POST-BARIATRIC SURGERY
GYNECOMASTIA SURGERY
Male breast reduction
Male breast enlargement is a common aesthetic and functional consequence seen in post-bariatric patients, with a significant impact on the individual. Obesity is characterised by a remarkable increase in the percentage of breast fat, causing breast enlargement and considerable mechanical stress to the skin. Following massive weight loss breasts become deflated, resulting in multiple functional and aesthetic irregularities. The overstretched and damaged skin will have lost its elasticity and therefore its ability to readapt to the underlying tissue, which causes remarkable skin excess and laxity. Diffuse stretch marks may appear and also the deep connective structures, which link skin and gland tissue, are damaged, resulting in breast tissue descent; moreover, fat deposits may persist. Of course, with or without weight loss, the natural ageing process contributes to a progressive loss of skin elasticity.
Gynaecomastia may be exacerbated by pre-existing or concomitant conditions independent of weight fluctuations, e.g., hormonal changes, certain medication or for unknown reasons. Any acknowledged and persisting cause of gynaecomastia is a contraindication and should be treated and solved before commencing surgery.
Gynecomastia surgery aims to reduce the size of large male breasts. An accurate pre-operative examination allows the surgeon to select the most appropriate technique, based on the severity of the defect:
- Removal of a skin strip from around the areola, with possible gland excision, with or without liposuction. In this case the scar is circumferential and lies along the areolar border.
- Removal of a skin strip from around the areola and the lower part of the breast, with possible gland excision, with or without liposuction. In this case the scar runs around the areolar margin, is prolonged downwards as far as the inframammary fold and is “J”-shaped.
Whilst care is taken to keep scarring to a minimum, post-bariatric patients often need major corrections, which result in long scars. However, scars run along less conspicuous areas, away from sight (e.g. along the inframammary fold and the periareolar margin).
Irrespective of the technique used, only deep, dissolvable sutures are used.
Gynaecomastia correction is performed under general anaesthesia (the patient is asleep) with a one-night hospital stay after the surgery.
Careful administration of pain-killers during and after the surgery ensures that post-operative pain and discomfort are kept to a minimum.
