GYNECOMASTIA SURGERY

– NEWPORT BEACH, CA –

The chest refers to the area that covers the rib cage in the front. It typically spans from the collar bones (clavicles) all the way to the 12th rib and is separated in the midline by the breast bone (sternum) to left and right chest. The chest area can be arbitrarily broken down to the breast area, upper chest above the breast, lower chest below the mammary crease and the outer chest on the sides.

Following weight loss, the fatty layer under the skin as well as the fat within the breast undergo shrinkage. This results in redundancy of the chest skin as well as breast skin envelope. Redundant excess chest skin is seen as horizontal and vertical laxity. Horizontal chest laxity causes skin and tissue excess under the armpits and over the outer chest. Vertical chest laxity affects mainly the breasts, causing breast sagging in both men and women.

However, when the degree of weight loss is significant, vertical chest laxity presents itself as breast mound descent on the rib cage and loose mammary crease attachments.
The loose tissue may also create a fold under the breast and over the upper abdomen. This tissue roll typically stretches towards the back and join the upper/ midback rolls. This is particularly common in V-shaped body structures where the upper body is larger than the lower body.

In both men and women, breast deflation and sagging (breast ptosis) develops. These are classified according to the degree of severity in both genders.

Dr. Agha’s Chest Deformity Classification:

Type 1

In this form, there is minimal chest/breast skin excess. The skin quality is good, but there is excess breast tissue with or without excess fat over the chest. These patients typically have fuller breasts that are noticeable in tight clothing.

Around 65% of men are thought to have type 1 chest deformity, although only a small portion seeks treatment.

Type 2

In type 2 chest deformity, you may have a mild to moderate degree of chest skin laxity and excess. The skin quality is also good, but there are excess breast and fat tissues on your chest.

Type 3

Unlike the first two types, the excess breast and fat tissues on your chest are coupled with marked skin laxity and hanging (vertical excess) breasts.

Type 4

Type 4 chest deformity is the same as type 3, but the excess breast and chest skin appears both vertically and horizontally. This is most commonly seen among patients who lost a massive amount of weight.

The vertical skin laxity appears as hanging breasts, while the horizontal skin laxity is seen as outer chest skin excess and bulge.

Type 5

In addition to the features of type 4, type 5 also features a stretched out or bulging lower chest skin below the breasts. It is also seen among massive weight loss patients.

Correction of Chest Laxity And Breast Sagging

Most weight loss patient’s typically present with Agha’s Chest Laxity Classification type 4 or 5. That means in addition to breast sagging (in both men and women), they also have outer chest and lower chest tissue excess.

To tackle these changes, a number of procedures have been described by Dr. Agha and other plastic surgeons.

In men with gynecomastia (excess breast gland), a horizontally-oriented elliptical excision of excess breast can lift the nipple areola on the chest while removing the excess breast tissue. Alternatively, the patient may end up with a curved incision at the breast crease, an anchor-type incision, or a horizontal incision on each side of the nipple areola. To learn more, please read our gynecomastia section.

In women with breast sagging, in most cases, an anchor-type incision is needed to remove enough skin to lift the breasts and to make them rounder. This can be combined with breast implants, breast reduction, or neither. To learn more, please read our breast surgery section.

For lower chest excess below the breasts as a roll of redundant loose skin, a reverse tummy tuck can be combined with the elliptical or anchor-type incisions excision to remove the additional skin laxity and to produce a smooth and tight chest contour.

For excess outer chest skin, a vertically-oriented elliptical excision below the armpit, removes excess outer chest skin. This procedure was pioneered and named the J-upper body lift by Drs. Agha and Hurwitz.

Dr. Agha’s Male Chest Deformity Classification and Approach to Chest Enhancement

Dr. Agha’s Classification	Features	Treatment
Type 1	-Minimal chest skin laxity -Good skin quality with excess breast tissue -May or may not have excess fat	-Liposuction for fat removal -Periareolar incision for breast gland removal
Type 2	-Mild to moderate degree of chest skin laxity -Good skin quality with excess breast tissue and fat	-Liposuction for fat removal -Periareolar incision for breast gland removal
Type 3	-Marked chest skin laxity -With hanging breast (vertical skin laxity)	-Horizontally-oriented elliptical excision for excess gland, skin, and fat removal
Type 4	-With hanging breast (vertical skin laxity) -With outer chest skin excess and bulge (horizontal skin laxity)	-Horizontally-oriented or Anchor-type incision to excise gland, skin, and fat -Vertically-oriented elliptical excision below the armpit to remove excess outer chest skin
Type 5	-With hanging breast (vertical skin laxity) -With outer chest skin excess and bulge (horizontal skin laxity) -Bulging lower chest skin	-Horizontally-oriented or Anchor-type incision to excise gland, skin, and fat -Vertically-oriented elliptical excision below armpit to remove excess outer chest skin -Reverse tummy tuck

Click here to learn more about recovery after chest enhancement and Gynecomastia correction.

Different Types of Gynecomastia Procedure

(Click to enlarge)

How Do You Recover From a Gynecomastia Procedure?

Gynecomastia can be performed as an outpatient procedure. After recovering in the recovery room for an hour or two, you may be able to go home in the company of a friend or family member. We also have a private duty nurse available to care for you in the comfort and privacy of your own home if you so choose. For those who have large volume liposuction, they are expected to stay overnight for further monitoring. Dr Agha is the best choice.

Day of Surgery– When you wake up from your procedure, you will be in the recovery room and will be wearing a compression garment. You should plan to wear the compression garment for four to six weeks following surgery. This functions to control swelling, conform the underlying tissue and aid in skin contraction.

Care Giver– When patients leave the surgery facility to go home, they are usually groggy for about 12 hours or overnight. That is why it is very important to have an adult who can assist you with getting around and taking your medications for at least the first 24 hours. We will assist in the Gynecomastia surgery recovery.

Drains– A small, thin drain tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. This will be removed at your first post-operative visit on day 5 or so.

Nausea– Most people are nauseated during the first 24-48 hours. To reduce this, we suggest that you take your nausea pill one hour before taking your pain pills or antibiotics.

Sleeping– During the first week after your breast reduction surgery, attempt to sleep on your back to avoid discomfort.

Painkillers– You’re likely to feel sore for a few days, but you should be up and around in 24 hours. Most of your discomfort can be controlled by the prescribed painkillers.

Showering– Remove your dressing, sponges and gauze pads on the third post-operative day. You may now take a shower. After showering, simply pat your incisions dry and replace your compression garment.

First Post-op Visit– Dr. Agha prefers to see you on day 5 for your first post-operative visit.

You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look remarkably similar and natural.

Swelling in your breasts may take three to five weeks to subside.

Driving– You may drive when driving does not cause pain. This usually occurs in 7-10 days if you have a car with power steering. It is not safe to drive a car within twenty-four hours of taking pain medication, as your reflexes and alertness may be altered.

Work– You should be able to return to work within a few days, depending on the level of activity required.

Walking– It is still important to start walking as soon as possible, usually the evening of surgery. This is the best way to reduce the chance of getting a blood clot in the legs.

Light Exercise– Dr. Agha recommends light exercise to reduce swelling and prevent clotting. Light exercise includes walking, stretching, moving arms and legs while sitting. After the first week or two, cardiovascular activities such as riding a stationary bicycle or brisk walking can be initiated. You may gradually advance your exercises as tolerated.

Activities– During the first week after surgery, you want to avoid activities that raise your blood pressure. This could cause bleeding at the operative site, which could result in a hematoma (collection of blood). Walking is an excellent form of exercise, especially during the first week. During second week, cardiovascular activities, such as riding a stationary bicycle or brisk walking, can be initiated. Running at this point may be premature. Avoid exercises which directly stress the area of your surgery for a full four weeks. Avoid heavy lift, contact sports and jugging for up to 6 weeks. By the time you are six weeks post-operatively, you will be nearing your pre-operative level. The reason to avoid stressing the surgical area has to do with healing and scarring. During the early phase of healing, one must avoid irritation around the operative site, as this can worsen swelling and fluid accumulation. This could cause development of a seroma (fluid collection) or cause problems with the wound (dehiscence or opening of the suture line, or widening of the scar).

Healing– You will begin to feel better after about a week or two and should be back at work within a few days following your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing.

Scarring– Every person’s body is different, and many factors contribute to scar healing. Your scars will be firm and pink for about six weeks. Non-smokers and those who follow the Enhanced Recovery Nutritional Supplements have a better chance of having rapid healing and thinner scar. Expect to wait at least nine months before your scars lighten in color and become as flat as the rest of your skin. During this time, you must protect them from the sun. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin-protection factor (SPF) of at least 15 at all times when in the sunshine.

Sensation– Regeneration of the sensory nerves is accompanied by tingling, burning, or shooting pains. As the nerves regenerate, the nipples commonly become hypersensitive. This will subside with time. You may find that gentle massaging helps. If however, this is accompanied by swelling or redness, infection, or bleeding, then you will need to see Dr. Agha at the office.

Follow-ups– Regular checkups protect against complications.

Emergencies– Some discomfort is expected following your surgery; however, be sure to tell us if:

There is an increase in swelling, pain, redness, drainage or bleeding in the surgical area.
You develop fever, dizziness, nausea or vomiting, or a general ill feeling.
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.