Gynecomastia Surgery Toronto
What is Gynecomastia surgery?
This is surgery for men who have excess skin, fat, or glandular breast tissue.The most challenging aspect of this surgery is the presence of excess skin, as avoidance of a long scar from skin excision is often a priority.
Who is a good candidate?
We often see 14 – 16-year-old boys with true (glandular) gynecomastia. Most often this problem resolves over one to two years once the hormonal transition of puberty is complete. Occasionally we will be asked to assess a boy who is psychologically and socially handicapped by their gynecomastia, and with the endorsement of a pediatrician we will offer surgery. Older boys with gynecomastia over 2 years duration can be offered surgery, often covered by OHIP.
We see many men with gynecomastia secondary to use of anabolic steroids. It is generally pretty obvious by appearance whether a patient is ‘juiced’, and it is amazing how often patients will deny using steroids nevertheless. We would not want to offer surgery to someone who remains on steroids, as they are likely to form further gland if they continue, and it is possible their breast development will resolve once they discontinue the drug.
Pseudo-gynecomastia describes breast enlargement from fat or skin excess. If you are somewhat over-weight, or previously were over-weight, excesses of these tissues will be present. Special techniques are necessary to correct all three tissue problems.
It is important to bring your complete medical and surgical history to the consultation, especially drug history and any history of urology or endocrinology consultations. We will need to be sure you do not have an underlying hormonal abnormality to account for your gynecomastia. Previous imaging or biopsy reports are also helpful, especially if only one breast is involved (we would need to rule out breast cancer).
Alternatives to Surgery
Vests are available that will hide breast enlargement. Drug therapy (e.g. Tamoxifen) has been described, but we have yet to see a patient prescribed this treatment.
Costsof Gynecomastia Surgery (2018 prices; subject to change)
Fees for gynecomastia surgery at our Toronto Cosmetic Plastic Surgery office (including facility and anesthetist) range from $1500 for ‘puffy areola surgery’ to $10,000 for mastopexy in massive weight-loss patients. A fee of $4-5000 should be anticipated for liposuction.
Preparation for surgery
We need you to be healthy and at a stable weight before surgery. We will provide written instructions on all necessary steps, supplies to obtain, etc. Dressings and compression vestsare easy to apply by yourself.
Small procedures can be performed under local anesthetic. Liposuction is used to reduce excess fat, and tunneling with the cannula is very effective for triggering a contraction of the skin of the upper chest to correct for loose skin. Gland is excised through a 1-2 cm incision that is hidden at the edge of the areola. If there is dramatic excess skin, this can be excised (mastopexy- see figure below).
Safety and Risks
Bleeding is a concern after gland excision, so chest movement should be limited (no arm or chest exercise) for 10 days following surgery.
Rarely is pain a problem after surgery. Dressings are easy to apply, and consist of pads secured by a compression vest. Most people will return to work within four days, and sports may be resumed at three weeks.
You can expect to see positive effects from your surgery immediately post-op, but a final cosmetic result may not be evident until a year after surgery, once contraction is complete and scar redness has fully settled. Gynecomastia surgery is one of our most effective and gratifying surgical procedures.
We offer a complete armamentarium to correct your gynecomastia, and offer hospital surgery for patients with medical problems or other complexities that would benefit from over-night stay.Our expertise in managing major weight-loss patients has provided us great insight into managing excess skin problems. Come in for a consultation, and you will leave wiser, and perhaps scheduled for a rewarding transformation.