Gynecomastia Surgery In Austin, TX

Gynecomastia typically results from tissue that forms at puberty and fails to go away. If it has been present for over two years and it’s still there it isn’t going anywhere without treatment. It’s always best to treat gynecomastia before it starts to do permanent damage to your psyche. The longer it persists, the more dysfunctional behaviors you will learn. Life is too short to waste living with it. You won’t wake up one day and it will be gone. You have to take the first step to cure. The sooner the better.

Austin Gynecomastia Center Innovations

Over the years, I have developed several surgical techniques that have withstood the test of time and have helped me immensely in keeping my procedures as complication-free as possible.

Vaser Ultrasonic Liposuction

Vaser liposuction is a new tool in my arsenal.  Vaser ultrasonic liposuction is a machine that contours fat with ultrasonic (sound) energy. This is different from standard liposuction that uses a cannula (tube) attached to a suction machine. The incision is smaller and therefore any scar will be smaller. Using the Vaser technique, it is easier for me to perform the procedure reliably and consistently. I only need a few of the many instruments required with the open technique. I no longer need my specially designed retractors. There’s less impact on the body due to the reduced physical strain. There is less pain, bruising and swelling post operatively. In fact, the Vaser ultrasonic liposuction is so powerful that I rarely use the following innovations that I developed previously, though I’m always glad to have them in my roster.

New Treatment Using Vaser Ultrasonic Liposuction

Waffle Technique

Puffy nipples are the result of excess glandular tissue beneath the nipple-areola complex. In some cases, removal of all this tissue may result in a depression, or noticeable concavity. Leaving tissue behind, however, which is not uncommon with inexperienced surgeons, often results in recurrence of gynecomastia because remaining tissue has a tendency to “clump” as a mass. The best way to get rid of puffy nipples once and for all is to use my waffle technique to break up the “spring” in the tissue. The result is a flat and even chest area.

Internal Flaps

Removal of the glandular tissue can result in a depression or divot, while leaving the tissue behind could result in residual fullness of the areola zones or puffy nipples: either scenario can result in dissatisfaction after gynecomastia surgery. In order to create an even contour and to support the overlying nipple-areola complexes, I like to create  internal flaps with the normal tissue. I can often rotate this tissue and suture it to other areas of normal tissue so the tissue layer is even and smooth. The whole idea is to leave an even layer of normal tissue once the unwanted tissue has been removed.

Quilting Sutures

In cases where a large gland is present and removed, there is what is called “dead space” afterwards. Blood or other bodily fluids will naturally fill this space during the healing process. This accumulation of fluid can cause some post-operative complications, such as  hematomas or  seromas. Left around for long enough, this fluid can cause “hard healing” leading to excess scarring and, at times, contour irregularities. Drains are often helpful but don’t work as well as suture closure of this dead space. The technique of quilting sutures has been used in other areas of plastic surgery with proven success, and is equally effective in male breast reduction.

Pleating Sutures

In cases when there is a large amount of tissue, or when there is very loose skin after notable weight loss, I may use pleating sutures to help gather and redistribute the skin during the early healing phase. This has been proven to be very effective in achieving an even contour, even in the most complicated cases. It can even elevate the nipple areola complexes to a higher, more normal location. This comes in very handy when there is significant tissue sagging not uncommonly seen in weight loss patients or overweight men. The goal of the pleating suture is to move the skin to a better location and allow it to heal down to the deeper layer so it stays put at the ideal place. This may prevent the need for later skin removal with large scars.

Wide Undermining

This refers to the surgical technique of dissecting beneath the tissue to sever the attachments to the overlying skin. This allows the skin to spread out in a larger area during the healing phase, promoting an even, wrinkle-free, crease-free contour. Think of it as spreading out excess tissue in a larger area so it is more likely to lay flat as opposed to being bunched up with creases and folds.

Gynecomastia and Bodybuilding

The gynecomastia that occurs in body builders who use steroids or  pro hormones is uniquely different. These men typically have very little body fat, and their gynecomastia is mostly firm, rubbery gland that is easily felt upon examination.

Bodybuilders often display puffy nipples and an odd shape to the chest, with the nipple-areola complex looking downwards and an area of fullness along the bottom of the muscle. Needless to say, this is a very disturbing feature to men who have spent an enormous amount of time and effort working their bodies to a state of strength and muscular definition.

Confession From A Bodybuilder – Gynecomastia From Steroids

The physiology of the development of breasts in body builders can be complex. However, as a simple explanation, the testosterone hormones or pro hormones are partly converted to estrogen (the female sex hormone), which can cause gynecomastia in some men. Pain in the area of glandular tissue is more common in these men. Pain indicates inflammation and irritation of the adjacent nerves. The chest area can be sensitive to touch and even something rubbing on the area can be quite painful. This pain often subsides with time as the tissue “burns out” and becomes less inflamed and more fibrotic.

These men have tough, well-localized glandular tissue that must be removed in its entirety. The gland can adhere to the overlying skin and to the underlying muscle. The goal of surgery is to remove as much of the gland as possible so that recurrence is uncommon even in those who continue to use hormones or pro hormones. These cases are often more challenging, as it is more difficult to work with the tissues after you remove a firm, adherent mass. The surrounding area needs to be contoured so the result is smooth and even.

Unfortunately, I can’t speak to the drugs or drug regimens designed to prevent or treat  bodybuilder’s gynecomastia. There are no scientific studies that approve or disapprove of these drugs, or that attest to their safety. Please use good judgment when you are dealing with the unknown. If you want the best advice, I would seek the counsel of a real doctor and not the local “go to” guy in the gym.

What Type Of Anesthesia Is Best?

Appropriate anesthesia is a compliment to any surgical procedure. Local anesthesia is best suited for only the smallest of cases, usually limited to those who have a small amount of fullness in Zone 1. Adequate contouring means reduction of tissue down to the sensitive area of the pectoralis muscle. Treatment of Zones 2 and 3 is difficult without general anesthesia because of the proximity of the Zones to the abundant nerves under the arm.

It’s important that your experience not be traumatic or barbaric. Your surgeon needs the best opportunity to perform expert contouring, which can only be achieved if you are immobile and relaxed. What’s the benefit of avoiding adequate anesthesia if your result is not good? Why not have your procedure performed without pain or anxiety, once and for all? Patients who only choose local anesthesia often tell me they probably should have chosen IV sedation or general anesthesia. Most procedures take less than an hour and a half to complete. All my anesthesia services are provided by a very experienced board certified anesthesiologist who has the same attitude as mine: we don’t fool around when it comes to your health and safety, period.

The use of any form of anesthesia beyond local requires that you have a ride home after your procedure and that you have someone stay with you for 12 hours afterwards. Many of my out of town clients bring someone along to care for them, or seek a local caregiver who can stay with them.

What Is The Recovery Like After Gynecomastia Surgery?

The recovery from gynecomastia surgery is not that interesting. Pain and discomfort is mild to moderate. On a scale of one to ten, it would be about a 5 at most. If general or IV anesthesia is used, you will feel somewhat foggy the first few hours afterwards. I offer oral pain medications that are to be used for the first 1 to 2 days. Most men take a day or two off before returning to work and other normal daily activities. Most patients can  get back to the gym 10 days after gynecomastia surgery while staying away from chest work for 2 to 4 weeks.

Compression garments should be worn for two to four weeks to control swelling, provide support and facilitate skin retraction. I encourage all my patients to massage the treated area with their hands or a roller device to soften the scar tissue and help the skin lay out nicely. This should be done several times a day for 20 minutes or more starting 3 weeks after your procedure and working it for eight weeks or more if needed.

Instructions For Post Operation Recovery

A plastic drain may be used after surgery to collect fluid and blood that tends to accumulate in the space formerly occupied by the tissue. The drains are removed after three to five days, depending on the amount of daily fluid accumulation. Drains are infrequently used in my practice because of I use techniques and technology, like Vaser liposuction and quilting sutures, which makes drains unnecessary.

It may take several months for the swelling to subside completely and for the tissues to soften or “relax.” Four to six weeks after the procedure, maximal scar formation can result in areas of firmness beneath the skin. This is normal. Massage helps to soften the scar, and if needed, small amounts of steroids are injected to soften the scar. The final position of the scar around the areola generally heals very well and won’t be visible to others, hence the beauty of the procedure.

Results after gynecomastia surgery are immediate. It should not have to take “months” for the swelling to go away for you to notice an improvement. The contour will be flatter, with no puffy nipples and with good muscular definition. Fullness of the lateral chest and underarms should be improved dramatically if these areas were full before treatment.

Not much is known about the psychological recovery from gynecomastia. There is no doubt that surgery helps tremendously, but the degree to which it helps depends on the individual. Some tell me it never crosses their mind again, while others say it’s a lot better but that they are not 100% over the trauma. I take photos of the excised tissue, and allow patients the opportunity to actually feel the removed tissue as well. Why? It’s simple. I’ve learned that men who suffered from gynecomastia often need a sense of “closure” and want to know that it was real and fortunately, gone forever. I am actively researching these psychological issues in the hopes that we can provide better solutions to this invisible aspect of gynecomastia. An abstract of my  ongoing study Psychosocial Correlates of Idiopathic Gynecomastia in Young Males: Preliminary Findings From a Mixed-Methods Study has been just been published in the Journal of Adolescent Health.

Can You Fix Gynecomastia With Liposuction Alone?

Complications

Potential complications can be broken up into two categories: early and late.

Early Complications from Gynecomastia Surgery Hematoma

Early complications include hematomas or blood collection in the area immediately after surgery, usually within 24 hours. This is noticed as increased chest size accompanied by pain and bloody drainage. Although not life threatening, hematomas require removal of the collection, because blood left under the skin can form scar tissue or become infected over time. If small, the hematoma can be removed in a simple office procedure, and if large, it may require a visit to the operating room. It should be known that a surgical drain does not prevent a hematoma. Physical activity may provoke hematoma formation, which is why I recommend that patients avoid any strenuous activities for 3 days.

Hematoma Formation After Massive Gynecomastia Removal Surgery

Late Complications from Gynecomastia Surgery Seroma

A seroma is a collection of watery fluid on the chest. Some men are just prone to seroma formation. I have observed that the rate of seroma formation is more frequent in those who consume a lot of fluids after their gynecomastia surgery. Many believe that drinking a lot of fluid will help the healing process, but this is not the case. Restrict your fluid intake after gynecomastia surgery to what is normal: 6-8 glasses of water a day. Drink if you are thirsty. If your urine is darker you can use more fluids. If it is clear you need less fluid. A small seroma the size of a walnut will generally go away by itself, but larger seromas, which can interfere with the healing process, can be removed with a small needle aspiration. Seromas can and do recur in an unpredictable manner, which may require several visits until resolved.

Mondor’s Disease

There is not much written about Mondor’s disease. I prefer using the word “condition” rather than disease because disease sounds so terrible and makes it seem worse than it is. The condition is benign (not harmful) and self-limited, which basically means it will go away on its own – sort of like a pimple. In my vast experience with gynecomastia, I have concluded that this condition is fairly common after gynecomastia surgery and is the second most common surgery-related “issue” that I deal with (seroma being the most common).

Mondor’s disease is characterized by inflammation veins in the chest, or “thrombophlebitis” and is not uncommon after surgery that involves multiple Zones of the chest. The most common clinical manifestations are painful subcutaneous cords, induration (hardening) of the tissues and skin tightness. Untreated Mondor’s condition will resolve on its own. However, I prefer to treat patients because Mondor’s is painful, delays the healing process and may even compromise the gynecomastia surgery result. Treatment includes taking non-steroidal anti-inflammatory medications (NSAIDS) like Aleve or Motrin and relief is typically immediate.

Hard Healing After Gynecomastia Surgery

Hard healing is a term used to describe excessive and unusual healing in the area treated. This is typically seen after the sixth to eighth weeks and is recognized as firmness of the tissues and palpable masses under the skin. The most common cause of this ‘over-healing’ is a patient’s unique healing response that is more aggressive than those of most others. Hard healers will have to be patient during the healing phase as time is their friend.

Options to reduce hard healing include massage, rolling techniques, steroid injections and sometimes, additional procedures to treat the actual scarring. This is the most unpredictable aspect of gynecomastia surgery recovery and is the reason why I am a stickler about post-operative massaging of the chest and the use of the roller and compression garments.

Steroid Injections After Gynecomastia Surgery (SCAR TISSUE REDUCTION)

Contour Irregularities

Contour irregularities are caused by a variety of reasons. This is often related to the quality of your skin and how your surgeon performs the procedure. Excessive tissue removal may result in a depression while inadequate removal may result in excess fullness. “Recurrence” is uncommon in an expert’s hands as it is often the result of undertreatment (not removing enough tissue and leaving gland under the nipple-areola complex.) After the swelling subsides weeks later, it then appears that a mass is still there. Treatment for recurrence requires a secondary procedure to remove this residual tissue. Recurrence is most likely to occur in those who have only had liposuction to treat their gynecomastia without tissue removal.

Infection

In experienced hands, infection after a male breast reduction is uncommon, rendering post-surgery antibiotics unnecessary. Treatment of a rare infection would require a drainage procedure, antibiotics or both.

Loss of the nipple areola complex is unlikely in standard treatment, but is more common in complex cases involving skin removal and relocation of the nipple areola complexes. This procedure is typically left to the most experienced surgeons who have performed this multiple times and understand the dynamics of this procedure.

Loss of sensitivity in the nipple areola complex is common post-procedurally, but usually returns to normal after several months.

What Is The Psychology Of Gynecomastia?

The most important issue concerning gynecomastia is the lingering psychological scars from having to cope with it for many years. The stigma of having prominent breasts can lead to antisocial behavior, anxiety, self-hate, poor self-esteem, poor body image, and problems with interpersonal relationships. It’s real and I hear about it every day.

Defense mechanisms persist in men who have or hadgynecomastia: wearing two shirts, taping the nipple areola complexes, being selective about what shirts to wear, not putting themselves into situations where they may have to expose their chests to others and slumping their shoulders. These are just a few behaviors adopted to avoid embarrassment. It often takes a lot of courage for these men to seek care.

The longer the condition persists without remedy, the greater the chance for psychological damage. This is the main reason I urge men to seek a male breast reduction procedure after an appropriate diagnosis has been made. I encourage all men who suffer from gynecomastia to seek evaluation as soon as possible. Put simply, if a mound in your breast area causes psychological distress, I would strongly recommend that you remove the source of distress. In my experience, the benefits of gynecomastia surgery far outweigh the risks of no treatment.

Why Do We Perform Gynecomastia Surgery?

If there is anything that I have learned after treating thousands of patients, it is the potential for a life changing, absolutely liberating experience that is nothing short of a game changer. It’s like having cancer and being told it’s all gone. It’s the constant reminder of gynecomastia that is no longer. It’s the burden that has been lifted. It’s about the new opportunities that lie ahead so you can live the life the way you choose. It’s peace of mind.