SEBASTIEN GARSON M.D
This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use surgery baldness. The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.
• DEFINITION OBJECTIVES AND PRINCIPLES
Gynecomastia is defined by an increase in the volume of the mammary gland in humans. It is a uni-or bilateral hyperplasia. Generally it is idiopathic, meaning there is no cause its occurrence, but in some cases it may be related to abnormal hormone production, or related to the use of certain medications. A balance is needed to eliminate a possible cause. This review will aim to assay the various hormones known to seek an testicular or pituitary tumor. A mammogram or ultrasound may be applied to analyze the density of the gland, or eliminate breast cancer in the older man, especially in case of unilateral form. If a cause is found, it will be subject to special treatment. Indeed, when a cause is found, treatment it may allow more or less complete regression of gynecomastia.
The breast enlargement in men, particularly during adolescence, is often resented and can cause many psychological problems. This physical harm in adolescents, even as he built his image as a man, can cause withdrawal itself, or a real complex. Moreover, this can be painful gynecomastia.
From an anatomical and pathophysiological point of view, the mammary gland is in normal humans, but it is infantile, reduced to a single mammary bud. In some cases, the mammary gland can develop if the hormonal environment is conducive.
If no cause has been found and if the patient is uncomfortable, surgery may be proposed, provided that the patient is in good physical and mental shape. We call this kind of intervention a "cure gynecomastia."
WHAT LOOKS gynecomastia
It is a development of the mammary gland centered on the areola, usually bilateral and symmetrical, firm and tender to palpation. The gynecomastia are differentiate adipomasties which are much more common and correspond to a local accumulation of fat. These adipomasties are not centered over the areola, consistency is soft, insensitive, bilaterally symmetrical, but both can be associated (adipocytes gynecomastia).
Adolescents may appear transient gynecomastia due to hormonal imbalance in favor of estrogen, disappearing in a few months.
Breast cancers have a different presentation, it is a rare form, affecting humans usually after age 40. These are unilateral lesions, hard, insensitive, associated with deformation or retraction of the nipple or a bloody discharge.
The purpose of the corrective surgery is to restore normal anatomy better with the principles of:
• reduce breast size by direct surgical excision (subcutaneous mastectomy) for glandular forms, or liposuction for fat forms. In the case of mixed forms, the surgeon must combine the two techniques,
• reduce excess skin: Generally, the decrease in glandular volume will allow skin retraction. This skin retraction is aided by liposuction but it is even more clear that this is a young man and the skin is of good quality (skin firm, elastic, no stretch marks). Some post-operative procedures such as massage can help the skin retraction.
In some cases, where the excess skin is too large, the surgeon may need to be reduced, but at the cost of scars on the skin. This reduction plasty skin can be performed right the first time or secondarily.
• BEFORE THE OPERATION
The results in the search for a cause of gynecomastia has been described above.
Obese men or overweight, a diet combined with exercise is introduced as a weight loss may reverse or even get rid of gynecomastia (adipomastie). Depending on the anatomical context, preferences and habits of the surgeon, and the wishes of the patient, a surgical strategy has been decided. Be predetermined and the surgical technique used and the location of scars (see section "Intervention").
A usual preoperative assessment is conducted in accordance with regulations. The anesthetist will be seen in consultation at the latest 48 hours before the procedure. Your surgeon and anesthetist should be informed about all the medicines you take. In fact, some of them can interfere with anesthesia or promote bleeding.
Except in special cases, any medication containing aspirin or anti-inflammatory drugs should not be taken within ten days prior to the operation.
Smoking cessation is recommended at least one month before and one month after the intervention (smoking can cause a delayed healing).
• TYPE OF ANESTHESIA AND CONDITIONS OF INTERVENTION
Type of anesthesia: it is most often a conventional general anesthesia, in which you sleep completely.
In some cases, anesthesia "vigil" (local anesthetic depth by tranquilizers administered intravenously) or even a local anesthetic may be used, however (to be discussed with the surgeon and anesthesiologist).
Terms of hospitalization intervention usually requires a hospital stay of 24 hours to 48 hours. The duration of hospitalization, however, depending on the surgical technique used. Indeed a simple liposuction require shorter than subcutaneous mastectomy hospitalization.
The entrance is usually done in the morning or even the day in the afternoon. In some cases, the procedure can be done in "ambulatory", that is to say with out the same day after a few hours of monitoring.
Each surgeon adopts a technique of its own and it adapts to each case to obtain the best results. However, it may hold common basic principles.
In the standard procedure, an incision is made at the lower edge of the areola. From this incision, the surgeon can remove the mammary gland (subcutaneous mastectomy) and excess grease. Often in addition to this move, the surgeon can perform liposuction on the outskirts of excess glandular to harmonize all.
If gynecomastia predominantly fat, resection may be sometimes liposuction alone. The scars are so very short and can be located at a distance of gynecomastia, as in the regions under the breast or underarm.
When gynecomastia and excess skin is very important, the surgeon may need to be longer and thus more visible scars. These scars can then be peri-nipples (around the areola), horizontal and extend to either side of the areola. In extreme cases the surgeon may need to graft the areola and nipple. Other types of scars are possible (vertical tail racket ...), they depend on each individual case.
During the procedure, a drain may be implemented depending on the technique used and the habits of the surgeon. This drain is used to remove the blood and lymph residues that may accumulate at the surgical site.
At the end of surgery, a dressing "modeling" is made, often with an elastic bandage.
The response time varies depending on the surgeon and the technique used, ranging from a few minutes in case of isolated two hours for complex shapes requiring a major reduction liposuction.
In some cases, we may request support from Social Security.
AFTER THE INTERVENTION: THE OPERATING SUITES
The postoperative course can sometimes be painful the first few days. Analgesic treatment adapted to the intensity of the pain will be prescribed for a few days. For individual liposuction, the patient may experience pain locally to type "very sore muscles." Edema (swelling), bruising (bruises) and interferes with elevated arms are frequently the first time.
The first dressing is removed after a few days. It is then replaced with a lighter dressing. Often the initial pan-ment is compressive, then quickly a lighter dressing is associated with a vest restraint to wear day and night for some time. This contention helps skin retraction and promotes even healing.
The total time off work varies from five to twenty and one day. It is advisable to wait one to two months before resuming sports.
The scar is a mandatory sequelae of surgery. The goal of the surgeon is to get a scar of the highest possible quality. Scars change for one or two years after the intervention: they are primarily white and fine the first month, then turn pink or red and indurated until the fourth month. Then they gradually whiten. It is imperative to protect them from the sun during the first year.
The length and location of scars vary depending on the surgical technique (see section "Intervention"). Their quality depends on the surgical technique and patient-specific factors (age, skin type and quality ...).
In all cases, the evolution of the scar must be rigorous and prolonged surveillance.
• THE RESULT
The improvement is often sharp and immediate. However, within two to three months is necessary to assess the final outcome. This is the time required for post-operative swelling disappears and the excess skin retracts. Beyond this period, the tissues become more flexible over time.
The decrease in breast volume provides physical comfort, especially when clothing. Finally, the result is often very beneficial psychologically as gynecomastia is often seen as a shadow to manhood.
Regarding the stability of the results, several cases are possible. For pure glandular forms glandular excision usually prevents recurrence. However, a significant weight gain may be accompanied by a new breast enlargement (adipomastie) and this is even more common for forms predominant fatty component.
• FAULTS OF THE RESULT
Some occasional imperfections can meet-ing:
• a residual volume asymmetry: it may be due to a smaller excision of one side than the other, especially when there was already a mismatch volume before surgery. In some cases, the asymmetry may be related to a larger one side postoperative edema: in this case, wearing a jacket and massage action will correct the defect. When the asymmetry persists a year after surgery and if it is inconvenient, surgical correction can then be proposed.
• asymmetry height areolas and nipples: the asymmetry is often present before surgery, however, you will not wear that little attention to even, you had not noticed. After the intervention, even if the surgeon tried to correct the asymmetry can persist and sometimes be "unmasked", ie made more visible.
In other cases, the asymmetry can be related to scar tissue under the skin. Daily massages associated OF a good hydration will help to correct the problem.
• a cupulisation the areola: it can be linked to a glandular excision too focused behind the areola without peripheral harmonization. If it is bothersome, surgical remodeling could be proposed.
• an excess skin: after surgical correction of gynecomastia, excess skin is not uncommon and can take several months to retract. Skin retraction is related to the quality of the skin. A touch can be desirable.
• recessed areas or small nodules under the skin: they are related to liposuction which in some cases may increase the appearance of "cellulite". This is normal: the daily massages associated with proper hydration will split these fibrous nodules and prevent adhesions depth (aspect of "cellulite").
• On the question of the evolution of scars, it was mentioned above.
The nipple sensitivity is generally not affected, or transiently during a few months. The insensitivity is exceptional. However, when the surgeon is required to graft the nipple-areola complex, it may become permanently insensitive and can be dis-orders in skin color (discoloration).
• POSSIBLE COMPLICATIONS
A cure gynecomastia although carried out mainly for aesthetic reasons, are nevertheless a real surgery, which involves risks associated with any medical procedure, however small it may be.
The postoperative course is generally simple with the waning of a cure gynecomastia. However, complications can occur, some general, inherent in any surgical procedure, more specific in the locoregional treatment of gynecomastia.
We must distinguish the complications of anesthesia and those related to the surgery.
Regarding anesthesia, during the mandatory pre-operative consultation, the anesthetist inform himself the patient anesthetic risks. You should know that anesthesia in the organism at times unpredictable and more or less easy to control reactions having recourse to a fully qualified anesthetist working in a surgical context that the risks are become statistically extremely low.
It must be borne in mind that the techniques, anesthetics and monitoring methods have made tremendous progress over the past thirty years, providing optimum safety, especially when the procedure is performed outside the emergency in a healthy person.
Regarding the surgery, choosing a qualified and experienced plastic surgeon, trained in this type of surgery, you limit these risks, without removing them completely.
In practice, the vast majority of cures gynecomastia conducted studies going without any problems. Postoperative patients are simple and are fully satisfied with their results. Yet sometimes complications can occur despite all
• Postoperative Bleeding and hematoma: bleeding can occur within hours after surgery. If it is important, it will result in swelling and painful tension (hematoma) and will require an act of evacuation.
• phlebitis and pulmonary embolism: the resumption of work very early to minimize this risk.
• serous effusion, an accumulation of lymphatic fluid in the area of mastectomy is sometimes observed. Also referred to lymphocele or seroma. It may require one or more punctures to evacuate.
• postoperative infection: it can occur in the days following the operation and results in fever, sometimes higher than 39 ° C. days The surgical area is then swollen and red and painful. Antibiotic treatment may be sufficient, but often a surgical drainage is required.
• Skin necrosis, the skin needs a good vascular supply (oxygen), to live. If the blood supply is insufficient or of poor quality (significant traction, hematoma, infection, smoking ...), skin necrosis can occur. It will be treated with appropriate care and dressings. The healing will be achieved but with some delay.
• Pneumothorax: very rare, it will benefit from a specific treatment.
• abnormal scars: the surgeon did his best to make beautiful stitches, but healing is a random phenomenon and sometimes the scars are not as discreet as necessary. In the same person, depending on the region of the body, healing may be different. Thus, the development of scars may be unfavorable to the development of hypertrophic scars or keloids, devolution and unpredictable occurrence that may jeopardize the aesthetic result of often lengthy and require specific local treatments.
• Disorders of the skin sensitivity altered skin sensitivity is common the first few months before then fades back to normal. Rarely, may appear poor sensory information with exaggerated sensitivity, these cases require special treatment. As we saw earlier, when the surgeon is required to graft the nipple-areola complex, it can remain permanently numb.
In total there should not overstate the risks, but just be aware that surgery, even seemingly simple, still a small share of hazards. The use of a qualified Plastic Surgeon ensures that it has the training and knowledge required to avoid these complications, or effectively treat if jurisdiction.
These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.
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