San Jose, CA-In the last two years, I have seen an increase from 25% to 40% in the amount of gynecomastia “redo surgeries” that I do.
There are several different issues that bring patients back for revisional surgery. Probably the most common complication is where liposuction alone was used to remove fat leaving behind the dense breast tissue. The only exception to this would be the patient that has “pseudo-gynecomastia” which means the enlarged male chest is caused by fat alone.
True gynecomastia has both fat and breast gland. Liposuction is very effective for removal of fat, but the surgeon needs to be careful not to remove too much as it works as a buffer so that the skin can move over the muscle. Breast gland needs to be removed by surgical excision as it is too dense to go through the cannula; the cannula is the narrow tube that removes the fat from the chest by liposuction. Gynecomastia specialists routinely perform this combination to get a masculine shape for the chest. However, there are many surgeons that believe they can reduce the male breast by liposuction alone. This is a common error leaving men with less than desirable results, necessitating “redo surgery” to remove breast tissue. Redo surgery is more difficult than the initial surgery as now there is scar tissue to contend with as well as the probability the skin has lost some of its elasticity.
Another cause for redo surgery is where the surgeon has removed too much breast tissue and/or fat leaving what is known as a “crater deformity”. When this happens, it needs to be corrected with a fat transfer using the patient’s own fat from another part of the body or preferably a fat flap which has its own blood supply and can be rotated into the crater.
Another reason men seek revision surgery is when they are unhappy with the resulting scar from their original surgery. Depending on how the surgery was done and where the incision was made can make the revision a bit trickier. Having an obvious scar is unacceptable as a tradeoff for the gynecomastia itself.
Each patient is unique and needs to be evaluated by a gynecomastia specialist; fortunately most cases can be revised. It is regrettable but the patient will need to wait until he has healed from the first surgery, and then allow time off for a secondary procedure and recovery and of course incurring additional costs.
Hopefully men will do their research and choose their surgeon carefully so that they can avoid possible “redo surgery”. At the time of the consultation, be sure to see many pictures of actual patients of the surgeon taken before and after surgery. Ask a lot of questions such as; how will the procedure be done, and how many gynecomastia procedures are done each year, is the surgical center or hospital accredited? Ascertain that your surgeon is Board Certified in Plastic Surgery and specializes in gynecomastia so that a revision will not be required.