What to expect during your consultation

The success and safety of your gynecomastia procedure depends very much on your complete
candidness during your consultation. You’ll be asked a number of questions about your health,
desires and lifestyle.

Be prepared to discuss:

      • Why you want the surgery, your expectations and desired outcome
      • Medical conditions, drug allergies and medical treatments
      • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
         including steroids
      • Previous surgeries

Your surgeon may also:

      • Evaluate your general health status and any pre-existing health conditions or risk factors
      • Perform diagnostic testing to determine the underlying cause of gynecomastia; this may
         include testing of your endocrine function
      • Examine your breasts and may take detailed measurements of their size and shape, skin
         quality, placement of your nipples and areolas
      • Take photographs for your medical record
      • Discuss your options and recommend a course of treatment
      • Discuss the likely outcomes of gynecomastia correction and any risks or potential
        complications
      • Discuss the use of anesthesia during your breast reduction

Preparing for surgery

Prior to surgery, you may be asked to:

      • Get lab testing or a medical evaluation
      • Take certain medications or adjust your current medications
      • Stop smoking well in advance of surgery
      • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can
         increase bleeding

Special instructions you receive will cover:

      • What to do on the day of surgery
      • Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Breast reduction
surgery may be performed in an accredited office-based surgical center, outpatient/ambulatory
surgical center, or a hospital.

What happens during gynecomastia correction surgery?

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty, and
reduces breast size, flattening and enhancing the chest contours.

In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to
sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position
and size of the areola can be surgically improved and excess skin may be reduced.

Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include
intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Liposuction: In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction
techniques alone may be used.

This requires insertion of a cannula, a thin hollow tube, through several small incisions.The cannula
is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from
the body by vacuum suction.

There are various liposuction techniques that may be used; the technique most appropriate in your
case will be defined prior to your procedure.

Excision: Excision techniques are recommended where glandular breast tissue or excess skin
must be removed to correct gynecomastia.

Excision also is necessary if the areola will be reduced, or the nipple repositioned to a more
natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

Will there be scars?

Any surgical treatment to correct gynecomastia will require incisions. While most incision lines
are concealed within natural contours, some may be visible and are a necessary result of breast
reduction surgery.

Important facts about the safety and risks of gynecomastia surgery

The decision to have gynecomastia surgery is extremely personal and you’ll have to decide if
the benefits will achieve your goals and if the risks and potential complications are acceptable.

Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

You will be asked to sign consent forms to ensure that you fully understand the procedure you
will undergo and any risks or potential complications.

The risks include:

      • Unfavorable scarring
      • Bleeding (hematoma)
      • Blood clots
      • Infection
      • Poor wound healing
      • Changes in nipple or breast sensation may be temporary or permanent
      • If liposuction is used, additional risks include uneven contours, rippling or loose skin,
         irregular pigmentation, excessive fluid loss or fluid accumulation
      • Anesthesia risks
      • Breast contour and shape irregularities
      • Skin discoloration, permanent pigmentation changes, swelling and bruising
      • Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs
         – can occur and may be temporary or permanent
      • Allergies to tape, suture materials, glues, blood products, topical preparations or injected agents
      • Breast asymmetry
      • Fatty tissue found deep in the skin might die (fat necrosis)
      • Fluid accumulation
      • Deep vein thrombosis, cardiac and pulmonary complications
      • Pain, which may persist
      • Possibility of revisional surgery

Where will my surgery be performed?

Surgery to correct gynecomastia may be performed on an outpatient basis, in an office-based or
ambulatory surgical facility, or a hospital setting. It may be performed under general anesthesia
or local anesthesia with sedation.

These decisions will be based on the requirements of your specific procedure and in consideration
of your preference and your doctor’s best judgment. Your plastic surgeon and the assisting staff
will fully attend to your comfort and safety.

When you go home

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.

The practice of medicine and surgery is not an exact science. Although good results are expected,
there is no guarantee. In some situations, it may not be possible to achieve optimal results with
a single surgical procedure. Another surgery may be necessary:

      • To perform additional tightening or repositioning of the breasts
      • To treat any complications that may occur

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that
the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

After surgery, dressings or bandages will be applied to your incisions and an elastic bandage or
support garment may be used to minimize swelling and support your new chest contour as it heals.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that
may collect.

You will be given specific instructions that may include: How to care for your surgical site(s)
following surgery, medications to apply or take orally to aid healing and reduce the risk of infection,
specific concerns to look for at the surgical site or in your general health, and when to follow up
with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your
individual recovery period.

      • Where will I be taken after my surgery is complete?
      • What medication will I be given or prescribed after surgery?
      • Will I have dressings/bandages after surgery? When will they be removed?
      • Are stitches removed? When?
      • When can I resume normal activity and exercise?
      • When do I return for follow-up care?

The results will be long-lasting

The final results of breast reduction in men are permanent in many cases.

However, if gynecomastia resulted from the use of certain prescription medications, drugs including
steroids or weight gain you must be fully free from these substances and remain at a stable weight
in order to maintain your results. Please discuss this with your physician before making changes
to your prescription medications.

All scars are permanent, even though some scars may be concealed in the natural contours of
the breast. Your improved upper body will likely enhance your self-image and confidence, whether
in a shirt and tie, a t-shirt, or baring your chest at the beach.

How much will gynecomastia surgery cost?

Cost is always a consideration in elective surgery. Prices for gynecomastia can vary widely.
A surgeon’s cost for gynecomastia may vary based on his or her experience as well as
geographic location.

Many plastic surgeons offer patient financing plans, so be sure to ask.

Cost may include:

      • Surgeon’s fee
      • Hospital or surgical facility costs
      • Anesthesia fees
      • Prescriptions for medication
      • Post-surgery garments, and
      • Medical tests