Most cases of gynecomastia are done under general anesthesia using a combination of liposuction and direct glandular excision. Most patients are sent home after an overnight stay and make an uneventful recovery. There are no restrictions on sports or any other heavy exertion after a month.
Even though there is a significant improvement in appearance during the initial weeks following surgery, patients should also be familiar with certain late changes that occur with healing. These are often a part of the normal process of healing. Being aware of these changes helps reduce anxiety among some patients.
The scar used for gland removal is a curve within the areola. The areola is the pigmented skin around the nipple. Scars within the areola tend to settle well when compared to scars at the junction of skin and areola or those in the surrounding skin. As with all scars in the postoperative period, the scars tend to contract. This effect is marked between 6 to 12 weeks. Following this, they again elongate and become softer. This transient contraction can result in a feeling of induration and pushing up of the skin around the nipple. We refer to this phenomenon as a trapdoor deformity. In most cases, nothing has to be done as the condition settles once the scar elongates and becomes softer over the next few months.
Even though the external scars are limited the operated areas involve the front and the sides of the lower chest. These areas can also undergo changes similar to the overlying scar. Some of the patients report the onset of a firmness appearing around one month following the procedure. This leads to anxiety as some individuals interpret this as recurrence of gynecomastia. As with the overlying scar, this is usually as a result of transient contraction of the wound bed. Over the next few months, the swelling and firmness subside. The tissues may take up to eight months to become supple. We reassure our patients to wait that long before they can appreciate the final results.
The formation of a scar is an essential part of healing. Even though a temporal sequence is predictable, in some cases these changes are more pronounced. Being aware of these changes and waiting it out is often the only remedy.
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