The operation is always performed under general anaesthetic and depending on the extent of the procedure it can either be done as a day surgery or a short in-patient procedure.
The surgical technique depends on the size of the breast. The surgical aim is to achieve a masculine contour by removing all glandular and all excess fatty tissue. As the skin is only able to retract to a certain degree once the breast tissue has been removed, in large breasts it is often necessary to remove a portion of skin as well.
In very small breasts where no skin needs to be removed the incision is placed along the lower border of the areola. This usually leaves a scar that is hardly visible.
The excess tissue in medium sized breasts can usually also be accessed through an incision along the lower border of the areola. By additionally removing a ring of skin only from around the areola the skin envelope can be tightened to achieve a flat contour. The resulting scar runs as a circle right around the border of the areola. If need be the diameter of the areola can be reduced in this procedure.
Large breasts require the nipple and areola to be moved upwards and removal of both skin and breast/fat tissue from above and around the areola. The incision for this procedure is placed in the breast fold, which corresponds approximately to the lower border of the pectoral muscle.
Just like the female breast, the male breast consists of both glandular tissue and fatty tissue. Glandular tissue is quite dense and therefore cannot be aspirated with a liposuction cannula. Liposuction can however be a useful tool to additionally correct contour irregularities caused by fat tissue remnants after the breast tissue has been removed.
The wounds are usually closed with absorbable stitches.
When large amounts of tissue are removed drains are often put in and left for approximately 24h.
To reduce swelling and promote healing a compression garment should be worn day and night for 4-5 weeks after surgery.
The are usually water resistant, allowing you to shower freely and can be left intact until your first follow-up appointment.
Strenuous physical activities involving the upper body should be avoided for about 6 weeks after surgery.
Regular follow-up appointments with your surgeon will be scheduled at 1 week, 6 weeks and 3 months after surgery.
As with every surgical procedure mastectomy for gynecomastia is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
General complications of all surgical procedures include:
Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)
The most common surgical complications after mastectomy for gynecomastia include:
- postoperative bleeding, hematoma
- unsightly or asymmetric scars
- delayed wound healing or wound breakdown
- decreased or altered sensation of the nipple/areola
- small tissue excesses, “dog-ears”
- asymmetry (size, shape, position of the nipple)
Rare complications of breast reduction include
- Fat necrosis
- partial or total necrosis/loss of the nipple-areola complex
- skin slough or necrosis
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special tests before surgery?
Usually not. The surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
Is my risk of breast cancer decreased after surgery?
Yes. Male breast cancer is quite rare and must be excluded in any case of rapid growth of breast size. If the breast tissue is radically removed your risk of developing breast cancer at a later stage are very low.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed after about a week. Lifting heavy objects and activities that strain the upper body and chest muscles should be refrained from for at least 6 weeks.
Will I get a sick certificate for the time I am off work?
If your health insurance is covering the procedure you can be issued a sick certificate.
If the procedure is purely aesthetic you will have to take leave of absence from work for the surgery and recovery period.
Will my health insurance cover the costs for the surgery?
Sometimes. Most insurance companies will expect at least two of the following requirements to be met:
The treatment of so-called “pseudo-gynecomastia”, where the breast enlargement is only due to excess fat, is usually not covered by health insurance.
Written confirmation of approval to cover the costs by your insurer will need to be obtained by your doctor prior to the procedure.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. unsatisfactory shape, size etc. ) are not covered.