PRE-OPERATIVE CONSULTATION

Before deciding on a gynecomastia surgery, you must meet with our surgeon for a pre-consultation. During this meeting, you will discuss your expectations, and the surgeon will evaluate what will yield the best results for you.

You will also receive a thorough overview of your options, and the risks associated with each surgical option. The surgeon will ask about your health to ensure you are suitable for surgery.

Based on your expectations and the surgeon’s recommendations, you will plan your surgery together. You are welcome to bring another person to the pre-consultation, as there is a lot of information to consider.

According to the law, you must have a 7-day reflection period after the pre-consultation before you can give your final consent to cosmetic surgery.



EXPECTATIONS

Male breast development can be caused by either increased fatty tissue in the breast area (lipomastia), male breast glandular tissue (gynecomastia), or often a combination of both. With significant breast development, there is often excess skin as well.

The surgery is planned based on your specific need but can generally be categorized into three types:

Liposuction: If the excess tissue primarily consists of fat, the surgery can be performed using only liposuction.

Surgical Removal of Glandular Tissue Combined with Liposuction: Here, the area is first liposuctioned, and then a cut is made at the nipple to remove the glandular tissue.

Removal of Excess Skin: With greater skin excess, the skin is expected to sag after removing fat and glandular tissue, requiring the removal of skin as well. This results in a significantly larger scar compared to the other procedures.

It is important to be aware that the results of cosmetic surgery are not permanent. The natural aging process and the rate of body aging are influenced by both genetic factors and lifestyle factors such as smoking, sun exposure, and weight changes.

Additionally, it is important to understand that surgery always carries a risk of complications, and the result may not always match your or the surgeon’s expectations completely. If you are significantly overweight or underweight, there is an increased risk of complications with anesthesia and wound healing. If your BMI is over 30, we may not be able to offer you surgery.

PREPARATION

Before the surgery, you must:

Stop taking medication containing acetylsalicylic acid such as Magnyl, Aspirin, Ibuprofen, and Treo one week before the surgery.

Avoid natural medicines, especially fish oil, ginger, and vitamin D, as they can increase the risk of bleeding. Stop all natural medicines three weeks before the surgery.

Any blood-thinning medication may need to be paused. This will be discussed with the surgeon during the pre-consultation.

Smoking must be paused least 4 weeks before and 6 weeks after the surgery. Smoking can negatively affect the cosmetic outcome, increase the risk of infection, and is generally bad for your health. We often choose not to offer surgery to active smokers.

It is a good idea to shop and prepare meals before the surgery, so you can focus on your recovery afterward.

On the day of the surgery, you should take a shower with thorough cleansing of your body and hair. Avoid using body lotion or other products on the area to be operated on. Wear loose, comfortable clothing, preferably a zip-up blouse, loose fitting pants, and flat shoes. Remove all jewelry and any piercings and leave them at home.



ANESTHESIA

The surgery is performed under general anesthesia. You must fast for 6 hours before the surgery (no eating, chewing gum, smoking, or similar). You may drink clear fluids like water and sugary drinks in small amounts until 2 hours before the surgery; do not drink milk, juice, etc.

It is crucial to adhere to the fasting rules, as anesthesia can be dangerous if you are not fasting, and the surgery is canceled, if you are not fasting.



SURGERY

On the day of the surgery, arrive at the clinic at the scheduled time. A nurse will greet you and you will be shown to your room, change clothes, and have an intravenous line placed. The anesthesiologist will discuss the anesthesia with you, and finally, you will meet with the surgeon, who will ensure you feel comfortable and well-informed. The surgeon will also mark the area to be operated on.

The surgery is performed under general anesthesia and lasts 1-3 hours, depending on the chosen procedure.

In some cases, the surgeon may place one or two drains (small plastic tubes). These are inserted through the skin to remove any blood and wound discharge from the healing wound areas.

To reduce the risk of infection, you will receive antibiotics during the surgery. The wounds will be closed with dissolvable sutures, and tape will be applied over the wounds along with an absorbent dressing. Finally, you will be fitted with a compression bandage.



AFTER SURGERY

After the surgery, you will be taken to the recovery room where the nurse will monitor you. You will receive something to drink and eat and pain reliefers if needed. Depending on the extent of the surgery, you may be discharged after a few hours.

Before you go home, the plastic surgeon and nurse will review the post-operative precautions with you and answer any questions you may have to ensure you feel comfortable. You should arrange for someone to pick you up, as you will not be able to drive yourself.

DAYS AFTER SURGERY

Since the surgery was performed under general anesthesia, you will be tired and sluggish on the first day, and you may experience nausea and dizziness. We recommend having an adult at your side for the first 24 hours.

It is important to take it easy for the first days after the surgery and generally listen to your body’s signals to reduce the risk of bleeding and swelling. Make sure to stay well-hydrated and consume a sensible protein-rich diet.



PAIN

It is important to take the prescribed medication. The medication will reduce pain, but you should expect some discomfort during the first 3-4 days.
Many people experience stabbing and sharp pain in the operated area.

This is normal and occurs because the nerves are re-establishing connections. These sensations can last for up to 1 year after the surgery.
You will be prescribed Paracetamol tablets and Ibuprofen tablets to be taken together 4 times a day. Additionally, you will receive a stronger painkiller, a synthetic morphine tablet, which you can take if you experience severe pain.

The nurse will thoroughly review the medication with you before you leave, and you will also receive written material describing everything.



DRAINS

If drains are placed during the surgery, they are often removed before you are discharged. If they are not removed, you will be given detailed instructions on how to care for them and when they are to be removed.



ACTIVITY

In the initial days after the surgery, getting out of bed might be difficult, so having someone to assist you is a good idea. It is important to get up and move around quickly to reduce the risk of blood clots. Engage in light activity, such as short walks, but take breaks when needed. For the first 1-2 weeks, avoid any strain on the wounds.

Avoid strenuous exercise for the first 4 weeks after the surgery. However, it is important to keep your body active with light activities, such as short walks.

We recommend not lifting more than 2 kg per arm in the first 6 weeks after the surgery and to avoid lifting your elbows above shoulder height during this period. You must avoid driving until you can handle the vehicle safely and no longer need strong painkillers. Always use a seatbelt, whether you are driving or a passenger.



WORK

You can resume sedentary work after 1 week. Physical labor should be avoided for 4-6 weeks.



SLEEPING POSITION

We recommend lying on your back for about 4 weeks after surgery. You may lie slightly on your side, possibly with a pillow behind your back.



BATHING

You can take a shower 24 hours after the surgery or when there is no longer any discharge from the wounds (unless you have drains). Before showering, remove the compressive bandage and the absorbing dressing. The brown plaster must remain until your follow-up appointment. It can withstand water.

Take a gentle shower, rinse the wounds to wash away soap residues (do not wash or scrub the wounds), and pat dry with a clean towel before putting the compressive bandage back on.

You should avoid taking baths, swimming in the sea, or going to a swimming pool and sauna until the stitches are removed and the wounds are fully healed.



BANDAGE

After the surgery, you will be fitted with a tight compression bandage on your chest, which you should wear continuously for the first 3 weeks, and then only during the day for an additional 3 weeks.
This will help reduce swelling and unevenness.



SCARS

The scars from the surgery will typically be red and swollen but will improve over 6-24 months. Over time, scars usually become narrow and lighter I color, but in some cases, they may become wide and darkly pigmented.

You may apply a soothing cream to the scars once they are completely healed. Avoid smoking, as it increases the risk of infection, slow healing, and unsightly scars.



CONTACT WITH THE CLINIC

You will be given a phone number upon discharge so that you can contact the clinic 24/7 if an urgent need arises.

You can also expect a call from a nurse the day after your surgery to ensure you are doing well and answer any questions.



FOLLOW-UP

After 7-10 days, you will have a follow-up appointment with the nurse. The plasters will be removed, and the wound will be inspected. New tape will be applied over the scars.
You will be given new tape to change every 10-12 days for about 3 months after the surgery.

The tape helps keep the scars narrow, flat, and level with the rest of the skin.
We will discuss how to manage the scars moving forward, any pain, etc. You will be offered a follow-up appointment with the plastic surgeon 3-6 months after the surgery. If you experience any issues before then, you are always welcome to contact us.

COMPLICATIONS

Infection: Infections are very rare. Symptoms typically appear after about a week and include redness, warmth, swelling, throbbing pain, and possibly fever. If an infection occurs, you will be treated with antibiotics.

Swelling and Bruising: This is expected and will decrease over the first few months.

Unattractive Scarring: Scarring can vary greatly from person to person. Most scars will become nice and white over time, but some people may develop red and thick scars, known as hypertrophic scarring. This process can take several years.

Bleeding: In very rare cases, bleeding may occur in the operated area, usually within the first 24 hours. This may require additional surgery and can affect the result and increase the risk of other complications such as tissue death and infection.

Sensory Disturbances: These can occur in the skin in the operated area. This typically resolves within 6-9 months after the surgery but can be permanent in some cases.

Asymmetry and Unevenness: The skin may become uneven, especially if you have stretch marks from before, causing asymmetry. The worse the skin quality, the higher the risk of skin looseness developing again over time and being uneven from side to side.

Small Wounds: If the stitching is tight, you may see varying degrees of small wounds or defects in the scar. These often heal within a few weeks.

Fluid Accumulation: In rare cases, fluid may accumulate in the operated area. If this happens, it may be necessary to drain the fluid with a thin needle. It is important to use the compression bandage to prevent this.

Tissue Death: This means parts of the skin lose their blood supply and die. If this occurs, it may require surgical removal or waiting for the body to heal the area from the inside, as assessed by the surgeon. Being overweight or smoking increases the risk of this.

Regrowth of Glandular Tissue: Gynecomastia may recur, occurring quickly in some individuals and not at all in others. It is important to understand the cause of gynecomastia to correct it and minimize the risk of recurrence.