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Gynaecomastia Explained
According to Sydney plastic surgeon Dr Kourosh Tavakoli,
chest or 'pec' implants are an ideal solution for men born with
chest wall deformities or for those who simply want to have a
better developed chest. Lise Petersen reports.
Gynaecomastia is a condition that affects a surprising number of
men (up to 30%). It involves the development of breast tissue
and according to Sydney plastic surgeon Dr Kourosh Tavakoli,
gynaecomastia may be associated with obesity, hormonal
metabolism imbalance, liver disease or medicinal abuse such as
the excessive use of anabolic steroids. There are two options
that are usually used to treat this condition, depending on what
is actually causing the enlarged breasts - either liposuction or
traditional surgical excision. 'In my consultation with patients
I ask them to explain their goals and expectations of the
surgery,' says Dr Tavakoli. 'Then I assess the nature of the
patient's breasts and the elasticity of their skin to determine
the cause of the breast enlargement. It may be caused by fatty
tissue and/or glandular tissue.' If the patient's gynaecomastia
is primarily caused by fatty tissue, Dr Tavakoli says
liposuction is usually the procedure of choice. 'Liposuction
surgery is a procedure used to actually remove unwanted
localised deposits of fat cells from the body,' he explains. 'A
cannula is inserted through a tiny incision placed in an
inconspicuous location on the skin. Using a vacuum system
attached to the cannula, excess fat cells are sucked out. The
result is a resculpting of bulging breasts into more attractive
contours.' If the patient's gynaecomastia is the result of a
glandular disorder, he says liposuction alone is not likely to
be adequate: 'Traditional surgical excision may be a better
option in this case. The excision may be performed alone or in
conjunction with liposuction. Typically, the incision is placed
on the edge of the areola (coloured area of the nipple). These
incisions are worked through to cut away the excess glandular
tissue, fat and skin from the breast.' Dr Tavakoli adds that if
the patient's breast reduction requires the removal of
significant amounts of tissue, larger incisions may be required,
and if the gynecomastia is extreme, and large amounts of fat
and/or glandular tissue have to be removed, excess skin may also
have to be excised. Prior to choosing a surgical solution to
gynaecomastia, Dr Tavakoli recommends a period of diet and
exercise. Should that fail, he says surgical intervention may be
indicated. Male breast reduction is performed on an outpatient
basis using general anaesthesia. The procedure can last from one
to three hours depending on the required extent of correction.
Patients will experience some pain for several days afterwards
but this can be controlled with oral medication. Antibiotics may
also be prescribed. Bed rest is recommended for the first day
after the procedure, and for the first few days following
surgery, patients are required to wear surgical dressings, which
will then be exchanged for a special compression garment. This
will be worn for about two weeks. Most men experience some
degree of swelling, bruising and minor tenderness but Dr
Tavakoli says these
symptoms usually subside in a short time.
Most patients are back to work within the first week. Surgical
risks may include infection, bleeding, asymmetry, scarring, and
muscle and/or nerve damage. Recurrence is high amongst steroid
users. 'Gynaecomastia patients tend to be some of the happiest
cosmetic surgery patients that I have in my practise,' explains
Dr Tavakoli. 'The improvement seen in their psyche and
confidence level is quite remarkable.'
There are two major groups of men who seek pectoral implant
surgery,' says Sydney plastic surgeon Dr Kourosh Tavakoli. 'The
first group consists of men who are born with chest wall
deformities such as pigeon chest or Poland's Syndrome (lack of
one side of the pectoralis muscle). Most of these patients think
correcting these problems is a huge operation that requires
major rib reconstruction. However for these men, the deformity
can be camouflaged well with pec implants.' In these cases Dr
Tavakoli says it is necessary to make a customised implant that
fits the defect. 'The customised implant may not be put under
the muscle, instead it is placed under the skin and it can give
the chest a more aesthetic, masculine contour.' The other group
of men seeking pec implants consists of men who genetically
don't have very developed muscles, or men who would like to have
a better chest but don't have time to get to the gym. 'The
critical issue for these men is to place the implant underneath
the pectoralis muscle - not under the skin,' Dr Tavakoli
explains. 'To perform the procedure an incision is made under
the armpit and the skin and muscle are carefully lifted up and
the implant inserted.' These implants are made from solid
silicone and have been shown to be very safe. They come in four
sizes and before surgery the chest wall is measured so the
correct sized implant is chosen. During the recovery period
after surgery, patients are instructed not to lift their arms.
When the dressings are removed, a gentle exercise program is
recommended for the following few weeks to permit a full and
comfortable range of motion of the arms. 'This allows the pec
implants to settle into the sub muscular pocket created by the
surgeon,' he says. Generally within a week or two, physical use
of the upper body muscles may be resumed and within six weeks,
full pectoral muscular activity may be recommenced. Dr Tavakoli
adds that surgical risks may include infection, bleeding,
asymmetry, scarring, and muscle or nerve damage but stresses
these complications are uncommon. 'Pec implants are a viable
solution for men who feel embarrassed about their chests, for
whatever the reason,' says Dr Tavakoli. 'After having the
procedure patients always comment on the positive change it has
made to their lives.' He says after pec implant surgery patients
can still work to build the pec muscles for an even greater
result.
About the author:
Dr Kourosh Tavakoli - Cosmetic Plastic Surgeon, MBBS, BSc (med),
MS (unsw), FRACS (plast.) Dr Kourosh Tavakoli is a fully
qualified Australian trained Plastic Surgeon specialising in
Cosmetic procedures. http://www.plasticsurgerysydney.com.au
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