What causes gynecomastia?

Most cases of gynecomastia have no specific underlying cause. However, gynecomastia can be caused by testicular and other tumors, although this is rare. There are many drugs that can cause gynecomastia including blood pressure medications, Valium, prostate medications, certain antacids, digitalis, antifungal drugs, chemotherapy agents, and marijuana, among others. Rare congenital disorders such as Klinefelter syndrome can also be responsible for gynecomastia, as can alcohol induced cirrhosis of the liver. Despite these potential contributing factors most cases of gynecomastia do not require a comprehensive work-up prior to treatment.

Most adolescents are driven to seek treatment for gynecomastia because of embarrassment in gym class or at the beach, and older men often because of self consciousness when wearing thin shirts during warm weather outdoor activities. Fortunately most cases of gynecomastia can be effectively treated and the results are permanent.

How is gynecomastia treated?

Gynecomastia is usually treated with a combination of liposuction and direct excision of breast tissue under the nipple area. The incisions are made along the lower half of the areolar circumference at the junction between the dark and light skin. These scars usually fade with time and are rarely conspicuous. Most mature men usually have some hair in this area that further contributes to obscuring the scars. Liposuction consists of injecting the breast area with a dilute anesthetic solution followed by sliding special tubes called cannulas back and forth through the breast tissue to dislodge and then extract the fat. Liposuction removes approximately 80 percent of the excess tissue but removes only the fat. There is also firm glandular breast tissue present that contributes to the condition and is not effectively removed by liposuction. Therefore after completion of the liposuction portion of the procedure the breast tissue is removed by excising it under direct vision through the incision described. The goal is to make the area flat while avoiding aggressive over-resection that could leave a dent. Extreme cases of gynecomastia with hanging breasts may require skin removal in addition to liposuction and tissue excision. The scars are much more significant when this is necessary.

Beyond adolescence beginning in the mid-twenties men will often develop prominent “love handles” around the waist in addition to gynecomastia. These areas can be conveniently treated at the same time with liposuction. The lower abdomen is another area that is commonly treated with liposuction concomitantly. While liposuction can remove bulges due to excess fat in these areas, it does not tighten loose skin. Therefore each patient must be carefully evaluated if liposuction of these other areas is being considered.

Where is the surgery performed and how long does it take?

Surgery is performed in the office as an outpatient and general anesthesia is used. Any specific anesthesia concerns will be reviewed with the anesthesiologist prior to surgery. Most procedures last less than two hours. All surgery is performed entirely by Dr. Hidalgo.

What is the recovery like?

Postoperative pain is typically low grade because surgery involves only the superficial tissues and not deeper structures such as muscle where there tends to be more pain fibers. Oral pain medication is sufficient to control discomfort for the first few days. The chest is wrapped with a wide ace bandage after surgery that is worn for the first week. Moderate swelling does occur but bruising tends to be mild in most cases. It is possible to return to work in a week or sometimes less. Exercise can begin after a few weeks and gradually increase in intensity.

Complications are rare. Bleeding or infection can occur with any surgery but are particularly unusual in gynecomastia surgery. Numbness of the skin in the treated area can occur and this can include the nipple itself. It is possible for numbness to be permanent.

What are some of the limitations associated with surgery?

While every effort is made to make the breast area as flat and smooth as possible, minor irregularities, asymmetry, or residual gynecomastia may become evident months later. If a touch-up procedure is indicated it is usually not performed until one year after the original surgery in order to allow complete healing and softening of the tissues to occur. Most revisions are short procedures that do not cause prolonged swelling, discoloration, or restriction of activities.

What are the costs involved in having surgery?

There are separate fees for surgery, anesthesia, and operating room use. Costs also include preoperative lab tests, medical grade photographs, and support garments.

What are the steps involved in proceeding with surgery?

If you are a good candidate anatomically a surgical date can be scheduled. Photographs and preoperative laboratory studies follow. Older men with significant medical conditions will need to obtain clearance from their internist or other specialist beforehand.

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A new drawing continuing in the American flag theme!

#flag #American #girls

A new drawing continuing in the American flag theme!

#flag #American #girls
...

Reverse abdominoplasty is appealing but only applys to those who have all of the following:

1. Loose skin in the middle
2. A perfect lower abdomen
3. Tight muscles
4. Breasts that will hide the scars or existing surgical scars in the breast crease

 Unlike traditional abdominoplasty, done for a different purpose, there is almost no swelling, little discomfort (no muscle work), and the scars are hidden. As indicated above though, true candidates for this procedure are uncommon. 

For the surgeons: this procedure is conceptually simple but challenging to execute. Enough skin has to be removed (4 cm or so) to get the job done yet avoid midline bunching. The inframammary crease has to be re-established and this is most effectively done sitting up, a tedious process!

#abdomen #tummy #wrinkles

Reverse abdominoplasty is appealing but only applys to those who have all of the following:

1. Loose skin in the middle
2. A perfect lower abdomen
3. Tight muscles
4. Breasts that will hide the scars or existing surgical scars in the breast crease

Unlike traditional abdominoplasty, done for a different purpose, there is almost no swelling, little discomfort (no muscle work), and the scars are hidden. As indicated above though, true candidates for this procedure are uncommon.

For the surgeons: this procedure is conceptually simple but challenging to execute. Enough skin has to be removed (4 cm or so) to get the job done yet avoid midline bunching. The inframammary crease has to be re-established and this is most effectively done sitting up, a tedious process!

#abdomen #tummy #wrinkles
...

Breast feeding results in atrophy of the gland, often manifesting as a deflated appearance. In these cases, the most common type, breast implants alone will re-establish pre-pregnancy aesthetics by simply replacing lost volume. More complex cases, like this one, also require removal of stretched skin to provide a simultaneous lift. When skin is removed it only takes a small implant to restore upper breast fullness. 

For the surgeons: Since implant size is small in these cases it typically represents less than 40% of total breast volume. Therefore the “feel” advantage of silicone implants typically becomes moot. Saline implants in this  setting are reliably stable for 20 years or more and are therefore preferred (125cc saline implants in this case).

#breast #lift #restore

Breast feeding results in atrophy of the gland, often manifesting as a deflated appearance. In these cases, the most common type, breast implants alone will re-establish pre-pregnancy aesthetics by simply replacing lost volume. More complex cases, like this one, also require removal of stretched skin to provide a simultaneous lift. When skin is removed it only takes a small implant to restore upper breast fullness.

For the surgeons: Since implant size is small in these cases it typically represents less than 40% of total breast volume. Therefore the “feel” advantage of silicone implants typically becomes moot. Saline implants in this setting are reliably stable for 20 years or more and are therefore preferred (125cc saline implants in this case).

#breast #lift #restore
...

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