A comparison of breast operations done in a hospital and the same procedure done in private operating rooms show that smaller can be quicker and just as good.

Writing in the July, 2010, issue of The American Journal of Surgery, five surgeons found the ambulatory (“ambulatory” means the patient leaves after surgery) surgical center they use was closing.  So they would  perform surgery in a nearby hospital instead. (Read more about the breast operations study.)

Choosing to make lemonade from what seemed like lemons, the surgeons duly booked their patients into the hospital operating room and then decided to compare the hospital’s experience to an ambulatory surgical center.

The doctor-authors pulled the records of 92 breast operation patients who had surgery in the ambulatory center between January 2004 and December 2005

Next, they studied the records of another 92 patients who had breast surgery in the hospital operating room, and also went home the same day. Moreover, the ages of the patients were similar.

The authors compared many aspects of surgery, including:

• Type and techniques of anesthesia
• Surgical procedures
• Recovery room events and activities
• The elapsed time from patient admission to the hospital to discharge

Results: There were very few surgical problems and a small number of infections in both the private clinic and the hospital.

Plus, recovery times were about the same for both groups.

The big difference? Time! The hospital took an average of 69 minutes longer.

Reasons why a hospital takes longer include:

• Nurses prep many patients, including outpatient and critically ill patients
• A private clinic has small and similar types of cases. But hospitals have more varied and complex cases.
• The preoperational area in a private clinic is closer to the operating room. Hospitals have endlessly long hallways.

Concluded the authors: “The..efficiency advantage of  a private operating room over a hospital has implications for patient and staff satisfaction, facility expense and surgeon productivity.”

If you would like to learn more about a top-rated, extremely sterile private operating room, read about the certified operating room in my office suite where I perform plastic surgery procedures of the breast, including:

• Breast reductions for men and women
• Breast augmentation for women
• Breast lift

Yearly, the professional plastic surgery societies like  the American Society for Aesthetic Plastic Surgery (ASAPS) crunch the numbers on the previous year so we know the ages of patients having all the popular cosmetic plastic surgeries – like face lift and breast augmentation – plus the numbers of each procedure completed, the cost of plastic surgery and so on.

For the most recent set of statistics – 2009 — all plastic surgery procedures and techniques declined by two percent over 2008’s statistics, due to the recession. Surgeries declined 17 percent while nonsurgical procedures went up almost a full percent.

Along with the decline in procedures went prices.

For gynecomastia surgery, the average cost of cosmetic plastic surgery during 2009 was $3,294, $116 less than the previous year.

Of course, the $3,294 is the average surgeon fee. Usually, you must add on charges for the operating facility and for the nurse anesthetist or a board-certified anesthesiologist, along with some other items incidental to the procedure like medications, pathology fees, compressions garments and so on.

Currently, interest in all types of cosmetic plastic surgery is increasing which brings us to another question over which economists are always scratching their wizened heads.

When are prices going back up?

We would imagine that as more patients inquire about, and go ahead with, man boob surgery or other procedures, the prices will rise.

So, could now be a good time for a bargain if you’ve already been thinking about gynecomastia plastic surgery? Will prices go up in 2010?

Could be! Hey, we don’t have a crystal ball, either!

But if you combine a lowered price for surgery with other common discounts, you may realize quite a savings.

An all cash, paid-in-full arrangement is usually worth a three percent discount while agreeing to have your surgery during the doctor’s least busy time may be worth one to two percent. In many places, if you agree to fill in for patient whose surgery is canceled at the last moment, you could receive another one to five percent discount.

Best case scenario: 10 percent is nothing to sneeze at! That equals a possible savings of 329 smackers on the average ’09 gynecomastia surgery.

Gynecomastia patient has one breast larger than the other

Occasionally, a patient comes into my office with one breast larger than the other and, to appear normal, wants gynecomastia surgery on just that one breast.

It’s a condition known in medicine as unilateral (meaning, one side only) gynecomastia which requires a unilateral mastectomy.

First, we make sure nothing else is happening — like a tumor.

But here’s the fly in the ointment: it is very difficult to operate on one breast and make it identical to the other. About the only way to accomplish the task is to perform surgery on both.

Otherwise, the outcome can be one breast that looks normal (the operated breast) but now the untouched breast may look odd — or even bigger in comparison.  And usually some excess tissue on the other breast also exists, but obviously not as much as the larger side.

So, most plastic surgeons want to perform surgery on both sides as well.

I usually recommend that both sides be done to provide the best and most optimal results possible.

While virtually all gynecomastia patients report being unhappy with their large, female-like breasts, having one breast that is far larger than the other only makes the problem worse.

Some body builders are extremely frustrated when they devote endless hours to weight lifting and then discover the large chest muscles they have developed only make the breast fat and tissue – known as “bitch tits” to them — stick out farther.

The one larger breast problem also occurs in teens and non-bodybuilding men.

Overall, you may be wondering how many men have – or will develop – any form of gynecomastia. If you look at the articles that have been written about the topic, it often depends on who counts.
Four M.D.s writing in a 1961 issue of the Journal of the American Medical Association (JAMA) reported that 65 percent of boys may have the problem but that it “typically resolves on its own.” (Also, typically, many do not!)

A military doctor, counting Navy patients on active duty in 1944 found eight percent had enlarged male breasts, or “man boobs.”

Other researchers, counting hospitalized men and  those in pathology labs, found about 40 percent have the condition with almost 60 percent of men over 70 having it.

One of the statistics I like the best is by Merl Yost, a psychoanalyst, gynecomastia patient, author of a book on gynecomastia and operator of the excellent website, Gynecomastia.org.

Yost wrote in a 2006 article for Men’s Health that about 91 percent of gynecomastia surgery patients were happy and would recommend the procedure to a friend.

All of which brings us to our next post: of the nine percent who were not happy, some had revision gynecomastia surgery.

Same patient as above after gynecomastia surgery

Surgically closed incision

Complications are part and parcel of any cosmetic plastic surgery procedure – including gynecomastia surgery.

They can include, in order of severity: bleeding, irregular contours, cratering of the nipple, infections, and poor wound healing or scars.

But a couple of proven ways help decrease your odds of turning up with a pesky, time-consuming complication.

The first may not be obvious – but it involves the plastic surgeon. The secret is actually no secret at all: choose one who does a lot of gynecomastia surgery.

American medicine is very specialized today, so for example, even among heart surgeons, some specialize in surgery on heart valves while others concentrate on veins.

It’s no different in all of cosmetic plastic surgery: A surgeon who has performed a particular procedure many times over several decades disturbs less tissue and is more precise while doing his work.

It all actually starts before surgery.

For instance, it’s okay to ask a plastic surgeon during your first consult how many times he or she has done the procedure you want. Look for a doctor who performs that operation at least once weekly.

That translates into less bleeding, bruising and swelling because less tissue has been disturbed.

Even before you go see the surgeon for the first time, look at the before and after plastic surgery pictures on the doctor’s website. There should be many.

Much of complication avoidance is following –  to the letter — the doctor’s pre-and-post surgery instructions. For instance, halting aspirin or other blood thinning medications several weeks before surgery is very important. As is wearing the compression garment after surgery precisely as recommended by the surgeon.

Depending on your particular circumstances, the surgeon may want clearance by your personal physician, a physical or certain blood checks.

Why? All surgical patients must be healthy enough to undergo surgery.

Just before surgery, your surgeon may prescribe some antibiotics. These are preventive because the first cause of concern after any surgery is infection.

Personally, I have not – thankfully! — had a case of post-surgical infection for years.

Much of that is because my office surgical suite, is JCHAO (Joint Commission on Health Accreditation Organizations) certified and is as sterile – if not more so – than any hospital operating room you’ll ever find.

You should be in frequent touch with your doctor for the week leading up to surgery and make sure you are not ill just prior to surgery.

And don’t be surprised if your surgery is put off if you show up on the day of surgery with a cold, sinusitis, a skin infection like active acne or even a pimple on your chest.

Going ahead could be courting a serious infection!

Over the years, I’ve found that many teens who develop the large, female-like breasts of gynecomastia, will gain needless weight on purpose to disguise their breasts. Sad as it may sound, it’s more acceptable in our culture for a boy to bulge all over due to overweight than to only bulge in his chest.

Still, male breast reduction surgery is possible. And I’ll be more encouraged than ever to perform the procedure if the boy admits he has been eating too much and promises to exercise and eat a more reasonable diet in the future.

Although many pediatricians and other surgeons prefer to be conservative and see if the condition just goes away, it’s very possible the youngster will suffer through his highly valuable teen years, waiting in vain.

But now, there is a new medical report out on teen gynecomastia patients observing male breast reduction surgery on obese and overweight boys.

I was also happy to see the researcher/ authors were plastic surgeons and experts in adolescent medicine at the Adolescent Breast Clinic at Children Hospital Boston and at Harvard.

The researchers studied the medical records of 69 teen boys who had male breast reduction surgery between 1997 and 2008. Writing in the April 2010 issue of Annual of Plastic Surgery, the authors noted they started the study because the roles of obesity or overweight on persistent gynecomastia are poorly understood.

The physician researchers were also sensitive to the fact that obese teens suffer greater psychological impacts.

Using the popular body mass index (BMI), the researchers carefully studied the records of 51 percent of patients who were obese, 16 percent who were overweight and 33 percent who were normal weight. (More about the gynecomastia study.)

They found major complications in four cases and minor complications in19.

Findings? The researchers found the obese patients required longer operations but that there was no different in the satisfaction of those patients or complications rates when compared to the normal weight group.

Conclusion? Obesity alone should not be used to rule out gynecomastia surgery.

Next: What does rule out teen gynecomastia surgery.

View teens’ before and after gynecomastia pictures.

After that, life for all gynecomastia patients is as predictable as it is miserable. Both boys and girls tease those kids without mercy because, really, boys are supposed to have flat, hard masculine chests.

Troy knows that wearing white will accentuate his large breasts so he takes great pains to dress in black or in large, baggy T-shirts with bold lettering. Of course, none of that will stop the daily badgering and belittling. And he dare not ever be seen with his shirt off.

The cruelest taunts of all include: “No girl wants a boyfriend with bigger boobs than she has!” and pointing fingers attached to others who shout  “Man boobs!”

Troy and his plastic surgeon, Elliot Jacobs, M.D., appeared on a recent television segment of The Doctors, along with Troy’s mom – who is now one very happy woman.

Why, you ask, is the mom so happy?

Because Troy had gynecomastia surgery about four weeks ago and is already enjoying the bliss of fitting in perfectly with his peers and not being singled out for a body feature that is seen by other teens as being something close to a freak of nature.

We can’t show you the actual television episode due to copyright restrictions but, thanks to the marvels of the Internet, we can provide a link at which you can watch Troy’s surgery as the actual breast tissue is surgically excised from his chest in a procedure also known as male breast reduction.

Watch the gynecomastia surgery at The Doctors’ website.

And for male breast reduction on a 15-year-old.

Be sure and watch for the cut-away model of a male breast with gynecomastia. It shows exactly how and where the problem occurs.

Before Male Breast Reduction Surgery

If you have a son in the teen years, you don’t want to miss Dr. Jacobs’ appearance on the nationally syndicated show, The Doctors on Monday, May 10^th.

Dr. Jacobs will be talking about adolescent gynecomastia and with one of his young patients who will comment on his own life and surgery shown in a film clip and some before and after gynecomastia surgery pictures.

If you’ve followed our blog posts, you know that large fleshy breasts on a teen boy can make his life a living hell.

The lad is:

• Belittled
• Ridiculed
• Shamed on a daily basis.

After Male Breast Reduction Surgery

This, at a time in life when a young man should be learning self-confidence, how to fit in with his peers and – above all – how to cope with the fairer gender. But instead, he spends all his time trying to hide his “man boobs.”

Sure, understanding girls and females can take the rest of any guy’s life. But a young man starts out completely behind the eight ball in the battle of the sexes if teen lasses reject him because no girl wants a boyfriend who has bigger boobs than she!

In New York, the show appears on WCBS-TV, channel 2 at 9 a.m.

In Los Angeles, The Doctors broadcasts on KCAL, channel 9 at 11:00 a.m.

To catch up on teens with gynecomastia, take a gander at our most recent posts on the topic:

• A cute teen girl in the school cafeteria pinches a boy with gynecomastia and asks what his bra cup size is.

• Teens ponder on telling others they have had male breast reduction surgery.

• Another teen with gynecomastia never left home because, if he socialized, he found “everybody staring at me.”

But in gynecomastia, the decisive moment can be the last straw that drives a teen or young man to make the decision to have male breast reduction surgery on his fleshy, female-like chest.

The excellent website, Gynecomastia.org has a forum in which males afflicted with “man boobs” recall their worst gynecomastia moments.

Not surprisingly, many deal with the lads’ experience with girls and women:

• A beautiful Russian woman and co-worker poked a guy in the chest and declared with a giggle to all present in a crowded bar : “You’ve got boobies!” Said the guy: “Any pre-surgery doubts I had went away in that second.”

• One wrote his gyno cost him the love of his life.

• Another was the victim of a sick practical joke. His buddies got together and arranged a blind date with a very attractive nurse…who was flat as a board. Neither the victim nor the nurse appreciated the stunt.

• In bed, a “hot girl” bluntly told her new boyfriend: “find a way to get rid of them boobs…” The same guy figures his gynecomastia is why he was still single at 36. (But he had gynecomastia surgery in 2008 and declared he now feels “new born.”)

• Wrote yet another: “In the seventh grade cafeteria, I was holding a tray of food in the cafeteria and a girl asked me what size cup I had. She was trying to pinch my breasts while I was trying not spill everything on the tray.”

Other guys can be no less cruel:

• ”At a union meeting, a guy who had been drinking grabbed my breast and yelled out: ‘Look at the tits on this guy!’ I wanted to crawl under a rock and die.”

• ”When I was 11, my friends called me ‘Breasts.’ Then in high school, I was known as ‘Chesty.’ I wanted to go home and cry each time; I know it has affected my self-esteem and confidence my whole life.”

• ”I had the nickname ‘Boobula’ in high school.”

• ”A group of friends in high school wrote in huge letters on my school notebook, ‘Logan Has Boobs!’ and that started me thinking about my gyno every single day. I’m 19 now, a college sophomore and am sending pictures of my chest to plastic surgeons for help.”

(model)

Read the comments on bulletin boards at gynecomastia.org and you’ll find that teens, younger and older men are often puzzled what to tell others about an upcoming male breast reduction surgery.

First: the law of the land governs your right to total medical privacy. That law, HIPAA (Health Insurance Portability Accounting Act) requires everybody to respect your medical privacy rights.

Sure, you have to explain an absence but “medical treatments” covers it.

Telling your parents?

Teens can point to the rash of teen suicides sprung in whole or in part by school bullies who cause yet other teens to live in utter misery due to an inherited body part that makes him look different.

So go ahead and tell your folks how having “man boobs” affects your life and how others bully or put you down.

In many cases, when a teen suffers, the parents suffer right along. (Read a heartfelt letter from a concerned mom with a 15-year-old who had gynecomastia.)

As for many Dads: They can be difficult at first because they worry about the family purse strings. Because they can see nothing is wrong with you, they may say no to surgery at first. But if you let your hair down with dad, and explain the meanness in your life, they often relent.

Many wonder how – or if — to break the news to their girlfriends.

Well, if you haven’t learned yet, let me clue you in: women love intimate conversation and knowing your innermost fears because they then feel closer to you. If you are humiliated, spell it all out for her, along with your plans for male breast reduction surgery.

She probably can already see you have some bulging on your chest and likes you nonetheless. And if she’s worth her salt, she’ll be the first to understand, support and see you through recovery.

Besides, it’s very difficult to hide your surgery recovery from an intimate.

And don’t think your case is the only one. If you read the bulletin boards and forums at gynecomastia.org, you’ll find kindred souls who are going through the exact same thing.

Skip ahead on those boards and you’ll find others who had the surgery; read how their lives, along with their self-confidence – have vastly improved.

Many describe gynecomastia surgery as having a huge weight lifted from their shoulders!

(Look at somebefore and after gynecomastia surgery pictures.)

Fortunately, times have changed — for the better!

In fact, the newest, most modern and patient-friendly general anesthesia is something that has recently been in celebrity news.

I’m talking about propofol, the substance that entertainer Michael Jackson referred to as “his milk” because of its milky white color. (Read more about Michael Jackson’s death and propofol.)

But Jackson’s untimely and unfortunate death does not mean propofol is dangerous. Quite the contrary – in the right hands and settings.

Propofol, known commercially as Diprivan, is a boon to cosmetic plastic surgery patients. It takes effect quickly yet allows the patient to wake quickly when halted – and with no after effects. The combination of propofol and other medications is known as “twilight sleep” (technically, conscious sedation.)

In the past, with general anesthesia, some would awake with a 24-hour headache or bouts of throwing up. Not so with “twilight sleep” anesthesia!

I now use propofol in every case except for soy allergies. That’s where the drug gets its white color – from its soy base.

Propofol is always administered by a board-certified M.D.-anesthesiologist in combination with other drugs which have different and additive effects during surgery.

The result is a cocktail of small doses of medications which keep patients sleeping quietly and gently, breathing on their own with a quick wakeup with no nasty after effects.

Formerly, general anesthesia – also safe in the right hands — knocked the patent out so the doctor had to insert a tube in the patient’s throat and attach it to a breathing machine. The anesthesiologist then used stronger drugs to maintain the sleep.

After surgery, some patients awoke slowly with a sore throat from the throat tube and had a drug-like hangover.

Some gynecomastia surgeons say they can use only a local anesthetic like lidocaine to numb the treatment area. But I’ve found locals are not comfortable to the patient. Local anesthesia can only be used to treat very small, localized  problems.

As for Michael Jackson’s case: the maker of propofol warns that the substance is only for use in a facility where proper electronic monitoring, resuscitative and support drugs are on hand. It is routinely used only by trained practitioners in certified operating rooms.

My opinion?

Using propofol for better sleep at home – even in the presence of a doctor — is as wise as taking cancer chemotherapy drugs only because you like your head bald.

Look at some before and after gynecomastia surgery pictures.