Questions Pre-op

[m85]

Hi,

I am having surgery on the NHS later next month and feeling very nervous about it all, I would really appreciate it if someone could explain the procedure the surgeon has recommended for me.

This is what the surgeon has recommended: "Skin reduction plus liposuction and excision of the fibroglandular component". He also mentioned "necrosis of the nipple areolar complex" what does this mean? My gynecomastia is grade 3.

Also, how much time would you recommend I should take off work, i work in a finance office job and looking at taking one week off, will this be enough?

Your feedback will be greatly appreciated

[Dr. Elliot Jacobs]

If I read you correctly, it appears that the surgeon plans to remove your excess tissue, including some excess skin.  This could result in additional scars on your chest.  Be sure to speak with the surgeon and have him explain in detail what he plans to do and where any anticipated scars would be located.

As for necrosis of the nipple areolar complex, this is a rare possibility that a surgeon may tell you ahead of the surgery.  It means that the nipple/areola could die after surgery.  I have never seen that at all -- it is so very rare.

Dr Jacobs

[m85]

Thanks for the reply Dr Jacobs.

The surgeon did mention that it is a possibility that one of my nipples may need to be removed but i'm not sure I am comfortable with this. I am due to have a pre-op appointment with him in 2 weeks so I will ask him to further explain however, do you think this would be due to my gynecomastia being quite significant and grade 3 and do you think i could avoid this by just asking for my breasts to be reduced slightly rather than a fully flat chest?

Also, will the scars from skin reduction be permanent or will they disappear in time?

Thanks again

[Dr. Elliot Jacobs]

I think a good discussion with your surgeon as regards potential outcomes and anticipated scars would serve you well.  Remember, oftentimes surgery is a trade-off -- scars for a better and more comfortable shape.

All surgical scars are permanent -- they do tend to settle and fade over time, but it is variable, depending on how your body tends to heal.

Dr Jacobs

[Litlriki]

As Dr. Jacobs has pointed out, you really need to talk in depth with your surgeon about your proposed procedure.  There are a number of ways to approach gynecomastia surgery for men with very large breasts, and one of those options is to remove the breast completely, including the nipple, and replace it as a free skin graft.  I have done this one time in my practice (Patient #3 under the Gynecomastia with Skin Resection photos), as this patient was exceptionally large following hormonal treatment for prostate cancer.  In his case, the scars remain thick and raised, and we continue to treat them, but he is otherwise very happy with the outcome.  I prefer to use procedures which maintain the blood supply to the nipple-areoalar complex, since the outcomes are somewhat more predictable.  Only you and your surgeon can determine which option is best for you, based on where you're starting and what your goals are, including the appearance of scars.

Good luck,

Rick Silverman