Revision Gynecomastia Surgery in New York, Connecticut, New Jersey

REVISION MALE BREAST REDUCTION SURGERY IN NEW YORK

Many men, from New York and around the world, who have had male breast reduction surgery are not satisfied with their results. Sometimes the results were actually acceptable, but the men were being hyper–critical. Other times, the goal of a trim, taut and contoured chest has not been achieved and the results are simply not acceptable. There may be loose skin, malposition of the nipple, irregular contours, cave–in of the areolar area (termed a crater deformity), too much residual tissue present or conversely too much tissue removed, poor scars, a large build–up of scar tissue under the skin or nipple, residual pain or tenderness, retained numbness, or any combination of the above.

All too often, after having been concerned with their gynecomastia for years, these men have had surgery and expect a perfect chest the very next day. Obviously, this is impossible. But many guys do tend to draw premature conclusions about the results of their surgery before everything has had a chance to heal, settle down and mature. It must be emphasized that all surgery heals with scar tissue and scar tissue and swelling take time to settle down after surgery – usually a minimum of six months or more. Hence, any consideration of revision surgery should be delayed until at least six months or more have elapsed since the original operation.

Please bear in mind, secondary or revision surgery is much more difficult and less predictable due to the natural scarring processes that result from the initial surgery. In essence, your first operation had to deal with only fat and breast tissue. Your revision surgery has to deal with fat tissue, breast tissue and scar tissue as well. In a sense, you do not have "virgin" breasts. Therefore, improvement – and sometimes significant improvement – is the goal for these operations. But perfection is rarely obtained. It is therefore important that you be realistic in your approach to revision male breast reduction surgery. Dr. Jacobs will do his best to inform you of the realistic expectations for your own particular operation.

WHAT ARE MY FIRST STEPS TO CONSIDER REVISION GYNECOMASTIA SURGERY IN NEW YORK?

While post–op photos sent by email are helpful, nothing will take the place of an actual hands–on physical examination by Dr. Jacobs. Therefore, a consultation in New York is most important. Be sure to bring photos of your chest prior to your original surgery and, if possible, a copy of the surgeon’s operative report, in which he details precisely what was done during your original surgery.

After reviewing your pre–op photos and operative report, and after taking your medical history, Dr. Jacobs will examine you. He will then discuss his findings, make recommendations for you and diagram and explain what should be done. Please understand that every single male breast reduction revision operation is unique and must be designed specifically to address the specific problems of the individual patient.

WHAT TECHNIQUES ARE USED FOR REVISION MALE BREAST REDUCTION SURGERY IN NEW YORK?

Revision gynecomastia surgery may require any combination of available techniques to achieve a smooth chest with a uniform pinch layer of skin and fat over the chest muscle. For example, if there are irregular areas of too much or too little tissue, surgery will be directed towards “leveling the playing field” by “lopping off the tops of the mountains” and “filling in the valley floors.”

Usually, the depressed areas of the chest are treated by filling them with one’s own fat tissue. If there is sufficient surrounding fat on the chest, then these tissues may be used by surgically loosening them, moving them into the areas of depression (“crater” deformity) and then suturing them together. This technique is called a “fat flap” and has been available to trained plastic surgeons for decades. If there is insufficient surrounding fat or if there is only a very small area of depression or a skin dimple, then a “fat graft” may be performed. In this procedure, fat from another part of the body is “harvested”, cleansed and then carefully injected into the depressed area. On occasion, more than one fat graft operation may be required.

Once the depression has been addressed, then additional, very precise liposuction of surrounding excess residual tissues can be performed. This is sometimes very difficult because some of the excess residual tissue may indeed be scar tissue, which is very difficult to remove with liposuction alone.

Sometimes excess gland tissue (under the areola) has not been properly removed at the first operation and therefore surgery will be directed to removing additional gland so that the areola lies flat with the surrounding skin. It is always easier to remove excess tissue than to replace tissue that was excessively removed.

There may also have been a build–up of scar tissue directly beneath the areola. If this is the only problem, then frequently revision surgery can be avoided by injecting some cortisone into the scar tissue, which will “melt” it and allow the areola to settle down. Sometimes more than one injection of cortisone will be necessary.

If the scars from the original male breast reduction surgery are objectionable, then scar revision surgery may be suggested. This is an operation to remove the scar and then reconstruct it and suture it again so that it should heal better. It will, however, result in a new scar in place of the old scar – there is no present method to remove scars and replace them with virgin skin. Finally, even with every effort made by the surgeon, it is your body that heals a wound and makes the scar. There are absolutely no guarantees as to how a revised scar will heal again.

Lax skin with or without malposition of the nipple (it sits too low on the chest) will also be evaluated. If lax skin or a low–lying nipple is present six or more months after surgery, then excision and direct removal of that skin and elevation of the nipple would be recommended – but there is a price. The price is additional, permanent scars on the chest. And while these scars will face in time, they will always be present. Hence, removing excess skin will be a trade-off of tighter skin for additional scars.

Numbness or its converse, sharp pain, are very difficult to treat with any type of revision surgery. Sometimes a nerve which causes pain may be caught up in scar tissue and injection of cortisone may be of help. Other times, repeat liposuction can be of help. But many times there is no way to restore sensation to the skin and the nipples if feeling has been lost. In rare cases, some sensation does return spontaneously over an extended period of time.

In sum, by utilizing any or a combination of the above techniques, improvement (not perfection) can often be achieved. And then one must be patient and allow the revision surgery to settle down, which will also take six months or more.

Finally, in very rare cases, there may unfortunately not be anything that can be done.

WHAT CAN I EXPECT AFTER REVISION MALE BREAST REDUCTION SURGERY IN NEW YORK?

As in your first gynecomastia operation, there will be a period of swelling and bruising. It will take many months for the final shape to emerge. There may be asymmetry initially, for different reconstructive techniques may have been used on either side in an attempt to achieve symmetry. Remember, scar tissue (present from your first surgery) does not behave the same as normal tissue. Even the injected anesthetic does not spread out through the tissues as easily or predictably – all due to scar tissue. You must be patient and allow appropriate healing to occur – at least six months or more. Ultimately, the result may not be perfect – but it should be perfectly acceptable and certainly an improvement over your original condition.