Excess breast development in men may be caused by a number of factors, such as a change in hormone levels (for example, by taking hormone therapy), accumulation of fatty tissue, side-effect of medication or reaction to changes in metabolism. However, in many cases it is difficult to identify the cause of gynaecomastia.

Gynaecomastia is a condition that makes men’s breasts swell and become larger than normal. The condition may affect one or both breasts, and is often caused by excessive glandular tissue. In men, sometimes the enlarged breasts disappear just like that, but if not, it can be an annoying and embarrassing problem.

Plastic surgeon

The consultation is always held with the plastic surgeon who will be carrying out your procedure.
During this consultation, you can discuss what bothers you the most about your enlarged breasts and what you would like to have changed. Your plastic surgeon will take photos for your medical file, and will examine your breasts. In front of a mirror, you will both discuss what you are looking to achieve with your breast correction. The plastic surgeon will then suggest the most suitable surgical technique for you and discuss it with you. They will show you before and after photos of breast correction procedures they have previously performed, and you will then have an opportunity to ask any questions you may have. In front of the mirror, you will be shown what this technique entails and what you can expect in terms of end results. The expected recovery period and any risks and complications will also be talked through with you.
You will then be in a position to make a well-informed decision. A summary of your consultation will then be set out in a treatment plan, and the overall costs will be discussed with you directly. The consultation will take approximately 45 minutes, and aims to inform you as clearly and fully as possible.

Consultants

Following on from your first consultation with your plastic surgeon, you will have an appointment with your consultant. The aim of this appointment is to tell you about the general aspects to be arranged with respect to your procedure. 

You are expected to arrive at the Boerhaave clinic half an hour before your procedure.

If you are having the gynaecomastia surgery under local sedation, the plastic surgeon will inject you a couple of times in the area to be treated while you are lying on the operating table. This will numb the places in which the incisions are going to be made.

If you are having the gynaecomastia surgery under general anaesthetic, a thin tube will be inserted into your arm (a drip), through which the anaesthetic will be administered. Any loss of fluid due to your stomach being empty will be compensated for by the drip. When you feel better again after the procedure, and can drink again, the drip will be removed. During the procedure under general anaesthetic, your vital signs such as pulse, heart rate and respiratory rate, will be continuously monitored by the anaesthetist.

A gynaecomastia procedure is generally performed with you in a supine position on an operating table. If you are bothered by excessive glandular tissue, the plastic surgeon will make a small incision along the bottom edge of your areola. They will then separate the glandular tissue from the skin and muscle via this incision. The glandular tissue can then be easily removed, leaving just a small amount behind to prevent the nipple from collapsing.

If your enlarged breasts are caused by fatty tissue, the plastic surgeon will perform liposuction.
Once the correction has been carried out to the satisfaction of the plastic surgeon, the incisions will be closed using small (absorbable) stitches. A wound dressing is then applied to the treated area. After this, you will be fitted with a special pressure girdle or pressure bandage covering the treated area.

Duration of gynaecomastia procedure

The duration of a gynaecomastia procedure depends on the scope of the gynaecomastia. A more extensive gynaecomastia procedure will obviously take longer. In general, a gynaecomastia procedure takes 60 to 150 minutes.

Recovery depends on the type of breast correction performed (liposuction or surgery). The bandage is to be kept on for 1 week. After the procedure, you obviously have to be careful. For a period of 6 weeks, you are to refrain from any strenuous physical exercise, lifting heavy weights or doing any heavy work.

Recovery

You generally need 7 to 14 days to recover from a breast correction. You may see swelling and bruising. The swelling will increase in the first few days, but will start to subside again after a week. This is a natural reaction of your body and is not generally worrying. This may last for a couple of weeks, and will disappear over the course of time.

After care

Our staff do their utmost to achieve the best possible results for you, and the same applies for care after your procedure. You also play a very important role in this process. It is therefore important that you follow the instructions you have been given.

Scar cream

At your first check-up, you will be given a scar care cream to take home with you. Once the wound has closed and the scabs have disappeared, you can start applying the scar cream. If you apply this cream to the closed wound twice a day, you increase the chance of the wound healing nicely.

A gynaecomastia procedure can deliver impressive results. However, you will not be able to see any immediate results directly after the gynaecomastia procedure.

Your skin will be swollen and raised, so the effect of the gynaecomastia procedure will not be visible. The skin needs time to tighten and readjust to the new shape of your body. After a couple of weeks, the swelling will have subsided and the build-up of fluid will have disappeared. Because the skin needs time to tighten again, it will not be possible to assess whether or not the procedure was a success until 3 months after the operation. The end results will not be visible until 1 year after the procedure. Only then will the body have fully recovered from the operation.

Scars

The scars after a gynaecomastia procedure are not large. A liposuction scar is half a centimetre long on average. If glandular tissue is removed, the scar will be approximately half the circumference of the nipple. The plastic surgeon will do everything they can to ensure that the scars are virtually invisible. The scars will initially be red and swollen, but this will start to fade after a couple of weeks. The scars will then be barely visible. It is useful to know that a scar takes 1 to 1½ years to completely calm down. So remember to apply the scar cream to your scars and stay out of the sun. After the first year, always use factor 30 or higher when you are in the sun, to protect your skin.

It is important you are aware that every surgical intervention can entail risks and complications. Plastic surgery procedures are in principle carried out on healthy people, so the risks and chances of complications are low. We make sure any risks are reduced to an absolute minimum, by providing plenty of information, taking a thorough medical history (noting your case history, including medication, any problems experienced in previous operations, allergies, etc.) and applying our professional procedures.

Each year, men successfully undergo gynaecomastia procedures at the Boerhaave Medical Centre. The chances of any complications arising are luckily rare. You can help reduce certain risks by carefully reading through the instructions you are given prior to your breast correction.

Possible complications of a gynaecomastia procedure may be:

• Haematoma (blood clot under the skin which has to be removed)
• Adverse reaction to the sedation
• Haemorrhaging
• Infection
• Change in sensitivity
• Permanent scars
• Damage to underlying structures
• Unsatisfactory aesthetic result.

Smoking

Patients who smoke or use tobacco or nicotine products (such as nicotine patches and chewing gum) at the time of their surgery have a greater risk of complications, such as skin loss and impaired wound healing. People who are exposed to passive smoking may also have an increased risk of complications such as these. What’s more, smoking may have a negative effect on the anaesthesia, which may in turn lead to an increased risk of bleeding. People who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of such complications. It is important not to smoke for at least 4 weeks prior to the operation and to keep this up for the entire recovery process.