Male Breast Surgery

Your consultation is always with Mr Turton. This is a detailed meeting to assess your current situation, medical history and suitability for surgery. Mr Turton will detail your options and alternatives, such as liposuction or surgical excision. He will also discuss the potential complications, any limitations, short and long term breast changes, costs, and the need for future surgery and follow-up.

You should avoid any medication, herbal preparations, skin creams and vitamins except those that Mr Turton has agreed it is OK to take. For example- No NSAIDS such as Neurofen the week before surgery. You will also be fasting, and cannot take any liquids, any sips of water, or any food (no sweets, or chewing gum even), from the time specified (usually 6-hours prior to surgery). Please carefully shave off any hair from the chest wall area two days before surgery. Arrive in good time, and you will be checked in first by nursing staff. You will be admitted several hours in advance of your operation so that it is completely unhurried. You should relax in your room (bring a book and magazines). Mr Turton will take your pre-op (anonymous) photo and mark you up. Mr Turton’s anaesthetist will evaluate you and confirm that you can proceed (If you are unwell or have developed a chest infection your operation would obviously be cancelled and rescheduled). You will be walked from the ward to the operating theatre reception for your check in, and then your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds! You will be under full anaesthesia for the whole duration of the operation, unless specific arrangements have been made for an alternative approach. Mr Turton will additionally use local anaesthesia which provides additional comfort on wakening. Everything is geared around you, your 100% safety, and your well being. You will be woken up in the recovery room, and supervised one-to-one with an experienced recovery nurse after the anaesthetist has reviewed you. You will then be taken back to your room where you may start your recovery within the comfortable surroundings provided.

Your operation will be conducted meticulously and unhurriedly. You are positioned on a fully padded state-of-the-art adjustable operating table. There are additional gel supports that will be placed under your ankles and for your arms to rest on. Your head is on a pillow. There will be pneumatic anti-thrombotic boots around your lower legs which will gently squeeze your calf muscles throughout the operation (Mr Turton has never had a cosmetic surgery patient develop a DVT), and there will be a special sterile operative warm air blanket (climate controlled warm air) covering your lower body (this is called the “huggy-bear”. An operation time 1 – 1.5 hours is typical for both sides. Mr Turton uses various techniques to reduce operative risks such as haematoma and infection; consequently his re-operation rate is well below average. You are fully monitored throughout the operation and the consultant anaesthetist is solely with you (one-to-one consultant care).

The chest area often feels slightly tender for a few days. You will be able to move about as normal, but you should avoid using your chest wall muscles forcibly, to avoid discomfort. This will be discussed.

As liposculpture uses local anaesthetic infiltration, it is commonly pain free after surgery.

Individual advice varies: From 1-day to 2-weeks, depending on the technique that has been used. You should have come off any strong painkillers before driving (such as Tramadol, Codeine, Dihydrocodeine or Tylex). You should be comfortable that you could make an emergency stop or be able to swerve sharply if needed before driving.

Usually after 1-week. Some patients return after less time, i.e. 3-days, and some longer. Jobs that involve strenuous lifting should be avoided for 2-weeks, and then discussed with Mr Turton.

If you have surgery in the afternoon or evening you will normally stay overnight. Expedited recovery surgery is coming soon as part of Mr Turton’s practice, and will enable you to go home just 2-hours after surgery. But for now, you will be reviewed by Mr Turton the morning after surgery and only released when ready. This is normally always by mid-day.

For your comfort, Mr Turton advises waiting a few weeks as the chest wall area will be tender during this time.

The incisions for liposculpture are tiny and leave tiny 2mm scars. Where direct surgical excision of breast tissue is to be performed, it can be carried out through a very cosmetic scar placed at the edge of the areola. This fades well and the scar is camouflaged well in most men. In extreme cases, the scars may have to be more noticeable, but this will always be discussed and shown directly with a pen during the consultation. All scars are permanent scars though and it is important to remember this.

During the first month after surgery, tissue swelling masks about 50% of the improvement so that the full cosmetic benefit will not be immediately apparent.

Walking- no restriction and it is important to mobilise straight away.

Cycling – from 3-weeks

Paddling in a pool, Sauna/Steam room use- from 3-weeks

Jogging – from 3-weeks; Weight lifting – from 6-weeks

Cross trainers, Gym, Yoga, Pilates – from 6-weeks

Gentle swimming- from 3-weeks

Golf- from 6-weeks (except chip-and-putt); Scuba diving -from 6-weeks

Tennis/Squash/Badminton – from 6-weeks

Athletic swimming – from 8-weeks

Angling – from 3-weeks

Surfing/Windsurfing/Body Boarding/Snowboarding – from 6-weeks

Combat sports – from 8-weeks

Body building – from 8-weeks

Rugby/Football – from 8-weeks

Cricket – from 3-weeks

In general, “Yes”. Male breast tissue is composed of thick glandular tissue and soft fatty tissue. The proportion of each is quite variable and this can re-grow. Just as when you put on weight you find that it goes onto abdominal area, you will also often find some of it goes onto the pectoral area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuation of 2-4 lbs, which has negligible consequences. Loose skin is not removed as part of gynaecomastia surgery except where explicitly planned as it carries greatly increased scarring, which can be unsightly. Therefore residual loose skin can also unsettle people. If you want loose skin to be removed, you have to do so with the acceptance of more adverse and permanent scars, and the additional costs of surgery.

You can’t. However careful choices can modify your risk. Keeping your alcohol intake down (especially avoid beer which is richer in phyto-oestrogens), discuss any new medication with Mr Turton as there are recognised causes of gynaecomastia from medication, avoid cannabis and steroids, and if there is a new re-growth you should be re-examined by your specialist are there are a number of very rare important and occasionally serious medical conditions that can cause this. Maintain your weight in the healthy range for your body mass index.

• Is the surgery guaranteed for any length of time ?

You are covered by the fixed price package for the management of surgery related complications. As these would manifest early, and usually in the first 2-weeks, the cover is typically for the first 3-months for peace of mind (check specific details at each hospital please). Breast problems that are unrelated to the surgery can occur subsequently in any patient (whether you have surgery or not) and are of course not covered. As a Specialist Breast Surgeon, Mr Turton would normally always be happy to see you for a consultation about any chest wall or breast related problem during your life. He has extensive experience of different breast related pathologies, investigation, and management.

Complications from surgery under Mr Turton are rare, but he will be unable to give you a categorical guarantee that they won’t occur. The sorts of problems that can very occasionally occur are infection, swelling, bruising, haematoma needing evacuation. If these complications do occur you will be covered by the fixed price package for further surgery, dressing clinic care or out-patient consultations.

Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery related complications occur.

Mr Turton will always strive to meet your expectations but if there are limitations as to what can be achieved (often related to your starting point) then these will be discussed. It is important to be realistic.

Your first post-operative follow-up is included in your surgical fees. Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £100; please check with Mr Turton’s secretary). You will generally require one further follow-up and then can take up the offer of annual or 2-3 yearly review depending on your circumstances. Costs reflect Mr Turton’s time, and the charges for his rooms, administration and running costs. You are not charged if you attend for review by an out-patient breast nurse. At your follow-up with Mr Turton, you will always see Mr Turton- any follow-up is not delegated to someone else.

The vast majority of Mr Turton’s patients feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling, usually become apparent in a gradual manner. At this stage Mr Turton is happy for the nursing staff to dispense Paracetamol and an anti-inflammatory tablet for pain relief. You will only occasionaly need to have a stronger pain killer as well, such as Tramadol or Codeine. This combination is best taken as required for the first 4-days. The anti-inflammatory and Paracetamol combination is very effective and can be continued for a few weeks if needed and according to how you feel, but should not be taken on an empty stomach. It is quite common for one pectoral area to be more tender, and to swell slightly more (this is often the right side), if surgery has been done on both sides. Similarly one pectoral area will often recover more quickly and this is quite normal.

Although this would be very rare, the gradual appearance of a great discrepancy in size would not be normal and should be assessed. Similarly if you feel unwell, feverish and develop a temperature you would also need assessment. If the skin over the chest wall swells and becomes reddened and tender you would need assessment. Changes like this would be very unusual indeed, but it is important to know that should they occur, a prompt review is required to assess the cause and treat it.

Occasionally patients feel nauseated as the anaesthetic leaves the system, or sometimes as a result of morphine that may have been given by the anaesthetist during the operation. Both of these are soon out of the system and generally gone by the following morning.

When the surgery is finished, the anaesthetic will stop and you will gradually wake up over about 5-minutes. At this point you are taken to the recovery area. You are supervised by the anaesthetist and the experienced recovery nurse and then by the recovery nurse alone. The tube that was in your mouth will have been removed and you will feel sleepy. You stay in recovery until fully alert and then you are taken back to your room where you will be made comfortable. The nursing staff will adjust your medication as needed. Your throat may feel slightly sore from the breathing tube but you will be able to sip water straight away.

At this stage there is still a drip in your hand, and this is taken down when you are drinking properly. The venflon (the name for the plastic needle in the back of the hand) is taken out the following morning, but can come out earlier if you are comfortable and not feeling nauseated.

If a surgical excision of gynaecomastia or fatty breast tissue has been performed there may be a drain by your side and this should be kept laid out straight alongside your body so that the tube is not curled up, otherwise it can kink, and stop the suction. This is removed the following day, and is not painful.

Your pectoral area feels tight and there will be a tubigrip (elasticated support) over your chest area. Sometimes a liposuction garment is used instead according to the tightness of fit required. You will go home wearing either one of these without removing either.

The dressings and the tubigrip/garment must be kept dry. This helps reduce the risk of wound infection. You should therefore have shallow baths (run the water just up to cover your legs) and keep the tubigrip/garment on (but dry) even when you are in the bath. Sponge wash the under arm area and pat dry afterwards.

You will be seen by Mr Turton the following morning after surgery and the nursing staff informed as to when the drains can be removed, if they have been placed. You will be given the “take home medication”- painkillers and any antibiotics and should have clear instructions and understanding as to when to take them. Please ensure you discuss this with the nursing staff if not sure and if you have any queries after discharge you will be instructed to ring the ward for immediate attention. Mr Turton should be informed of any problems.

The commonest one is feeling sleepy for a few hours. Sometimes the anaesthetic or morphine makes you feel sickly, but usually for a short duration only.

You may feel slightly bloated for a few days. This is often due to slight constipation caused by morphine, codeine and tramadol medication. A gentle laxative (lactulose, movicol or senna) will help resolve this.

A loose shirt is ideal, nothing that needs pulling on over your head.

Yes. Please check with Mr Turton in relation to what you do. Generally 1-week off. 2-weeks or more may be needed if your job involves lifting or heavy manual work. If very sedentary, you can occasionally return after 3-days, but remember that you may still be taking Paracetamol and Voltarol.

Mowing lawn – 3 weeks

Washing car – 3 weeks

Shopping – 1 week

Decorating – 6 weeks

The golden rule is “if it feels sore, then don’t do it”. Listen to your body.

As this can be strenuous as well as painful, especially if you get knocked, you should wait until after 3-weeks.

Yes, but you should use factor 50 + suntan lotion, or keep scars taped and completely covered by clothes. Remember that you can get sun-burn through thin cotton. If the scar does get sun burn it causes a permanent redness.

During the first 3-weeks, the pectoral area tends to feel quite tight and slightly swollen.

After 1 to 2-weeks usually, unless Mr Turton advises you of specific exercises as part of the expedited recovery programme.

Usually at 4-weeks; before this it may be uncomfortable.

Tattooing temporarily injures the skin and it is conceivable that you could get cellulitis (redness caused by skin infection). You should avoid this for 3-months after surgery for male breast reduction.

Heavy is anything that is uncomfortable. In general terms lifting shopping bags that are full is what I would term “heavy”. Lifting a kettle is OK. Lifting a baby is not.

It is also important to try to avoid using your arms to shuffle yourself up and down the bed, for the first 2-weeks. When you do so, you are pushing hard with your hands onto the mattress and this is forcibly contracting the pectoral muscles.

The operation is carried out under full general anaesthetic and this is regarded as the safest approach. Pure local anaesthesia is an uncomfortable way to perform a male breast reduction. It can be done using the body-jet liposculpture machine and Mr Turton will be very happy to discuss this with you if desired.

True gynaecomastia can occur in babies and adolescents. It is usual practice to be assessed by a paediatrician and referral for surgery is unusual in this age group.

After a period of assessment by Mr Turton in teenagers, surgery can be considered where it has failed to resolve. In all other individuals over 18-yrs surgery or liposuction can be considered where appropriate.

An ultrasound scan or mammogram and biopsy may occasionally need to be booked by Mr Turton if there are any features that require additional diagnostic information. Male breast cancer is rare, but occurs more commonly with increasing age. This must be differentiated from gynaecomastia and pseudo-gynaecomastia.

Yes. Ideally at least 2-days prior to surgery, otherwise at least 4-weeks after surgery.

It is realistic that there is a clearly visible improvement through surgery and liposuction in over 95% of cases. The final result is reached after 3 – 12 months and is usually permanent. It is very unusual that the breast will become enlarged again, though there are reports in the literature. Stimulation by anabolic steroids will however, commonly cause regrowth.

Liposculpture and liposuction techniques require at least two incisions to allow a criss-cross approach to the fatty tissue. The scars are placed usually well away from the nipple area close to the side of the chest wall.

Surgical excision techniques can be performed by a crescent shaped scar at the very edge of the areola.

Skin healing occurs in the first 7 days, but continues to mature over 6-12 months. The scars must be cared for and you should avoid touching or feeling along the scar line for the first 8-weeks. The scars gradually fade over the first 12-months to a pale colour. This can be speeded up by using bio oil on the scar after 3-months, or a silicone gel called Dermatix (only available over the counter).

It can take six to nine months, though usually 6-weeks.

Most patients will notice the improvement immediately the dressings are removed, but it is dependent on resolution of tissue swelling and gradual tightening of the overlying skin.