Every surgical procedure including Gynecomastia Surgery involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand all possible consequences of gynecomastia surgery. The following are those defined by the American Society of Plastic Surgeons.
It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require an emergency treatment to drain the accumulated blood or blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time following injury. Intra- or Post-operative blood transfusions may very rarely be required. If blood transfusions are needed to treat blood loss, there is a risk of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Fluid accumulations infrequently occur in between the skin and the underlying tissues. Should this problem occur, it may require additional simple procedures for drainage of fluid.
The chance of infection is very low with this type of surgery, considering that you are going to receive prophylactic antibiotics. Should an infection occur, additional treatment including antibiotics, hospitalization, or additional surgery may be necessary.
Change in Nipple and Skin Sensation
You may experience a diminished (or loss) of sensitivity of the nipples and the skin of your breast. Permanent loss of nipple sensation can occur after gynecomastia surgery in one or both nipples. Massage during your recuperation phase helps reduce hypersensevity of the skin when the sensation returns. Changes in sensation may affect sexual response. In rare circumstances the nipple may be lost entirely due to poor circulation and/or smoking.
You will experience pain, burning sensation, and skin irritability after your surgery. These symptoms of varying intensity and duration may occur and persist after gynecomastia. Chronic pain may occur very infrequently, sometimes from nerves becoming trapped in scar tissue and other times for no hard reasons at all.
Skin Contour Irregularities
Contour and shape irregularities including visible and palpable wrinkling and dimpling may occur. Although the majority of these resolve over time with the help of massaging, some may remain permanently. One breast may be to a degree smaller than the other as it always is in normal non-treated chests. Nipple position and shape will not be identical one side to the next, depending on the original position of your nipples, as well as how your skin shrinks. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility when there is excessive redundant skin. This may improve with time, or it can be surgically corrected. Nipple retraction may occur after gynecomastia surgery as a result of skin shrinkage, which can be corrected.
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, especially with massaging; but in rare situations it may be chronic.
Skin Discoloration / Swelling
Bruising and swelling normally occurs following gynecomastia surgery. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). There is the possibility of visible marks in the skin from sutures. In some cases scars may require surgical revision or treatment.
Some breast asymmetry naturally occurs in most men. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features. Differences in terms of breast and nipple shape, size, or symmetry may also occur after surgery. Additional surgery may be necessary to attempt to improve asymmetry after gynecomastia.
Fatty tissue found deep in the skin might die. This may produce areas of dimpling or firmness under the skin. There is the possibility of palpable or visible contour irregularities in the skin that may result from fat necrosis. Additional surgery to remove areas of fat necrosis and to improve contour may be necessary.
Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.
There can be a recurrent breast and adipose tissue growth after breast reduction surgery depending on your hormone levels and extent of weight gain.
Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple tissue may die due to poor circulation and/or smoking. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.
In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.
Damage to Deeper Structures
There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
Surgical Wetting Solutions
There is the possibility that large volumes of fluid containing dilute local anesthetic drugs and epinephrine that is injected into fatty deposits during surgery may contribute to fluid overload or systemic reaction to these medications. Its occurrence is rare. Additional treatment including hospitalization may be necessary.
In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.
Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even rarely death from all forms of surgical anesthesia or sedation. The chance of this is much less than the chance of a fatal car accident.
Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of gynecomastia surgery. Asymmetry in nipple location or unanticipated breast shape and size may occur after surgery. Unsatisfactory surgical scar location visible deformities at the ends of the incisions (dog ears), loss of function, wound disruption, poor healing, and loss of sensation may occur. It may be necessary to perform additional surgery to improve your results.
Also, the goal of the surgery is to reduce breast size, and not to give you a chest of an athlete or a body builder. Therefore, you might not be fully satisfied with having a flattened chest with no well formed Pectoralis Muscles. It is your responsibility to develop these muscles by proper training if you seek such chest physic.
Cardiac and Pulmonary Complications
Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances. Inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of blood clots or swollen legs that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
Subsequent alterations in the breast shape may occur as the result of aging, sun exposure, weight loss, weight gain or other circumstances not related to your surgery. Breast sagginess may normally occur.
Breast Disease in Male Patients
Breast disease and breast cancer can occur independently of gynecomastia surgery. If a mass is detected, seek professional care immediately to obtain proper care.
Breast and Nipple Piercing Procedures
Individuals who currently wear body piercing jewelry in the breast region are advised that a breast infection could develop from this activity.
Interference with Sentinel Lymph Node Mapping Procedures
Breast surgery procedures (periareolar, transmammary) that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer. If this is a concern, individuals considering breast surgery by the periareolar, transmammary approach may elect to consider another surgical approach (inframammary or standard periareolar).
Intimate Relations After Surgery
Surgery involves coagulating of blood vessels and increased activity of any kind may open these vessels leading to a bleed, or hematoma. Activity that increases your pulse or heart rate may cause additional bruising, swelling, and the need for return to surgery and control bleeding. It is wise to refrain from sexual activity until your physician states it is safe.
Mental Health Disorders and Elective Surgery
It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
There are many adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications. Be sure to check with your physician about any drug interactions that may exist with medications which you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)
Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications of skin dying, delayed healing, and additional scarring. Individuals exposed to second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smoking may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding. Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type of complication.
It is important to refrain from smoking at least 6 weeks before surgery and until your physician states it is safe to return, if desired.
There are many variable conditions that may influence the long-term result of gynecomastia. Secondary surgery may be necessary to perform additional tightening or repositioning of the breasts. Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are particularly associated with gynecomastia. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.
For the men, both young and old, who have suffered the torment of “woman-like breasts,” Gynecomastia surgery has been a tremendous blessing– restoring their self-confidence in every aspect of their life. I look forward to helping you to live your life to the fullest through a comfortable, safe and successful Gynecomastia surgery.
S. Sean Younai, MD, FACS
Our center also includes the Regency Surgery Center which is a state-of-the-art outpatient surgery facility certified by Medicare and accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc., (AAAASF).
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