Breast

BREAST AUGMENTATION

Breast augmentation, or augmentation mammoplasty, is a procedure aimed to increase the volume and improve the shape of the breasts. It can be carried out by placing implants or with fat from the own patient.

Mammoplasty is one of the most common procedures in plastic surgery nowadays, for aesthetic purposes or as reparative surgery such as post-cancer breast reconstruction or congenital abnormalities.

In this section, we will consider the breast augmentation with implants. This procedure helps to increase or balance the size of a small breast (hypoplastic one), or to recover the volume or shape after a partial or total loss (pregnancy, weight loss, aging…).

In consultations prior to the surgery, patients should indicate sincerely their expectations, in order to allow the plastic surgeon to show them the available options, risks, and limitations of each one of them. Moreover, the specialist will explain you what type of anaesthesia will be used, and if hospitalization is needed.

The procedure can be performed with different types of incisions, aimed at minimizing or hiding the scar.

Periareolar: the incision is made in the lower border of the areola, in the transition between the skin of the areola and the breast. The healing is good, producing a scar that is almost imperceptible.
Inframammary: the incision is made in the infra-mammary fold, a natural shaded and little exposed area; therefore, it is practically imperceptible. The key of this approach is to leave the scar exactly on the fold, neither on the skin of the breast nor on the skin of the abdomen.
Transaxillary: the incision is made in a natural fold of the armpit, avoiding a scar on the breast. This incision is particularly advantageous in patients with small breasts and with a barely marked inframammary fold.

Dr. Tarragona will explain you the pros and cons of each type of incision, and which one will be the optimal for your specific case.

The implant can be placed in different planes depending on the patient:

Subglandular: the implant is placed under the mammary gland. It is recommended in patients with a certain amount of breast tissue and subcutaneous fat (positive pinch test).
Subfascial: the implant is placed under the fascia of pectoralis major muscle, being completely separated from the breast.
Submuscular: the implant is placed under the pectoral muscle. It is the best option for reducing the visibility and palpability of the implant in the upper pole, presenting certain advantages in comparison to other planes, such as less capsular contracture and better visualization of the mammary gland in mammograms.
Dual plane: the upper part of the implant is placed below the muscle and the lower part below the gland. It has been developed as a variation of the submuscular technique to minimize the risk of breast deformations, considering the different degrees of breast ptosis.

The choice of the most appropriate implant will be made based on the desired results and the characteristics of the patient. Your surgeon will advise you of the characteristics of the implant:

filing (saline, silicone, glass bead)
shape (round or anatomical)
coating (silicone or micro-polyurethane)
surface texture (smooth or rough)
volume
size

Postoperative evolution and recovery

The surgery is performed under general anesthesia, thus the patient remains asleep throughout the surgical procedure. The duration of the procedure ranges between 1 and 2 hours, depending on each case.

Patients are usually discharged the day after the surgery, requiring a week of relative rest, after which the first treatment will be made, and the stitches removed. Depending on each case, the result will be perceived sooner or later. The final result is considered one year after the surgery.

Patients should wear a special design bra and a chest band during the first weeks.

How is the surgery performed?

The surgical procedure involves making a small incision to raise the breast tissue. A pocket is then created, and the breast implant is inserted directly under the breast tissue or under the pectoral muscle. Drainage tubes are placed, which will be removed on the next day, and a dressing or bandage over the breasts.

Can the implant be broken?

It is very unlikely that the breast implants break. Nowadays, breast implants are of fifth generation, and are provided of the most advanced technology for avoiding the break and other complications. Moreover, these implants are subjected to strict quality controls (especially in Europe and North America), and plastic surgeons carry out techniques and atraumatic sutures in order to minimize the risk of break.

Is the scar visible?

The scar will be visible during the first days after the intervention. However, the scar will be reduced over the time, and it will be, at the end, almost imperceptible. Besides this, there are some dressings and lotions for improving its appearance during healing.

When will I be able to return to normal life?

After the surgery, it is normal to feel a little tired for few days, but you will be able to do almost a normal life after 24-24 hours. Most of the inconveniences are controlled with medication, prescribed by your surgeon. Nevertheless, you may feel pain in the breasts for a couple of weeks. It is normal to feel a burning sensation in the nipples during the first weeks. Sutures will be removed after 7-14 days; and the oedema will disappear after 3-6 weeks. You will be able to go back to work in few days, depending on the activity you usually do. It is recommended to avoid lifting objects over the head for 2-3 weeks. You will feel hypersensitivity in the breasts for 2-3 weeks, thus it is advisable to avoid physical contact up to 3 or 4 weeks later.

How mammograms are affected by breast implants?

Women with breast implants can undergo the same mammograms and other imaging diagnostic techniques than women without implants. Occasionally, breast implants can interfere with the detection of breast tumours during the mammogram. The patient should inform the technician before undergoing the procedure to take the necessary measures. This is important, because there are especial projections that allow visualizing correctly the mammary gland in patients with implants.

Do breast implants produce cancer?

There is no association between breast implant and breast cancer. However, some scientific studies in last years have suggested a possible relationship between breast implants and the development of a rare lymphoproliferative disorder, named breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, nowadays there is no a strong causal relationship for this. The BIA-ALCL seems to be develop exclusively in women with textured implants. It is a treatable disease and is developed at a very low frequency. The best prevention strategy is to follow the instructions of your surgeon and fulfil with revisions and follow-up after the intervention.

Are the results immediate?

Breast augmentation surgery leads to bigger breast immediately. However, final results are achieved some weeks after the intervention when the swelling is reduced and the skin stretched. Incision lines can take months or, even, a couple of years for disappearing. Please follow the postoperative instructions from your surgeon and go to the scheduled follow-up visits to achieve the optimal results.

Should implants be replaced after some time?

Despite implants have no expiration date, sometimes they need to be replaced. It is recommended to visit the specialist annually to check the status of your implants.

Can I breastfeed with implants?

Yes, breast implants do not interfere with breastfeeding. Current studies indicate that women with breast implants have not a higher amount of silicone in the milk than women without them.

Are there complications during the intervention?

Breast augmentation surgery is a safe intervention; as long as is performed by a qualified plastic surgeon. However, as every surgery, complications may occur, such as:

Attributable to the implant:
- Capsular contracture: When a foreign body (such as the breast implant) is introduced in the organism; this develops a tissue around it (capsule). In some cases, this capsule can compress the implant, causing discomfort.
- Break of the implant: Since the quality of implants has increased, the likelihood of break has been reduced to minimum. There is no risk for health. The problem could be solved just changing the implant.
- Autoimmune diseases: Our immune system recognizes foreign bodies and infections, and help removing them by marking with antibodies. Occasionally, the immune system can identify the implant as a foreign body or aggressor of our organism.
Attributable to surgery:
- Hematoma: It is frequently reabsorbed by the own organism. The risk of hematoma can be minimized by taking acetylsalicylic acid or anticoagulants for at least two weeks before the intervention. Any of these actions must be consulted with your specialist.
- Seroma: Fluid can be accumulated around the implant. Sometimes it is necessary to extract the fluid; nevertheless, it can also be reabsorbed by the own organism. In severe cases, drainage may be necessary.
- Infection: As any surgical intervention, infections may occur. Normal symptoms are fever and inflammation. The standard treatment requires antibiotics and/or the withdrawal of the implant.
- Anaesthesia reactions.

BREAST LIFT

Mastopexy, or breast lift, is a surgical procedure aimed to raise and improve the shape of the breast or “breast ptosis”. Breast falling may be caused by different causes such as pregnancy, breastfeeding, loss of skin elasticity, and/or gravity. Breast ptosis is classified according to the location of the nipple-areola complex (NAC) respect to the inframammary fold:

Grade I: NAC at the same level than the inframammary fold.
Grade II: NAC below the inframammary fold.
Grade III: NAC below the inframammary fold with the nipple looking down.
Pseudoptosis or fake ptosis: NAC is adequately located, but the distance between the nipple and the inframammary fold is increased.

Mastopexy can be performed under two different situations:

Simple mastopexy: In patients who do not want to increase the volume of the breasts. The nipple will be re-located, and the skin removed. The mammary gland will be used to improve the shape and volume of the breast, with no need of implants.
Mastopexy without implants: In patients who want to increase the size of the breasts. The nipple will be lifted, and the excess of skin removed. The implant will be placed; providing volume to the upper pile of the breast (neckline).

Mastopexy is performed in an operating room under general anaesthesia, thus hospitalization is required. The patient will be discharged after 24 hours. The intervention lasts between 1.5 and 3.5 hours, depending on the grade of the sagging breast.

After surgery, the patient will return to normal life in 24-48 hours. Gauze dressings will be removed after few days, whereas sutures after 7 and 14 days. The oedema will not disappear completely until 3 or 6 weeks later.

There are different types of techniques:

Periareolar: The incision will be made around the areola. This allows reducing the size of the areola, and lifting the breast, in cases of grade I ptosis and NAC not raised more than 2cm.
Circumvertical: The incision will be made around the areola, vertically to the inframammary fold. It also allows reducing the size of the areola, and a higher removal of skin than the previous technique. It is indicated for grade I or II ptosis.
Inverted-T incision: The incision will be made around the areola, vertically to the inframammary fold and horizontally through it. It is indicated for grade II and III ptosis with severe atrophy and excess of skin. It is also able to reduce the areola. It is indicated for very sagging breasts associated with certain degree of gigantomachia (excessive growth of breasts), and, thus, requiring surgical removal of breast tissue either in vertical and horizontal planes. It is indicated for moderate or severe breast reductions with grade II or III ptosis.

In consultations prior to the surgery, patients should indicate sincerely their expectations, in order to allow the plastic surgeon showing them the available options, risks, and limitations of each one of them. Moreover, the doctor will explain what type of anaesthesia will be used, if hospitalization is needed, and the cost of the intervention. Do not forget to indicate to the surgeon if you are smoker, if you are taking any medication or vitamin, the number of previous pregnancies, and if you want to be pregnant again.

Why do breasts sag?

There are several causes why the breasts are empty or fall down; for instance, after pregnancy or breastfeeding, after a severe weight loss, etc. This occurs due to a couple of factors: the laxity of the internal structure of the breast (Cooper’s ligaments), and the loss of the support by the skin, holding the weight of the breast.

How long will I remain in the hospital after the intervention?

Unless complications, in most of cases the patient is discharged the following day to the intervention.

When will I be able to return to normal life?

After mastopexy, you will be able to work in a few days, depending on the activity you usually do. Please, follow the instructions of your surgeon about which activities you can do. Your breasts will be more sensitive than normal for 2 or 3 weeks. Thus, it is advisable to avoid physical contact up to 3 or 4 weeks later.

How is the surgery performed?

An incision is initially made (around the areola, vertically downwards from the areola to the inframammary fold, or vertically to the inframammary fold and horizontally through it); then the underlying breast tissue is lifted and corrected to improve the shape and firmness of the breasts. The nipple and areola are re-located to a natural level. If necessary, enlarged areolas can be reduced by removing the skin around. The excess of skin from the breast will be removed for compensating the loss of elasticity. Finally, the remaining skin will be adjusted while suturing.

Is mastopexy always associated with breast augmentation or reduction?

Not necessarily. However, a person who needs a mastopexy usually has voluminous breasts. So this intervention is frequently associated to the resection of skin and mammary gland, which will be replaced by an implant. In breasts with low volume, a breast augmentation can be simultaneously performed.

At what age can mastopexy be performed?

In this intervention the age is not decisive if the patient is healthy.

Are results permanent?

After the mastopexy, scars are important and permanent. Besides this, plastic surgeons will do their best for making the scars imperceptible. Scars will be less noticeable over the time. The effects of mastopexy, although long-lasting, are not permanent because of several reasons, such as pregnancies, changes in weight, and aging. Nevertheless, the breast will never be fallen as before of the intervention. The effects will last longer if an implant is placed.

Is breastfeeding possible after a mastopexy?

In most of cases, it is possible to breastfeed after the intervention.

Are there any complications during the intervention?

Breast lift is a safe procedure, as long as carried out by a qualified plastic surgeon. Yet, as any surgery, there are complications and associated risks.

BREAST REDUCTION

Breast reduction is a procedure aimed at reducing the size of the breast by removing fat, breast tissue and skin, resulting in an improvement of the shape, reduction in weight and being more firmly. Similarly, it can be carried out for reducing the size of the areola.

Women with breasts of excessive size can experience problems associated to the excessive weight of the breast such as pain in neck and back pain, respiratory issues, or skin irritations under the breast. This intervention is generally performed to relief a physical problem, more than for aesthetic purposes.

The surgical intervention is carried out under general anaesthesia, and its duration varies between 2 and 4 hours. Hospitalization is usually required, and the discharge is the next day. A bandage bra is placed after the intervention and is changed after 24 hours (during hospitalization).

Once the intervention has finished, the patient will notice the relief in the back pain, the improvement in the bone stability, the improvement in lung function and in the quality of sleep. Satisfaction of patients after the surgery is high (rarely, the patient feels no significant improvement in pain); together with the aesthetic improvement and personal perception.

In consultations prior to the surgery, patients should indicate sincerely their expectations, in order to allow the plastic surgeon showing them the available options, risks, and limitations of each one of them. Moreover, the specialist will explain what type of anaesthesia will be used, if hospitalization is needed, and the cost of the intervention. Do not forget to indicate to the surgeon if you are smoker, if taking any medication or vitamin, the number of previous pregnancies, and if you want to be pregnant again.

Hypertrophic breasts usually have a glandular, fat, or mixed pattern. The specific surgical technique depends on the composition of the breast.

There are 3 types of incisions:

–Circular pattern around the areola. In this case, incision lines after the intervention will become visible and permanent scars, although they are imperceptible beneath the swimsuit and bra.

– Racquet-shaped pattern, with an incision around the areola and vertically to the inframammary fold.

– Inverted-T incision or anchor pattern

Are there complications with breastfeeding after breast reduction?

Patients generally do not experience any problem for breastfeeding, but the possibility of not being able to do so exists for a low percentage of patients. In these patients, there is no spontaneous recanalization of milk ducts.

How is the procedure?

The technique employed to reduce the size of the breasts depends on your characteristics, the composition of your breast, the amount of wished reduction, the personal preferences, and the advises from your surgeon.

An incision is initially made, the tissue is removed, and the nipple is re-located. The areola is reduced when removing the skin, if necessary. The underlying breast tissue is reduced, lifted, and shaped.

Occasionally, for women with voluminous and sagging breasts, it is necessary to remove the nipple and the areola, and then re-locate it in a higher position in the breast (nipple graft).

Finally, incisions are joined to re-shape the breast.

When can I return to work and exercise?

Despite feeling discomfort, some days after the intervention, the patient will be able to return to daily activities.

In case of sedentary activities, the patient will be able to work after one week of the intervention. After two weeks, the patient will start to do moderate exercise and after one and a half month, the life will be normal.

Will I feel sensitivity of breasts and nipples after the intervention?

Yes, in most of cases. However, some factors have an influence over the final result, such as the previous sensitivity, the volume of breasts, and the techniques used. Each case will be evaluated by your surgeon for choosing the most appropriate technique for you.

Are there complications during the intervention?

Breast reduction surgery is a safe procedure if it is performed by a qualified plastic surgeon. However, as a surgical intervention, there are complications and associated risks, such as:

Bleeding: it is possible, although unlikely, that you experience an episode of haemorrhage during or after the surgery. In case of postoperative haemorrhage, you may require an urgent surgery in order to remove the accumulated blood. You have to inform to your surgeon if you are taking any medication able to interfere with the surgery (such as aspirin or anti-inflammatory).
Infection: rarely occurs. If so, an additional treatment may be necessary, including antibiotics or surgery.
Changes in skin sensitivity: you may experience a change in the sensitivity of nipples and skin of breasts after the intervention. The permanent loss of sensitivity of one or both nipples after a breast reduction might also occur.
Healing problems: although normal healing is expected after the surgical procedure, complications related to healing may occur, especially in smokers. Scars can be anti-aesthetics or with a different colour than the surrounding skin. Additional treatment may be required, including surgery for treating the abnormal healing.
Firmness: after the surgery, an excessive firmness of the breast may occur, due to internal healing or fat necrosis. This fact is not predictable and, if an area with fat necrosis or scar occurs, biopsy or an additional surgical treatment may be required.
Asymmetry: after the surgery, differences in the shape of the breast or nipple, size or symmetry can occur. An additional surgery may be required in order to revise an asymmetry after the breast reduction.
Breastfeeding: It is usual to be able to breastfeed after a breast reduction. However, sectioning areola and nipple, or milk ducts, could preclude breastfeeding. If you are planning to be breastfeeding after the intervention, it is important you to discuss it with your surgeon before undergoing the procedure.

How long will I remain in the hospital after the intervention?

The patient usually is discharged the next day of the intervention.

Is the procedure painful?

Breast reduction is a common and painless procedure. Discomfort related with sutures and skin tension may occur during the recovery period.

When are the results visible?

Results of the breast reduction are immediately visible. Postoperative inflammation and incision lines will disappear over the time. The breast will achieve the final appearance after some months.

TUBULAR BREAST

Tuberous breasts, tubular breasts, or “snoopy breast” are a deformity of the breasts produced by an abnormality in the base of the breast, with no known cause, and characterized by a poor development of the inferior quadrants of the breasts, producing the absence of breast tissue under the areola (lower pole hypoplasia). The breast fold is lifted and the breast tissue is ruptured through a dystrophic areola. These breasts are frequently asymmetric and along with this, other deformities of the spinal column or thoracic wall are developed.

There are three grades depending on the severity of the abnormality of the base of the breast:

Grade I: Hypoplasia of the inferior-medial quadrant. It is the most frequent (56%).
Grade II: Hypoplasia of the two inferior quadrants, with a frequency of 26%.

There are two subtypes within this grade:

With enough skin in the subareolar region.
With not enough skin in the subareolar region.

Grade III: Hypoplasia of all quadrants, showing a minimum breast base. It is the less frequent (18%).

The most adequate surgical technique is chosen according to the grade:

Grade I: the intervention is carried out for distributing adequately the mammary gland and filling in the quadrant with deficit. The excess of tissue of the inferolateral zone can be used to create a glandular flap, filling the inferolateral pole. In mild cases, the defect can be corrected by lipofilling (fill-in technique).
Grade II: there are different techniques:
With implant (Puckett’s technique): After the reduction of the areola, a periareolar incision is made and the gland is separated from the inferior skin of the breast to reach the area where the new inframammary fold is After this, the gland is separated from the pectoral muscle at the same level that the nipple, but posterior to the breast, and a horizontal incision is made back and forth. Therefore, the gland is divided into two parts, superior and inferior. The inferior flap will be used to expand the inferior pole of the breast. The anatomical silicone implant can be placed once the flaps are separated.
Without implant (Ribeiro’s technique): A cross-sectional incision to the breast is made, under the areola, until the fascia of the pectoral muscle, which divides it in two flaps. The superior one will be used to conserve the nipple-areola complex (NAC), whereas the other to provide volume and expand the inferior pole, after folding up over itself.
Others: lipofilling or reconstruction by using expanders.
Grade III: it requires several surgeries to achieve the best result. The skin deficit makes necessary to place submuscular expanders to obtain a greater skin coverage.

The duration of the surgery ranges about 2 hours, being discharged the following day of the intervention.

An appropriate diagnosis is crucial because if a tuberous breast is not correctly identified before the surgery, a second surgery will be necessary to solve the previous breast deformity. The tuberous breast surgery requires specific surgical techniques. In most of the cases, the patients visit the specialist looking for a breast augmentation with no knowledge of this condition. In the consultations prior to the surgery, patients should indicate sincerely their expectations to allow the plastic surgeon to show them the available options, risks, and limitations of each one of them. Moreover, the specialist will explain what type of anaesthesia will be used, if hospitalization is needed, and the cost of the intervention. Do not forget to indicate to the surgeon if you are smoker, if taking any medication or vitamin, the number of previous pregnancies, and if you want to be pregnant again.

Are the scars very visible?

Incisions are made in an area of the breast which will be removed, and where the nipple-areola complex will be re-placed into the new location. The sutures will be made around the areola, in most of cases. In voluminous breasts, an inverted T-incision will be made in a vertical line downward and through the inframammary fold, under the breast; no requiring implant. At the beginning scars will look pink but will improve progressively becoming imperceptible, if the instructions of care provided by the surgeon are followed. These scars are imperceptible beneath the swimsuit and bra.

Will I lose the sensitivity of my breast after the intervention?

It is possible to loss sensitivity in the first days of the intervention due to the inflammation. However, after some days, you will be recovering your sensitivity. Nevertheless, some patients can experience partial decrease in the sensitivity of the nipple.

When can I return to normal life?

The patient can return to normal life and work in a few days. However, the patient will have to wait about 3 weeks for performing intense exercise. You should follow the instructions given by your surgeon. It is recommended to avoid lifting objects over the head for 2-3 weeks. Sutures will be removed between 7 and 14 days after the intervention.

How is the surgical procedure?

The key in the intervention consists of weakening the basal fibrous ring to extend the base of the breast implantation and create an adequate inframammary fold, in harmony with the anatomy of the patient. Procedures will vary according to the grade of severity, but all of them have in common the section of the fibrous ring, the reconstruction of the areola, and the use of anatomical implants.

At what age is a tuberous breast detected?

In early adolescence, women can perceive some alterations in the breast, such as the tubular breast and a big areola. The best time to perform the intervention is at puberty, once the gland is completely developed.

Are there complications during the intervention?

Tuberous breast surgery is a safe procedure, if performed by a qualified plastic surgeon. Nevertheless, as any surgery, complications and associated risks can occur. As any surgical procedure, infection can occur. This complication is very rarely developed, and very easy to treat with antibiotics.

The risk of postoperative haemorrhage is very low, although possible. The skin has shape memory which can cause what is called a double fold, due to the tissue constriction prior to the the intervention, appearing the former fold (previous to the intervention) and the one that would appear after the placement of the implant. This complication can be solved with an additional surgery, such as lipofilling the zone for reducing the transition between the former fold and the new one.

GYNECOMASTIA

Gynecomastia surgery consists on a mastectomy for correcting the excessive development of the male breast, due to an increase in the size of the mammary gland. Gynecomastia affects to 40-60% of men. It can affect one or both breasts.

Gynecomastia can produce emotional discomfort and affect to your self-esteem.

Although, in most of the cases, there is no possibility to identify a specific cause after an adequate diagnosis, its relationship with other situations and conditions is well known:

Hormonal changes related with aging (decrease of testosterone and increase of oestrogens).
Obesity, as the amount of body fat can increase the levels of oestrogens.
Medications and other substances (some chemotherapeutic agents and antibiotics, antidepressants, drugs for the treatment of cardiovascular diseases, excessive consumption of alcohol, amphetamines, anabolic agents, etc.).
Diseases producing low levels of testosterone (hypogonadism), such as Klinefelter syndrome or problems of the pituitary gland.
Overactive thyroid (hyperthyroidism).
Conditions in the liver.
Diseases of the kidney and renal insufficiency.
Tumours in testicles, suprarenal glands, or pituitary gland.

In the consultations before the intervention, a complete medical record will be made, and a breast examination looking for the possible causes of gynecomastia. Also, a set of analyses to discard out the pathologies mentioned above, including hormonal profile of sexual and thyroid hormones. Under suspicion of a medical problem as cause, you will be sent to the corresponding specialist. Patients should indicate sincerely their expectations to allow the plastic surgeon to show them the available options, risks, and limitations of each one of them. Moreover, the specialist will explain what type of anaesthesia will be used, if hospitalization is needed and the cost of the intervention. Do not forget to indicate the surgeon if you are smoker or if you are taking any medication or vitamin.

The correction of the gynecomastia is a procedure in which fat and glandular tissue are removed from the breasts and, in severe cases, excess of skin is also removed. A flat, firm and well-contoured chest will be obtained.

There are four main types of procedures:

Simple surgical removal. It is mainly indicated in cases with increased breasts due to glandular hypertrophy. A periareolar incision is made in the lower pole of the areola.
Simple liposuction. It is indicated for cases with predominance of fat tissue. The incision is made in the lateral zone of each inframammary fold.
Surgical removal and liposuction. It is indicated in cases with glandular hypertrophy and increase of fat tissue.
Surgical removal and skin resection. It is indicated in cases with excessive skin, when requiring relocating the nipple-areola complex.

The surgery usually lasts for one and a half hour. Local anaesthesia and sedation or general anaesthesia may be required, and thus hospitalization.

Am I good candidate for a gynecomastia?

This intervention can be carried out in healthy men, of any age. However, it is discouraged in obese or overweight men who have not tried first to correct the problem with exercise or weight loss. There are also no good candidates: individuals who drink alcohol in excess or smoke products derived from marijuana, since these drugs, along with anabolic steroids, can cause gynecomastia. Therefore, these patients should change their habits previously in order to check if the breast decreases; before considering surgery.

Are there complications during the intervention?

If the procedure is carried out by a qualified plastic surgeon, complications are rare and minor. Yet, as any surgery, there are always risks such as asymmetries, healing retraction, infection, excessive bleeding, and development of seromas.

How is the recovery period?

A temporary inflammation occurs after the intervention. To help to reduce the inflammation and keep the skin well attached, it is necessary to wear an elastic garment for a while. Although most of the swelling will disappear after a few weeks, it may take three or more months until the final result of the surgery is visible. You should avoid intense exercise for 3 weeks. You will be able to recover your normal physical activity in one month approximately.

At what age is possible to undergo the gynecomastia?

The intervention can be carried out with 16 years old; however most of cases are done between 20 and 50 years old.

How is the surgery performed?

Liposuction techniques will be performed when gynecomastia is caused by an excessive fat tissue. Small incisions will be made and the excessive fat tissue will be removed. Resection techniques are recommended if breast gland or excessive skin has to be removed, areola reduced, or nipple re-located. Occasionally, both techniques are used.

Is it possible to recover the removed volume over the time?

In most of cases, the results of the procedure are significant and permanent.

Nevertheless, if the cause of gynecomastia remains over the time, it is possible to recover a part or all the volume removed with the intervention.

When can I return to normal life?

In most of cases, the patient will return to normal life after 2 or 3 days, although it is possible to feel mild discomfort.

Regarding exercise, the patient will be able to do mild exercise since the first day, but you will wait 3 weeks to do severe exercise.

Is the intervention performed with general anaesthesia?

It depends on each case. Sometimes, the procedure can be performed under general anaesthesia, or local anaesthesia and sedation. You should consult the surgeon which type of anaesthesia is most appropriate for you. General anaesthesia is the most frequent, for patient’s comfort.

How long will I remain in the hospital?

Gynecomastia may require hospitalization if mastectomy is also performed, because of the use of drainages. When liposuction or a small resection of tissue is performed, the patient will be discharged in a few hours after the intervention. If it is performed under local anaesthesia and sedation, the patient will go home the same day of the intervention.