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Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Gynecomastia surgery can be performed under local anesthesia with sedation (Twilight) or general anesthesia, depending on the extent of the procedure and patient preference. For Grade 1 or 2 cases, deep sedation is often sufficient, enabling rapid recovery and discharge.
For Grade 3 or 4 cases requiring skin excision, general anesthesia is preferred to ensure complete muscle relaxation and secure the airway. The anesthesia team continuously monitors vital signs. Long-acting local anesthetics are injected into the chest wall during surgery to provide pain relief that lasts well into the recovery period.
The procedure begins with the infiltration of tumescent fluid into the chest area. This solution contains saline, lidocaine (a numbing agent), and epinephrine (a vasoconstrictor). This step is crucial for “hydro-dissection,” which separates the fat cells and gland from the muscle.
Epinephrine constricts blood vessels, resulting in a nearly bloodless field. This minimizes bruising and allows the surgeon to visualize the tissues clearly. The fluid also firms up the fat, making it easier to emulsify and remove.
Modern gynecomastia surgery utilizes VASER (Vibration Amplification of Sound Energy at Resonance) technology. A specialized probe emits ultrasonic waves that specifically target and emulsify fat cells while preserving blood vessels, nerves, and connective tissue.
This fat liquefaction enables gentle extraction and stimulates skin retraction. VASER is particularly effective in releasing the fibrous attachments of the glandular tissue, making the subsequent excision easier and less traumatic. It ensures a smooth, contoured result rather than an irregular, lumpy surface.
Following VASER emulsification, the surgeon uses micro-cannulas to aspirate the liquefied fat. The liposuction is performed in a fanning motion, carefully sculpting the chest wall. The surgeon focuses on the lateral pectoral border, the axilla (armpit), and the upper abdomen to create a seamless transition.
The goal is not just to remove fat but to sculpt a shape. The surgeon leaves a thin, uniform layer of fat over the muscle to maintain a natural feel and prevent adhesion of the skin to the muscle fascia.
Once the fat is removed, the dense glandular disc remains under the nipple. The surgeon makes a small, semi-circular incision along the lower border of the areola (the Webster incision). Through this tiny opening, the gland is dissected from the nipple and the muscle.
Using a “pull-through” technique, the gland is grasped and carefully removed. The surgeon feathers the edges of the remaining tissue to ensure there is no depression or “saucer” deformity behind the nipple. This step is critical for flattening the puffy nipple.
For Grade 3 or 4 cases, excess skin is removed. The incision pattern may be periareolar (donut lift) or, in severe cases, a horizontal incision. The surgeon removes the redundant skin and advances the remaining skin to tighten the chest wall.
If the nipple is too low, it is repositioned superiorly to a more masculine location on the pectoral muscle. This part of the surgery requires meticulous measuring and suturing to ensure symmetry and minimal scarring.
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In most VASER-assisted cases, drains are not necessary. However, if there is significant bleeding or an ample void space, small drains may be placed to remove fluid and prevent seroma formation.
The incisions are closed with fine, absorbable sutures buried under the skin. Surgical glue or sterile strips are applied to seal the wounds. This multi-layer closure ensures that the tension is taken off the skin edges, promoting a fine, hairline scar.
Immediately after closure, a medical-grade compression vest is applied to the patient. This vest is critical. It applies even pressure to the chest, collapsing the space where the fat and gland used to be.
This compression prevents fluid from filling the void (seroma), minimizes swelling, and helps the skin adhere to the chest wall. The vest acts as a mold for the new chest shape while the tissues heal.
The first 48 hours involve rest and drainage management. If tumescent fluid was used, some leakage from the incision sites is normal. Patients are instructed to rest with their upper body elevated to reduce swelling.
Pain is typically mild to moderate, often described as a deep soreness similar to a heavy chest workout. Patients are encouraged to walk around the house to promote circulation, but must avoid any arm movements that engage the pecs.
By the end of the first week, patients can typically return to sedentary work. The initial dressing or drain (if used) is removed. The compression vest must be worn 24/7, removed only for showering.
Bruising may be present but begins to fade. The chest will feel stiff and numb due to the disruption of superficial nerves. This is normal. Patients are advised to limit the arm range of motion to avoid stretching the incisions.
With modern VASER techniques and internal quilting sutures, we rarely use drains for Grade 1 and 2 cases. Drains are typically reserved for Grade 3 or 4 instances in which a large amount of skin and tissue has been removed to prevent fluid buildup.
The incision is placed precisely along the bottom edge of the areola, where the dark skin meets the light skin. This natural camouflage makes the scar virtually invisible once healed. In skin excision cases, the wounds are larger but placed strategically.
Most men compare it to the soreness you feel after doing way too many pushups. It is a deep ache and tightness, rather than sharp pain. The compression vest can feel annoying or itchy, but it provides comfort by holding everything in place.
You can drive once you are off all narcotic pain medication and can move your arms comfortably enough to turn the steering wheel quickly in an emergency. This is usually about 3 to 5 days after surgery.
The surgery disrupts the small sensory nerves in the skin. Numbness across the chest and nipples is widespread. Sensation typically returns gradually over several months as the nerves regenerate, often accompanied by little “zaps” or tingles.
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