes and lesser complications. They continue to reap the benefits of the procedure long after the surgery.
Liposuction is among the more popular procedures done by a plastic surgeon. Liposuction is carried out as a single procedure or in combination with other surgical procedures. Some individuals refer to it as the 'keyhole' surgery for gynecomastia.
Liposuction has certain advantages over open or conventional surgery. These include small incisions, faster recovery, and less postoperative discomfort. Liposuction can be carried out both under general or local anesthesia. Doing liposuction under local anesthesia has certain benefits.
So, what are these benefits?
The important ones include,
Are there any differences in technique with liposuction under local anesthesia?
There are a few differences.
Firstly, the patient is awake, and the monitoring of the patient is simple. When done in an awake patient, it takes longer to complete the procedure. There are a few reasons for this. The initial infiltration of the anesthetic solution in the treatment areas is done in multiple steps and takes longer to complete. Also, we prefer the use of smaller cannulas for infiltration and fat aspiration (suction). We usually use cannulas of sizes 3 mm or below in an awake individual. Due to the smaller cannulas, the aspiration of fat takes more time to complete. Liposuction in the awake individual is more gentle.
Who is the right candidate for liposuction under local anesthesia?
Almost all candidates for the procedure under general anesthesia are also good candidates for the procedure to be carried out under local anesthesia. However, if the patient is very anxious or has a fear of needles they may not be a good candidate for local anesthesia alone. Such individuals would be better suited for general anesthesia.
To summarize liposuction, in awake patients has a better safety profile. It has the added benefits of a faster recovery, and this also makes it suitable as an outpatient procedure.
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I like to keep it simple.