Highlighting His Headlights

OP. DR. YUNUS DOĞAN

All about gynecomastia surgery

Remember when you wrote your first essay in school and you started it with “Webster’s Dictionary defines ___________ as… “? We’re taking the textbook definition approach here too, but since we’re fancy we’ll do it in Greek. “Gynecomastia” comes from two root words: “gyne,” meaning woman and “mastos,” meaning breasts.

Gynecomastia - enlargement of male breast tissue - occurs in around 70% of pubescent males but can go away on its own. Then up to 65% of middle-aged and older men can be affected, according to uptodate.com. Do these boys and men need to frantically make appointments for breast reduction surgery? Why are so many males afflicted?

The National Institute of Health’s (NIH) Library of Medicine (NLM) has a few theories regarding possible causes of gynecomastia: puberty, hormonal disorders and drug use. Interestingly, while our cruelly critical society tends to blame the patient’s sedentary lifestyle, the NIH claims that over half of the reported cases are idiopathic, or spontaneously occurring without a cause.

Gynecomastia in teenage boys usually goes away on its own between six months and two years after initial onset. Unless caused by an underlying medical condition, gynecomastia - we’re talking about the idiopathic one here - in fully-developed adult males may still resolve itself within a year. If you’ve hit the year-mark and still have symptoms, you may need surgery.

This article is the third in a series highlighting some of the most popular plastic surgery procedures. In the Highlighting series, we tell you ALL the alternative names of the surgery so you learn the medical terminology as well as develop a little street cred with slang terms. We share a little history of the procedure and describe the general process. We mention possible complications and give you an idea of the typical recovery time.

Also known as:

Gynaecomastia, gyno, man boobs, moobs, m’noobs, man breasts, man titties.

First recorded gynecomastia surgery

Somewhere between 625-690 AD a Roman soldier bravely charged into battle, bronzed breastplate a-bouncing and caught the eye of Byzantine physician Paulus of Aegina. Dr. Paulus (or is it Dr. Aegina?) would eventually be known for writing the “Medical Compendium in Seven Books” and accurately detailing surgery in book six. Many consider Dr. Paulus of Aegina one of the founding fathers of plastic surgery in general.

Among other aesthetic procedures, Dr. PoA was the first to document the characteristics describing gynecomastia. He was also the first to attempt the surgery to correct the condition via large, moon-shaped incisions that were often more embarrassing than the gynecomastia itself. (You should have heard the jokes in the soldiers’ locker room.) The NIH published this dryly detailed but well-illustrated article, “Surgery for Gynecomastia in the Islamic Golden Age: Al-Tasrif of Al-Zahrawi (936-1013 AD)” that shows examples of Dr. PoA’s large incisions.

General process

First, you need a surgeon. When you’re thinking about plastic surgery it’s important to do your research! You can find a great one if you follow our advice. Gynecomastia surgery can be done under general anesthesia - administered through an IV - or under local sedation, depending on the patient’s situation. There are two techniques that can be used to correct gynecomastia, liposuction or tissue removal.

With either method, the surgeon will first make small incisions in the breast, near and around the nipple. Liposuction will use a thin tube called a cannula to suction excess fat out. If necessary, glandular breast tissue and extra skin will be cut away and removed. Your nipple may also be resized and repositioned.

You will most likely have drains after this plastic surgery, kept in place to collect fluid and promote healing. Follow your surgeon’s treatment plan for recovery. Follow our advice to maintain your results.

What could go wrong?

Complications that may occur include:

• Asymmetry - we tell female patients that their breasts are sisters, not twins. You can think of yours as brothers: they’re similar but not identical.
• Changes in nipple or breast sensation - these could be temporary or permanent. Remember, your skin and nerves have been cut apart and need time to fuse back together.
• Unfavorable scarring - all surgery leaves a scar and these might be noticeable (at least while they heal) if you’re out Baywatch-running on the beach.

What could go right?

The good things that you should mentally focus on include:

• More masculine-looking pectoral muscles. Hit the gym and the bench press. Maybe you can make them twitch on command instead of bouncing as you run.
• Freedom to wear tight shirts or no shirt. No more looking down to see bulging or saggy nipples behind your clothes!
• Improved self-esteem, confidence and physical sensation. You won’t be so sensitive to comments about moobs after surgery. And if your moobs themselves were super sensitive before surgery, they’ll be a little more chill after too.

Recovery time

It’s safest to plan on “calming your tits” for a few weeks after surgery. Rushing back into your old routine and activity level may be more harmful than helpful. There are a few factors that will determine your downtime: you can be more active more quickly if you’ve only had liposuction. Conversely, if you had some tissue removed, you need to rest longer. Regarding work, your day to return and your level of ability will be dictated by the type of work you do and the procedure(s) you had. Always follow your surgeon’s recommendations.

The last stitch

If you notice changes in your breasts in terms of shape, size or sensitivity, see your doctor to determine if you have gynecomastia. Establishing the cause will dictate your treatment; early diagnosis can lead to early relief and more time in tight tank tops!