Written by Dr. Miguel Delgado
What is the best way to find a Plastic Surgeon?
To find a Plastic Surgeon in your area, click here to view our list of top gynecomastia surgeons. It's always a good idea to check your potential surgeon's credentials with your state's medical board, as well as your local medical society and hospitals in your area.
How can I tell if a particular Plastic Surgeon is experienced with GRS (Gynecomastia Reduction Surgery)?
Your potential surgeon should display confidence during the initial consultation. Ask to see before and after photos of previous Gynecomastia patients. The surgeon may be able to put you in contact with previous GRS patients. Most importantly, ask the surgeon how frequently he/she performs GRS each year. As the old saying goes... practice makes perfect!
Will my insurance company pay for GRS?
Unfortunately in most cases they will not cover this procedure. We have had only one insurance company agree to cover a case.
What if my insurance company denies my claim? What are my options? Do patients ever win appeals?
If your insurance company denies your initial request for coverage, you can always file an appeal. Most appeals are not won, however there have been a few cases that have prevailed.
What is the best way to approach my insurance company?
When requesting coverage for GRS, it is most important to inform them that you have a congenital condition and that you experience breast tenderness if this is the case for you. If you are overweight, it would be a good idea to get as close to your ideal weight prior to making a claim, as this can have an affect on their decision.
How much does the surgery cost?
In the USA, the average total cost of GRS is around $6000 to $7,500, broken down as follows:
- Surgeon's fee: $3,000 to $5,000
- Certified Operating Facility fee: $1,500 to $1,800
- Anesthesia fee: $275/hr. (Board Certified Anesthesiologist)
- Miscellaneous costs: Compression vest, lab tests, pathology and prescriptions
What blood tests should be done before surgery?
A "CBC," or complete blood count, is required of all our surgical patients. For GRS patients, a "PT/PTT" may possibly be requested if you have been using any type of aspirin-containing medications or certain types of vitamins/supplements. This test measures your "clotting mechanism".
Who should do the testing and evaluation of blood tests?
You can have the testing done at any lab convenient for you. The results should be faxed to your surgeon and anesthesiologist for evaluation before surgery.
Does it matter what causes Gynecomastia?
Yes. Gynecomastia can be drug induced (i.e. steroids, excessive marijuana or alcohol use). Medications such as Propecia (prescribed for hair loss) can also cause Gynecomastia. It is highly advisable to discontinue the use of these substances prior to surgery.
Is there a minimum age requirement for patients interested in GRS?
There is not a minimum age requirement for GRS, however many surgeons prefer to wait until the sufferer has completely finished puberty (18-20 years old). The reason for this being that for many teens who are still in their pubescent period, the Gynecomastia they're experiencing can, and usually will, go away on its own. The surgeon will use his clinical judgment if the case is severe and causing severe social/psychological issues. This may encourage surgery at a younger age.
Is there a maximum age limit for patients interested in GRS?
There is not an age limit for GRS, however if you have any medical conditions that could compromise your health during surgery, your surgeon may be hesitant to proceed or decline to perform the surgery altogether.
What medical conditions would prevent me from having GRS?
It is very rare for a patient to be turned down for surgery, however there are some serious medical conditions that can cause concern. Severe heart disease, malignant hyperthermia or severe bleeding disorders would be reasons for a surgeon to deny service.
Will there be any scarring?
If the surgeon removes glandular tissue, he/she will make a small peri-areolar incision, a half-circle incision around the lower half of the areola. In most cases the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot distinguish them from your normal skin.
What is the most common technique for GRS?
The most common technique for GRS is where the surgeon makes a peri-areolar incision to remove glandular tissue and then performs liposuction of the area for definition. Some surgeons only use liposuction, but in most cases we think this is a mistake unless it is pseudo-gynecomastia (all fat content). Twenty percent of my practice is re-do surgery from unhappy patients. This is most often due to the technique of liposuction only. This leaves the glandular tissue behind.
I understand that there are two types of liposuction, tumescent and ultrasonic. Is one better than the other?
The tumescent technique is the gold standard for liposuction. Basically, the surgeon enlarges the area to be suctioned with a large amount of sterile fluid combined with a vaso-constrictive agent such as epinephrine to reduce bleeding. The fat and the fluid are then suctioned out.
Ultrasonic liposuction uses sound waves to break up fat which is then suctioned out.
In our opinion, there is no advantage to this technique and we do prefer tumescent. In some surgeons' hands it works very well.
I have large pendulous breasts. How do you remove them and how much scarring will there be?
This is a very different and often more complicated problem. The skin has a tremendous ability to contract, especially if a patient is young. we usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. At the end of the procedure, we usually place drains in the area to allow fluids to drain for a few days following the surgery. Foam padding and a compression garment are also used as part of the post-op care. We have only had to perform a full breast reduction on one patient in the past that had a very extreme case of gynecomastia. We try to avoid these extensive scars at all costs.
Our Philosophy: Our goal for surgery is to make our patients feel comfortable shirtless or at the very least be comfortable in a light t-shirt. If a patient has noticeable scars after surgery then he will most likely not feel comfortable without a shirt on. If it is necessary to do another surgical procedure due to excessive skin following the initial surgery, then we can perform a peri-areolar lift minimizing the scar visibility.
I am 30 pounds overweight. How will this impact my surgery?
Gynecomastia does not react to either weight loss or gain. The breast is composed of breast glands and fatty tissue. The change in body weight can affect the fat content of the chest. The breast gland will increase in size due to hormones or other drugs, like steroids.
What do I need to do in preparation for surgery?
It is absolutely necessary to quit smoking starting at least 2 weeks prior and continuing until four weeks after your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote excessive bleeding. Herbal remedies such as St. John's Wort, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding. Bottom line is it is best to avoid all medications/vitamins/supplements such as these for two weeks prior and two weeks after your procedure. In our practice we supply the patient with a comprehensive booklet of pre-operative instructions before the surgery, clearly outlining these recommendations.
What is the recovery time following GRS?
The initial recovery period is the 7 to 10 days right after your procedure. If drains are used, they will typically remain in for about three days after which they will be removed at your first post-op appointment. Total recovery time can vary from patient to patient. Most patients can expect to be fully healed by 3-6 months. At this point most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. Sometimes, it may take as long as a year to completely heal to the point where the scars are no longer visible.
For the first 4 to 6 weeks after surgery, it is necessary to avoid all strenuous activities, especially those involving the upper body such as lifting weights or intense workouts at the gym. In addition we advise my patients to wear a compression garment for 6 weeks post-operatively.
You as a patient have invested a lot of time and money into this procedure, and as such you owe it to yourself to also invest the time and patience needed for healing in order to achieve optimum results.
What do I tell my employer, family and friends?
All medical conditions and patient records are confidential. At my practice, we gladly provide any letters/paperwork necessary to excuse you from work. We can provide such medical excuses without giving any details to your employer by simply stating it is for a medical condition. Your employer does not have the right to know what your surgery is for. Your medical information is between YOU and your DOCTOR and nobody else!
As for family and friends, you can tell them exactly what your surgery is for or you could tell them that you are having 'benign lumps' removed from your chest. Saying that you are having benign lumps removed is not lying and more than likely they will not pressure you into divulging anymore information than that.
Gynecomastia is a very common procedure, and yet, we have many patients that don't want to tell anyone that they are having GRS. It is completely normal to not want to share the details of your surgery with anyone, and it is at your discretion to do so if and when you feel the time is appropriate.
How long will I be in the hospital? Will I have to stay overnight?
This is a same-day outpatient surgical procedure. The actual surgery takes about 2ВЅ to 3 hours. After your surgery, you will be taken into recovery for at least one to one and a half hours to be observed and attended to by a nurse. Once your surgeon feels you are in a stable enough condition, you are released to return home. It is necessary to have a family member or close friend escort you home and stay with you for at least the first 24 hours.
How much pain will I be in post-surgery and for how long?
A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimum discomfort and most never complain of any severe pain, only soreness of the area. Regardless of you pain level after surgery, we always prescribe pain medication for you to have on hand should you need it.
Some doctors use drains and others do not, what is the difference?
We use drains in most of my cases. Drains help reduce swelling and promote better skin condition following your procedure. Remember, the function of a drain is simple. It allows the fluid underneath the skin to drain into a small bulb/bottle, where it can easily be emptied by the patient. This prevents such fluid from collecting inside the body and needing to be drained by other means.
What kind of stitches do you use externally? How long will they be there?
We use very thin 6-0 nylon sutures that are removed 7 to 10 days after surgery.
Do I need to avoid exposing my scars to the sun after my procedure? I have heard that it is recommended not to tan for a year, is this true?
Early sun exposure to your incisions after surgery is not advisable. To avoid scar pigmentation, you should use sunblock on your scars for 3 to 6 months following surgery. We also recommend silicone sheeting to be placed directly on the incisions for 2 months after surgery. We find the silicone gel sheeting improves the appearance of the scars by flattening them and decreasing the pigment.
What if I don't like my results? Will I need to have more than one surgery?
Within the first year, a redo or touch-up procedure is covered by the patient's initial surgical fee. However, it is important to remember that one must have realistic expectations for the outcome of any type of cosmetic surgery. That being said, we do want all of our patients to be happy and we will always do what we can to achieve that.
Do I need to wear a compression vest? What is it for? How long do I have to wear it?
It is necessary to wear a compression vest for about four to six weeks following the procedure. After the gland is excised and liposuction is performed, a large open space exists. The compression garment helps the tissue come together and close properly. The placement of the drains helps as well. Another function of the garment is to help reduce the initial swelling and contract the skin over the surgical site.
When can I return to work?
Usually patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity then it is easy to return shortly after the procedure. If you do physical labor then it is recommended to wait at least 10 to 14 days or whenever you feel you are ready. Listen to your body! It will tell you when it is ready to return to your normal activities.
Are there any post-operative complications that I should be aware of, i.e. painkillers, constipation, excessive swelling, etc.?
Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication, this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood underneath the skin, made noticeable by excessive bruising, swelling and pain, typically of only one side of the chest. If this happens it is imperative to contact your surgeon immediately.