GYNAECOMASTIA

Dr Sundeep Vijayaraghavan did his MCh in Plastic Surgery in 2004 and immediately joined Amrita Institute of Medical Sciences in the Department of Plastic Surgery. He has been working as the Professor of Plastic Surgery since 2011. His special interests are aesthetic surgery and difficult reconstructions.

Know more from Dr Vijayaraghavan on Gynaecomastia:

Who is a good candidate for a Gynaecomastia surgery?

Gynecomastia is the enlargement of the male breast. It causes a lot of embarrassment and difficulty in wearing clothing of their liking. Young adults are the usual candidates who consult a plastic surgeon for getting rid of it. Puberty is the time when there is a hormone surge and many develop gynecomastia. But most resolve naturally without any treatment. Some cases run in the family, and some are related to obesity. Use of anabolic steroids especially for body building also result in gynecomastia, which is many a times painful. Some other medicines also cause it. Some of the cases are as large as female breast and some are as small as a puffy nipple. Nowadays, more and more men are coming to improve the shape of their chest.

How can best results be derived from this treatment? Tell us about the surgical technique adopted by you?

Like any cosmetic surgery, besides removing the excess glandular tissue on the chest, an operated look should never be there. There should not be any visible scars as far as possible. It involves removal of the excess fat, all the gland and shaping the chest.

We do cross chest liposuction as well as excision of the gland through 8 mm incision in the areolar skin junction on either side. With cross chest liposuction, there is no need for any separate incision for liposuction and all the excess fat can be taken out through the same incision that is used to remove the glands. Also lot of emphasis is given for shaping of the chest. So besides of the side of chest wall, the infra mammary folds and excess fat on the front of chest up to the edge of the ribcage is taken out. Many a times, we inject fat into the muscle and under it to get a good masculine sculpted look.

What is the recovery time for a Gynaecomastia surgery and what does the post-treatment care involve?

This is a day care procedure without use of drains. The patient can return to work in a week. Massage of the sides of the chest should be done for 10 days. Pressure garments are worn under the shirt for a month. Exercise can be resumed in a month. Usually 80 per cent of swelling is gone in three weeks and final appearance is obtained in three months.

Any contraindications involved that one should be aware off? Also, is there anything the patient must not do after the procedure?

Very rare cases such breast malignancy and testicular malignancy should be ruled out. Any medicines that increase the risk of bleeding is stopped. Avoid smoking to improve healing. Lifting heavy weights and exercises with the arms are avoided for three weeks.

Gynecomastia is a risk-free surgery. Rarely there could be bruising, hematoma formation, contour irregularities, hypertrophied scarring, liquid collections and numbness of the nipple areola complex. Most are self-resolving. Sometimes small office procedures may be required to correct them.

Tell us about one of your most challenging case studies for this treatment.

Among the challenging cases, few patients that come for consultation have grade three gynecomastia, which is like a female breast. In those cases, a more radicle treatment with excision of the excess skin is needed. This may need revision surgeries as well after three months.