This is a surgical procedure to treat Gynaecomastia, the enlargement of the glandular component of the male breast, unfavourably nicknamed ‘man boobs’.
Gynaecomastia is a dual component problem of excessive breast glands and fat tissues that cannot be eradicated through diet and exercise alone. Through using the latest, surgical devices and pioneering his own successful methods, Mr Karidis is one of the UK’s leading surgeons in Gynaecomastia.
The term gynaecomastia (pronounced guy-neh-co-mastia) is Greek for woman's breast and it was first coined by Galen, a second century AD physician. It is used to describe excess glandular or fatty breast tissue in a man and it comes in a variety of degrees ranging from very mild to significant enlargement accompanied possibly by sagging of the skin.
The breast, whether male or female, is made up of basically two components and is of course covered by the skin. The main internal components are the glandular tissue component (firm, dense and hard) and the fatty tissue component (softer tissue). The ratio of glandular to fatty tissue in any breast varies from individual to individual. Although strictly speaking gynaecomastia refers to enlargement of the glandular component of the breast, in reality for most patients there is an excess of both fat and glandular tissue.
Although the exact cause of male breast enlargement is not as yet entirely clear, there can be no doubt that it is basically a result of the actions of circulating hormones on specific cells in the breast area. The vast majority of the time the cause is developmental, whilst in a smaller percentage this is linked to the use of certain drugs(i.e. anabolic steroids, Finasteride). Some researchers feel an imbalance in the male to female hormone ratio of the male body(yes, males do have quantities of female hormones circulating in their bodies!) rather than the absolute level of these hormones is significant in the development of this condition. There is also very often a genetic(or hereditary) element in the cause of gynecomastia. Although sometimes this condition appears at birth the principal time it is arises is during puberty as this is the time when increased hormonal activity starts to occur. In fact some studies suggest that as many as 65% of boys in the 14-15 year age group encounter this. Within 2-3 years the incidence drops radically so that the condition affects only about 8% of males of 18 years of age. However the incidence rises again with progressive age reaching an incidence of about 30% in older men. Predictably therefore there are large variations between the degrees of breast enlargement encountered. What's important to remember is that the condition is mainly and largely, a normal finding, although as noted very rarely it can be associated with drugs(marijuana in large quantities) or organ disease. This will be ascertained at the initial consultation.
This will depend on what the cause is. If the development of your gynecomastia is drug associated then it is possible that upon cessation of the offending drug, the enlargement may subside. In this case, it may however require anywhere from a few months to even a couple of years for it to resolve, if it’s going to resolve. If the cause is developmental, then the chances of a spontaneous resolution will depend on your age. In general the younger you are, the more likely the chance that it will resolve on its own. However, once a patient gets to 16 years or older, then the chances of self-resolution greatly diminish.
In general, once gynaecomastia has become established, there are no physical repercussions to speak of, although some men report occasional discomfort when the breast is pressed upon. The most commonly reported impact however is usually a psychological one. Thus it is quite usual for men to report feeling very conscious of their condition, stating that it affects what and how they wear their clothes, shirts, t-shirts etc. as well as curtailing their ability to participate in certain activities that require them to be topless e.g. swimming.
Although it is always important to remain physically fit and healthy, and to keep your weight within the normal range, unfortunately it is not always possible to reduce your gynecomastia with exercise or diet. This is because the majority of the time, the problem is excess glandular tissue which unfortunately no amount of exercise or healthy eating will eradicate. Conversely many men report than when they do lose weight, the gynecomastia actually looks worse. This is because as the fatty tissue around the gland shrinks with weight loss, the gland subsequently stands out more, making the condition appear more prominent.
The predominant treatment to deal with gynecomastia is surgical. As mentioned previously the problem of gynaecomastia is that it’s usually is a dual component problem, i.e. excess of both breast gland and fat. As such a combined surgical approach is necessary in order to achieve the flat chest that most men desire. In order to reduce the fatty component, liposuction is used. More particularly, Mr. Karidis firmly believes that Power Assisted Lipoplasty (PAL) is the gold standard to treat gynecomastia and that this has significantly increased our capability of reducing the enlarged male breast(see Liposuction notes). As a result Mr. Karidis is pleased to be able to offer this technology for the benefit of his patients. Nonetheless, it is also important to remember however that despite the advent of PAL most patients will require, an additional surgical incision, usually around the nipples to deal with the other component of the problem, the excess gland which is situated just beneath the nipples. In Mr. Karidis opinion, he feels that all men will require removal of gland to some degree or another. Mr. Karidis has developed his own pull-through technique which only requires a small 7-9 mm incision under the nipple, from which he is able to remove the excess glandular component of the problem. By utilising this dual approach, Mr. Karidis ensures that you will achieve the flat chest you desire. In very rare cases where patients have undergone large weight fluctuations or reductions, such patients also experience sagging of the skin. In these rarer situations, some form of skin removal and tightening will also be required. Obviously in these situations the scars will be significantly longer and more visible, and the healing time will also be prolonged. In Mr. Karidis experience, this group of patients is proportionally tiny and the overwhelming majority do not require skin removal. Of course this will be determined and explained to you at the time of your consultation.
Only a consultation will be able to determine if you are an suitable candidate for a combined liposuction/gland removal procedure. A consultation preoperatively accomplishes several objectives. A thorough medical history and appropriate physical examination will be taken to ascertain your health status. If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications can cause increased bleeding, so you must avoid these. Determining your suitability will partly be defined by the quality of your skin. In most cases as the skin is a dynamic organ responding to your normal weight fluctuations, it is able to shrink and re-accommodate to the new body contour after liposuction and gland removal. In the some cases however, whereby patients have decreased skin elasticity as witnessed by loose, hanging, or crepey skin in the affected area, liposuction alone will not produce the desired result. In these situations some form of skin removal/reduction will be required instead in combination with liposuction and gland removal. This will be discussed at your consultation. The best patients for Liposuction and gland removal are those individuals who are active and healthy, of average or near average weight (within 10-15% of their ideal weight), and have reasonably good skin tone and elasticity. Age by itself is not a significant factor and in fact patients from age 16-65 have benefited from liposuction.
The following description below pertains to gynecomastia correction using liposuction and gland removal with no skin excision necessary. Firstly liposuction, using the Power Assisted Liposuction technique is performed(please see here for details). Throughout the Liposuction procedure Mr. Karidis is always conscious of leaving a smooth layered thin blanket of fat attached to the underside of the skin, in order to minimise the possibility of any irregularities or rippling of the skin. Once the required amount of fat is suctioned from around the breast gland, the gland is then more easily accessible and can be 'pulled through' more readily through a small, 7-8 mm incision at around the 6 o’clock position of the areola(red area around the nipple). The gland is usually removed in piecemeal fashion. This piecemeal removal avoids the need for a larger incision which would have been required to remove the whole gland in one piece. During the removal of the breast gland, Mr. Karidis ensures that he removes about 99% of the gland. A small amount of breast gland must be maintained in order to support the areola and to avoid unsightly dips and irregularities in the region. As the incisions are tiny, they do not require sutures and are left to heal on their own. A compression vest is then supplied for you in order to apply some pressure to the region for about 10 days. When skin excision is also required, due to excessive sagging, the ensuing scar size and positioning is different and will be explained to you at the time of the consultation. In these situations the operation details are more along the lines of female breast reduction (see our Breast Reduction page).
The short answer to this is no. As fat cells have achieved their set number in any given part of the body by puberty, increased caloric intake will not lead to volume gains in the treated site. It is however important to maintain your weight afterwards by sensible eating and regular exercise. This is because, if you do put on excess calories after surgery, you will notice that other areas of your body may be then be affected. The only exception to this rule is if there is a massive weight gain. In this case new fat cells can be seen in the previously treated area. As Mr. Karidis removes about 99% of the gland volume very little remains to enlarge and therefore it is exceedingly rare for the condition or gland to reappear, provided you do not stimulate the gland through external factors i.e. drug use.
After your surgery, you will find that you are fitted with a snug elastic compression sleeveless vest. This must be worn over the chest area to control swelling and bleeding, and to help your skin shrink to fit your new contour. You will need to wear this compression garment continuously for about two weeks (apart from taking it off for a shower) after surgery. After this time, you may wear the garment, if you feel the need for only a few hours in the day to help support the area in the last few weeks of the healing process which can last 2-3 months.
The success of this operation depends on the good elasticity of the patients skin. The vast majority of patients have degrees of gynecomastia that are not excessively saggy and so in these instances the natural skin elasticity will ensure that the skin snaps appropriately into a more aesthetically pleasing position. Of course the application of the garment that you will be given will also help to guide the skin back into the desired position in the immediate postoperative healing period.
After the surgery you may notice some bloody fluid draining from your incisions. This is just the normal drainage of fluid(usually bloody) that occurs after surgery during in the first 24-36 hours postoperatively. This is actually very good and is invaluable in reducing overall postoperative swelling and bruising. Drainage of the fluid is possible because, unlike traditional teaching, Mr. Karidis does not use stitches to close the small incisions. As the incisions are very small, these seal off and heal quite quickly on their own and the ensuing scar is no different, if not better, compared to the use of stitches. There is also the obvious advantage in that it negates the need for stitch removal. The down side of this practise is that during the first day or two, your dressings and clothing will usually get soaked quite quickly and therefore you will require regular changes. Thankfully all this usually stops by the end of the first 48 hours after surgery. Despite the wound drainage nonetheless you are also likely to experience swelling and bruising to varying degrees. Occasionally this bruising is quite spectacular. Bruising can take up to 3 weeks to disappear although very occasionally a light tinge of yellow can still be seen in the skin up to 2 months following treatment. Obvious tissue swelling, while expected, can last up to 4 weeks. Any pain you experience will be controlled through prescribed pain relief.
At around 2-3 weeks after surgery, you will discover that the areas treated will feel hard and irregular. This is part of the normal healing response. The body starts to lay down scar tissue (which is hard in nature) in response to surgery in an attempt to 'heal' itself. This scar tissue can also block lymph drainage channels temporarily and occasionally cause the skin overlying the treated area to look dimpled or take on an 'orange skin' appearance. Thankfully the scar-build up ceases and eventually resolves completely, along with all of its manifestation. However this period of hardening and irregularity can take up to 6 months to resolve. You will also experience sensory changes in the area treated. This may result in numbness of the skin or alternatively it may feel hypersensitive. Either way this is usually temporary and returns to normal in about 6-8 weeks. Overall because of these effects, it's not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better.
Scars are not a complication but a normal event after any surgery. As described, tiny scars of about 3-8 mm in length will form. Thankfully the scars in Liposuction and gland removal generally heal quite well, gradually fading with time. However it is important to keep in mind that this may take up to two years to complete. If you are of a darker skin type however, then expect your scars to be darkly colored for a longer period of time (about 3 years). Daily massage of the scars, from about 4 weeks post operatively, is advised to expedite and facilitate this process. This will be explained more to in your follow up visits. You must understand however that no responsible surgeon will ever be in a position to predict any scars ultimate appearance.
All surgery carries some uncertainty and risk. When gynecomastia is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. Thus complications that can occur include thickened, deeply coloured or unattractive scars at the site of the small incisions; irregularities of contour or dimpling of the area treated; unevenness or asymmetry between sides; prolonged numbness and swelling; haematoma or seroma formation (a collection of blood and fluid under the skin that must usually be drained by the surgeon), and infections. In extremely rare cases, skin loss resulting in permanent scarring has been reported. Despite any surgeons best efforts, it is however possible that a small number of patients may require a secondary tidy up procedure, usually after 9-12 months, to correct or improve any residual uneven contour or shape irregularity. This will be determined at the follow up checks. You can reduce your risks by closely following your surgeon's advice both before and after surgery.
The recovery time varies with every patient and the type of activity the patient intends to resume. It is important to realise that although only tiny incisions are made, liposuction creates a large wound hidden under the skin and therefore as healing is a gradual process, adequate rest in the days after surgery will be required. However you should start walking around as soon as possible to improve the circulation and avoid stagnation of blood which could lead to the formation of blood clots. Most patients resume light activities within 2-3 days and depending on their work can be back between 3-7 days. However because of variations in swelling and bruising, sometimes this may be delayed up to 10 days. Exercise is usually recommenced at about 2-3 weeks. Don't be depressed however if it takes you longer to resume your full activities. Remember every individual is different and great variations occur.
There are very few forms of surgery that are completely painless. Discomfort is a euphemism for pain and many doctors use these interchangeably. In the case of gynecomastia correction with liposuction and gland removal, the degrees of pain vary from patient to patient, but this can be controlled by pain killers, which will be prescribed. The initial pain lasts around 1 week however there may be residual soreness in the treated area, mainly upon palpation, for up to 4-5 weeks. Along with the soreness you may experience some stiffness which usually abates as your mobility increases.
Gynecomastia correction using liposuction and gland removal takes approximately 40 minutes. In the event that skin removal is necessary then procedure can take up to 2 hours.
Gynecomastia correction can be performed successfully either with a local anaesthetic alone, local anaesthesia with mild sedation (twilight anaesthesia) or with a General anaesthetic (completely asleep). If you decide to have it done with a local anaesthetic, you will probably feel some vibration and friction during the procedure and to some patients this may be uncomfortable. You may also occasionally feel a stinging sensation as the cannulae moves closer to the muscle. Obviously if you are put to sleep then you will not be aware of anything, and for many patients this is the preference of choice as it only involves a very light general anaesthetic with quick recovery. The decision will very much depend on the patients individual circumstances and desires. Such decisions are best made after a thorough consultation and discussion with Mr. Karidis.
In accordance with the National Healthcare commission guidelines, and according to the last ten years of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis performed on average 80 procedures per year. It is easy therefore to understand therefore that having been in private practice since 1997, Mr. Karidis has performed a large number of these procedures.
SENIOR NURSE PRACTITIONER KAROLINA SAYS...
"Sleep with your upper body slightly elevated to help quicken any reduction in swelling and bruising."
SENIOR NURSE PRACTITIONER KAROLINA SAYS...
Sleep with your upper body slightly elevated to help quicken any reduction in swelling and bruising.
NURSE SUZI SAYS...
"A balanced healthy diet, rich in protein will help you heal from surgery - try drinking a fresh green juice every morning"
NURSE SUZI SAYS...
A balanced healthy diet, rich in protein will help you heal from surgery - try drinking a fresh green juice every morning
NURSE SUZI SAYS...
"Write down any questions and take them into your consultation with Mr Karidis – that way you won’t forget anything"
NURSE SUZI SAYS...
Write down any questions and take them into your consultation with Mr Karidis – that way you won’t forget anything
NURSE SUZI SAYS...
"Prepare your body for surgery by keeping it soft and supple by moisturising skin twice daily (avoid vitamin E containing products)"
NURSE SUZI SAYS...
Prepare your body for surgery by keeping it soft and supple by moisturising skin twice daily (avoid vitamin E containing products)
NURSE SUZI SAYS...
"Always wear sun block (SPF 50+) over surgery scars to stop pigmentation "
NURSE SUZI SAYS...
Always wear sun block (SPF 50+) over surgery scars to stop pigmentation
NURSE SUZI SAYS...
"Stock up on comfy lounge wear for after your surgery – front opening tops are ideal"
NURSE SUZI SAYS...
Stock up on comfy lounge wear for after your surgery – front opening tops are ideal