Frequently asked questions

What is Gynaecomastia?

The word means ‘woman’s breast’ and is usually a variation of normal, women’s breasts vary in size and so do men’s. Male and female breast is identical under the microscope and both appear and grow at puberty; studies suggest 60% of 14-15 year old boys have gynaecomastia, reducing to 8% at 18 years of age and increasing to 30% in older men, which means very many thousands have the condition. If Gynaecomastia appears after puberty another cause must be excluded, including testicular and brain tumours; and certain chemicals and drugs can be to blame.

What is breast tissue made of?

All mammals have breasts, which are obviously milk glands, but there is considerable variation in structure. The breast is part gland (which is firm and dense) and part fat. As a rough guide the breast of a thin teenager is 90% gland and 10% fat and a 50 year old man or woman has the reverse ratio. Gynaecomastia patients are often overweight (like women requesting breast reduction) because they would like to be thought of as simply overweight rather than abnormal; and this can increase the percentage of fat in the gland.

Am I suitable candidate?

If your breasts are outside the normal range and significantly affecting your confidence then you should consider having a consultation. You should be fully grown, fit for surgery and within 10-15% of your ideal weight.

What happens at the consultation?

At consultation we check whether you are outside the normal range and discuss the causes, the procedure and possible problems that can occur.  Do not be embarrassed because I had gynaecomatia myself so know exactly how you feel!

What does the surgery involve?

The gland is removed surgically and the fat is removed by liposuction (lipoplasty, suction assisted lipectomy and liposculpture are all the same). Liposuction can be modified by ultrasonics and power assisted vibration and surgeons vary with their preferences. The traditional method involves a puncture at the axilla to admit the liposuction cannula and an incision at the edge of the dark skin around the nipple (the areola) to remove the gland. I have modified the technique to allow the whole procedure to be carried out via a 1cm or so incision in the axilla; and an average operation takes about 40 minutes.

What type of anaesthesia do I need?

The operation is nearly always carried out under general anaesthetic but rarely patients that cannot have a general anaesthetic for whatever reason may have the procedure done with local anaesthetic injections. You will have a full description of the anaesthetic in your consultation ‘Fact-Sheet’ and your Consultant Anaesthetist will talk to you in your room prior to surgery. Most patients remark how little pain they experience and you will receive appropriate analgesics both during and after the operation.

What happens after surgery?

You wake up in the recovery ward with a snug Elastoplast pressure dressing over your chest (which gives a reliable and constant pressure to encourage the cavity formed by the removal of the glands to heal up inside). I also place small suction drains in the cavities to remove any serum or blood, which would otherwise slow down the healing process. You stay overnight, the drains are removed the next morning (unless they are still working) and you can go home or stay locally for another day if you have come a long distance. You will be given a one week course of antibiotics and analgesics if required.

What can I do when I get home?

The most important post-operative message is to be very careful for the first week (at least), problems can occur if you do not rest properly and allow things to heal up inside. You can do a little more as each day goes by and on average one week is sufficient time to have off work. It is at least four weeks before you can start significant exercise and always listen to your body, if you are uncomfortable, slow down! Some have very little post-operative pain and are tempted to overdo things, but they must resist this because strenuous exercise after any surgery can start bleeding under the skin which will cause the formation of more scar tissue.

What about dressings, stitches and pressure garments?

You will need dressings over the axilla incisions for a few days; and the stitches are hidden and dissolve themselves. You should leave the pressure bandage undisturbed for a week, then remove it and phone my office with your news. Bruising is normal but if you have a significant ‘bubble’ of fluid under the nipple area then it’s best to return for an examination. Now is the time to don your pressure garment and wear this 24/7 (except for showering) for 2 to 4 weeks and then at night only for a few more weeks. The patients who get the fastest and best results are those who wear their pressure vests the most. Gentle massage is beneficial after one month.

What can go wrong?

There can be problems with any operation, namely - Bleeding, Infection, Nerve damage and Scars. There are also special problems with Gynaecomastia correction, wrinkling due to subcutaneous scar and residual fat. Sometimes a hidden asymmetry of the pectoral muscle can be revealed by the removal of the breast. The consultation includes a full analysis of all these possibilities, their likelihood and what you can do to minimise the risks. (See also Questions page)

Will the breast grow back?

Hardly ever, because fat cells do not regenerate unless you have a very significant weight gain. There are always a few residual gland remnants whatever the technique, and these will only enlarge if stimulated (by for instance ‘body building’ or hair growth drugs).

When am I back to normal?

Most say they are back to normal at six weeks, but don’t forget, healing progresses slowly for many months and sometimes years. The benefits are obvious immediately, but you must be very patient for the final result because scar tissue takes a year or more to finish settling. You will be able to assess this because only when the skin scar in the axilla has faded completely will the scar under the skin be settled as well. There is a lot of individual variation and some settle in weeks and others take more than a year. Don't forget you may never be completely 'normal' because the subcutaneous anatomy has been altered, in other words the repair tissues are not quite the same as in those who have not had surgery.  This means the skin may not be as tight against the muscle, especially if the gynaecomastia was very prominent and a little looseness may be inevitable.  Only the really big cases need skin excision however; and any case a little slackness still looks perfectly masculine.

How many Gynaecomastia corrections does Mr Levick perform?

In accordance with the National Healthcare Commission guidelines, the annual audit figures of the Priory Hospital show that in the last five years (2004-2008) Mr Levick carried out  Gynaecomastia Correction on 212 patients, that is an average of 42 per year.

Summary

I have two rules of Cosmetic Surgery

1. - If in doubt – don’t!

2.- Always talk to real experts.

In other words, be sure that you want to undergo surgery for your own reasons and talk to people who really know about the surgery, that is other patients or an experienced Plastic Surgeon. Many think they know all about Gynaecomastia but in reality don’t and are likely to give you inaccurate and misleading information. This surgery changes many lives for the better but on rare occasions can have the opposite effect, so make sure you are an expert yourself before you decide. Everyone you know loves you whatever your breasts are like, it’s how you feel about yourself that matters!