If you suffer from enlarged male breasts, you are not alone. Medically known as gynecomastia, enlarged male breasts can be a source of insecurity and embarrassment for men. Male breast reduction surgery can help men overcome this condition. Dr. Eliot W. Jacobs, a New York board certified plastic surgeon, specializes in treating patients with gynecomastia in NYC, NJ, and Connecticut.
For his NYC, NJ, and Connecticut gynecomastia patients, Dr. Jacobs typically performs male breast reduction surgery on an out-patient, ambulatory basis. The surgery is done in our fully accredited, hospital-type operating suite, which is certified by The Joint Commission. The surgery takes from 60 to 90 minutes and is performed under “twilight sleep” sedation.
Safe, “twilight sleep” anesthesia (see below) is administered by a board-certified MD anesthesiologist. The patient will be sleeping gently and comfortably – eyes closed, without any pain and totally unaware of the passage of time. And he will awaken quickly after surgery – refreshed, alert and with no grogginess, nausea, hangover or sore throat.
Tumescent fluid is then injected into the areas of concern through a tiny 1/8 inch nick in the skin on the side of the chest just under the armpit. This fluid, a standard technique used by every surgeon, contains additional medication to numb the tissues, different medicine to reduce bleeding and saline (salt water) which makes the tissues soft, mushy and easier to remove.
Then aggressive liposuction, performed through the same nick in the skin and utilizing Dr. Jacobs’ custom-designed instruments, is initially used to contour the breast. In some cases, this is all that is necessary since the instrument is capable of removing both fat and breast tissue. The chest wall muscle (the “pec”) is unaffected by the surgery – we obviously cannot provide additional muscle and no muscle is injured or removed. By removing the overlying excess tissues, the skin will tighten, contour and re-drape, just like tissue paper, to reveal the underlying muscular contours. In essence, the tissues “masking” the muscles will have been removed.
In some cases, there may be residual, very solid breast tissue directly beneath the areola which the instrument cannot remove. In these cases, an additional incision around the edge of the areola will facilitate direct removal of the excess breast tissue. Care is specifically taken at this point to remove sufficient breast tissue but ensure there is no “cratering.” If necessary, fat flaps are used to reinforce the support of the areola. The wound is then closed with dissolving sutures underneath the skin, so there are no external sutures to be removed.
If there is additional fat extending onto the sides of the chest or into the armpit, these fat deposits will then undergo liposuction through the same nick in the skin. If excessive armpit sweating has been a problem, this too can be addressed with a tiny incision in the armpit crease. (see a description of treatment for excess sweating elsewhere on this website). During New Jersey male breast reduction surgery, the skin of the chest will spontaneously tighten, depending upon the patient’s innate skin elasticity. In addition, the diameter of the areola will spontaneously decrease in size. Drains are rarely used.
At the termination of the procedure, the chest will have a better, more trim and contoured shape which will reveal the contours of the underlying muscles, the skin will have tightened and the areolar diameter will have diminished – all with minimal scars!
WHAT HAPPENS AFTER MALE BREAST REDUCTION SURGERY?
Routinely there will be some swelling, bruising and temporary diminished feeling in the chest and the nipples. These are all normal! All of these symptoms subside within several weeks.
The discomfort after male breast reduction surgery, which begins several hours after completion of the surgery, has been described as “an intense chest muscle burn” and mostly disappears within 2-3 days. Pain killers are prescribed as well as an antibiotic to prevent infection.
Most men are able to return to sedentary-type work within three to seven days after the surgery. A snug compression garment will be placed on the chest and should be worn under one’s clothing for approximately four weeks. Strenuous exercise and sports may begin four weeks after surgery. Complete healing may take from three to six months.
WHAT TYPE OF ANESTHESIA IS USED?
Virtually every case in New York & New Jersey has been performed under very safe “twilight sleep” (technically called conscious sedation) anesthesia, which is administered by a separate, board-certified, MD anesthesiologist. The anesthesiologist’s job is to keep the patient comfortable and safe while Dr. Jacobs concentrates on the surgery.
During surgery, the patient is sleeping gently with his eyes closed, unaware of the passage of time and in no pain. Dr. Jacobs will then administer injections of local anesthetic, which are not felt because the patient is asleep. The combination of local anesthetic and intravenous sedation provides for painless surgery.
At the completion of the surgery, the patient will awaken virtually immediately, with no nausea, vomiting, grogginess or hangover. He will be immediately alert and oriented and may even inquire about the operation. It is our belief that this technique provides the best, most pleasant and safest anesthetic experience for the patient.
General anesthesia, in which the patient is rendered unconscious, requires that a tube be placed in the patient’s airway and a machine used to breathe for him. This type of anesthesia is not used in the office operating room environment. Sometimes, due to a patient’s request or medical necessity, male breast reduction surgery is performed in a local New York hospital and general anesthesia may be used.
In a small percentage of specific cases, local anesthetic may be used for surgery. In these cases, the patient is awake and injections of local anesthetic serve to numb the chest. Local anesthesia is not sufficient if any liposuction will be used during surgery.