After Gynecomastia Surgery

So many patients ask what happens after a male breast reduction procedure, I prepared a handout listing virtually all the questions that are most frequently asked. (FAQs.)

(I also have a handout instructing patients what to do before surgery.)

After any cosmetic plastic surgery procedure, the main concerns are:

• Infections
• Bleeding
• Fluid collections

The chest is usually – temporarily – swollen and slightly bruised at the surgery site. So you won’t be able to see the results of the surgery right away.

You may also be aware of some numbness, tingling, itching or mild burning that goes away after a few weeks.

Usually, I tell patients their chests will feel like they’ve done a very heavy chest workout like 300 push-ups.

A tight fitting compression vest is vital to stop fluid or pools of blood building up under the skin. Rarely, you may have some surgical drains under the vest.

And here’s where you have to be your own plastic surgeon and make yourself do what’s in your own best interest: wear the compression vest 24 hours daily, seven days a week except for showering.

And we’re talking three to four weeks after surgery. Not to worry; a compression vest fits nicely under your street clothes.

Here are some rare, but possible, post surgery symptoms for which you should get back to me or my staff immediately:

• Severe discharge, redness, tenderness or pain at the surgical site
• One side much more swollen
• Muscle aches beyond soreness
• Nausea
• An overall ill feeling with fever

Most guys are able to go back to sitting activities like desk work in two to three days.

More hardy exercise or sports can usually be resumed after about three to four weeks. But you’ll have to wait three to six months to see the full results of surgery on your chest.

Another rare, possible but totally unpredictable side effect is scar development on the chest or directly under the nipple any time after surgery. I’ll treat those at no extra charge for up to a year after your surgery.

Looking at the long term, the bulging, female-like breast tissue that was causing you so much embarrassment will not return. However, if you gain a lot of weight, some fat will appear on your chest.

But look on the bright side: if you protect your surgical investment, consume a sensible low-fat diet and continue with a reasonable exercise plan, you will only enhance the results of gynecomastia surgery!

Oh, I am SO ugly!

Just about anybody who is interested in plastic surgery has read and wondered about Heidi Montag’s many plastic surgical procedures.

Many are up in arms about Heidi having ten cosmetic plastic procedures in one day and wonder why somebody so obviously addicted to cosmetic plastic surgery is allowed to go under the knife.

But there’s a bit more here than meets the eye.

Heidi works in a highly competitive industry where appearance is not the only thing, it’s everything. Moreover, she has managed to keep herself in the public eye with all the comments about her procedures, including:

·         Liposuction

·         Rhinoplasty revision

·         Buttocks augmentation

·         Chin reduction

·         Breast augmentation revision

To the casual eye,  Heidi is young and strong.

Bear in mind I have not examined her but, off hand, I would agree that 10 surgeries in one day are a bit much but probably safe, providing that she has followed California law and had the required blood work, physical exam and medical clearance done before surgery.

But addicted to plastic surgery?

Probably not.

The official name of plastic surgery addiction is known as Body Dysmorphic Disorder, or BDD.

The hallmark of the disorder is dissatisfaction with one’s own body. Oftentimes, the perceived flaws are seen only by the patient and not by anyone else.

No amount of plastic surgery can correct what the victims sees as terrible flaws because it is a disorder of perception. The victim looks in the mirror and sees only ugliness – and is off to see yet another cosmetic plastic surgeon about correcting it

But plastic surgeons are trained to spot BDD. They must be –  the “victims” are famous for suing cosmetic plastic surgeons, claiming the outcome is shoddy, when, in fact, any rejuvenation surgery on a BBD patient is often found to be disappointing (at least to the patient).

Given Ms. Montag’s many appearances in skimpy bathing suits, I would venture to say that the young starlet could not be said to hate her appearance or her body. Just the opposite!

In a certain way, she is revelling in her new appearance and attention and is probably sifting with relish through the new offers of work she has received.

Some patients often ask me, “Doctor, how will I be able to build my confidence back, now that I have a flatter chest?”

Actually, it’s easy. Just sit back, relax and let it come automatically and naturally. Assuming the surgery went well and everything is healing normally, I usually see huge changes in guys within only a week’s time.

For one, they stand taller. It seems like many gynecomastia sufferers hunch over to try and hide their too ample chests. But once male breast reduction has taken place, they are feeling more masculine and consequently stand taller.

I also notice a change in clothing. Whereas the usual mode of dress is usually something baggy to help hide a bulging chest, I usually see a sudden switch to tighter golf shirts or tee shirts.

When dressing professionally, I often hear men saying their suit or sports jackets are fitting better and lying flatter below the collar bone.

Many teens, 20-and-30-somethings drop the other more extreme measures used to hide an overly fleshy chest. Some boys and men wrap long lengths of ace bandages around their chests to hold their breasts down. Some use tape while yet others have discovered compression garments —  used after surgery – to mask their condition.

(Read more in our previous post about how gynecomastia patients often conceal their condition.)

But once I release them, none of that is necessary. Many tell me they feel comfortable going shirtless for the first time ever in their lives.

After one young dad’s gynecomastia surgery, he said he was able to drop the flimsy excuses he used to make. For instance, his kids wanted him to come in the water and play. But, before his surgery, he declined, saying he had a cold or that the water was too chilly.

Speaking of releasing patients: I try and keep their before and after gynecomastia surgery pictures handy for their last appointment. Why? After just a few months, some will quickly get used to having a flat chest and forget what their chests used to look like.

So they are often amazed at their before pictures!

The thinking seems to be a flabby chest will seem normal if the rest of the body is heavy, too.

Teen boys with large breasts often do exactly that, gaining as much weight as possible.

It’s not a good idea.

For one, it’s  hard on your body and your health. Keeping that excess weight into and through the 20s, creates a higher risk of developing type II diabetes, high blood pressure and perhaps sleep apnea.

Keeping that weight into your 30s and 40s, increases the risk of atherosclerosis, or arterial disease, which additionally puts you at risk of heart trouble.

Gaining weight also makes the job of the plastic surgeon job harder and the results of gynecomastia surgery less pleasing.

Here’s why:

Picking up a lot of weight stretches your skin and contributes to skin drooping and sagging if and when you get around to losing the excess weight. The skin loses its elasticity.

If you then opt for male breast reduction surgery, you’ll have more scars because more tissue and the lax, excessive skin must be removed from the chest.

So, if a patient has been heavy, the gynecomastia surgery to get a smooth, flat and contoured chest may require more than minimal scars.

Of course, in the best possible scenario, all patients would arrive on the day of surgery at their optimum weight.

But that doesn’t always happen. Time after time, patients tell me they are too embarrassed to exercise at the gym due to their so-called “man boobs”. (Gyms are especially rife with the cruel moniker, “bitch tits”.) And if they can’t exercise, they can’t lose the weight.

If an overweight patient requests gynecomastia surgery, I may go ahead — particularly for moderately overweight men — with the understanding I can only reduce the thickness of the chest to match the thickness of the surrounding tissues.

If I took too much tissue away from the chest, it would look concave in relation to the rest of the patient’s body.

The outcome? The patient is still overweight but with smaller and less conspicuous breasts.

Alas, the patient will look like a normally overweight man, with a small fold under his breasts…..instead of an overweight man with enlarged, female-like breasts.

Of course, it’s probably worse in the mind of patient because he imagines everybody is staring only at his chest.

For a teen, the first year of high school is tough.

Due to the huge wash of testosterone washing through his pubescent body for the first time, girls become tremendously important. But for teen girls, cruel remarks are unfortunately seen as being fully in order and even fun.

Except for the boy at which the zingers are aimed!

The standard teen remark is usually something about no girl wanting a boyfriend with bigger breasts than she has. Ouch!

Thus begins a long covering and concealing process, using large shirts, baggy sweat shirts, hoodies  and, sometimes, several layers of T-shirts, shirts and sweat shirts. Some guys even bind their chests with yards of Ace bandages or cover their “poofy” nipples with tape which can discolor the skin.

Factor in summer weather and you have one miserable kid.

At the pool or beach, you’ll find that same youngster swimming in a T-shirt — if he dares go into the water at all. Then, as soon as he gets out, he wraps his torso in a big thick towel or beach towel.

Almost all gynecomastia patients, unless they can find something darker, choose to wear black tops.  That color seems to best hide bulky or fleshy bulges.

Most wouldn’t be caught dead in white which tends to reveal almost all the body’s outlines.

As the guy with “man boobs” studies his condition more, he also discovers the compression garment which is actually intended for wear after surgery.

Nonetheless, some men will don a compression vest daily to flatten their breasts before dressing. The vests are made of elastic and compress the fatty tissues.

The downside: compression garments are hot!

Possible upside: the misery factor starts many guys thinking more seriously about diet and exercise. Many join a gym, work hard and lose weight — except in the one place they so devoutly wish to slim down: the chest and breasts.

Then, having tried literally everything, they start reading, learning and thinking about the next logical step:  male breast reduction surgery.

A few moments spent with typical gynecomastia surgery before and after pictures often brings him to a consultation with a plastic surgeon.

Over the years, I have seen very few health plans cover a gynecomastia surgery.

However, there are a few things you can try. But don’t get your hopes up too high!

Insurance companies know that some teens grow out of gynecomastia and therefore deny your request for surgery, saying the surgery is cosmetic and not medically necessary.

However, you can get your health plan’s attention by showing the ways that a case of gynecomastia is very likely to cost more money for care later on.

To stand even a slim chance at getting coverage, you must include letters from:

• The parents
• The surgeon
• An endocrinologist
• A psychologist, or therapist
• A coach or Phys Ed teacher

Insurance firms want to know:

• The lad’s condition includes “glandular”, or real, breast tissue
• The patient’s condition is leading to depression, isolation, possible diabetes, eating disorders and cardiovascular problems later on.
• That teens are physiologically grown, that no illicit drugs are being used nor any hormone or endocrine issues are the cause of the gynecomastia.
• A psychologist has mentioned the patient’s unwillingness to undress for P.E.; noted his difficulty in social situations; hunched posture and wearing double and triple layers of clothes to hide the breasts; feelings of worthlessness, low self-esteem and any eating disorders
• If pain is present
• The surgeon has described his exam and made surgical recommendations
• Included photos of the chest

All the information must be absolutely true. The health plan will carefully check everything!

The insurance firm may also ask the patient to see a gynecomastia expert of their own.

However, the news is not all bad.  One 2007 case of a gynecomastia surgery dispute went all the way to the New York state Supreme Court.

A father maintained his 17-year-old son considered giving up college due to the terrible ridiculing that goes hand-in-hand with large male breasts.

The Supreme Court and appellate division ordered the man’s health plan to pay $5,000 of the $7,500 surgery, calling the lad’s condition a “deformity.”

Added the judge: “The boy’s condition was a tangible and unusual source of turmoil, more akin to a clubfoot than to a large nose…”

Read more about the court-ordered gynecomastia surgery.

We’ve already discussed how gynecomastia causes extreme embarrassment, social withdrawal and can ruin a person’s self-image, making him feel worthless.

Truth be told, there is plenty of pain to go around!

On one website supporting a petition asking insurance companies to cover gynecomastia surgery, you can see lives being held back.

For instance, Bruce blogged:

“I opted out of a promising military career because I would not disrobe…I suffer from depression and often isolate myself. (Health) insurance will pay for tummy tuck and breast reduction in women but not for gynecomastia. Would somebody explain why?”

Mark B. wrote:

“The emotional impact can lead to feelings of hopelessness, depression and thoughts of suicide…there is pain and tenderness when jogging..gynecomastia plastic surgery has nothing to do with cosmetics. All we want to do is live normal and productive lives.”

Giovanni V. added:

“It is not normal to have breast tissue if you are a man!”

Louis P shared:

“Having gynecomastia as a teen, I put on a lot of weight because I thought I could hide it…I’m now 40 and trying to lose the 100 pounds I put on…An adolescent boy should not have to suffer through what I did!”

Porta S. wrote:

“At age 15, my son’s breasts are larger than mine; he can easily fill a size B bra. This otherwise healthy, athletic boy has to deal with kids gasping in horror when changing clothes in gym.”

Chase, 18, blogged:

“I have not led a full life due to my gynecomastia and it kills me! I try not being depressed but I can’t help it. Insurance coverage would give me the second chance I so desperately need.”

Jim, 48 said:

“In high school, my girl friend said ‘What the hell is this?’ while we were swimming. To this day, I won’t take my shirt off in public.”

Dedan L. wrote:

“I developed gynecomastia at 13. Whether I was 135 or 235, it made no difference. Even at my largest and leanest, 215 and 8 percent body fat, I still wore a rash guard (a spandex athletic shirt) to the beach.”

Karen added:

“My 13-year-old son has gynecomastia; it’s heartbreaking to see him worry so much about how much breast shows through his shirt.”

56-year-old Paul blogged:

“I have considered taking razor blades and performing surgery on my man boobs. My entire life has been affected by gynecomastia.”