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Category: Gynecomastia Risks

When to Worry About Male Breasts

Determining the Cause for Gynecomastia

Breast cancer in men in San Francisco 

It is recommended that men who have enlarged or swollen breasts see a doctor for an evaluation. If gynecomastia is the diagnosis, most cases are benign and can be left untreated unless it is embarrassing and causes emotional stress, in which case surgery may be recommended.

Your doctor will ask many questions to find out what may have caused breast enlargement such as:

• When did your breast first become swollen?
• Do you drink alcohol? How much?
• Do you take prescriptions drugs? Illegal drugs?
• Do you take any supplements or steroids?

Additionally, the doctor will want to know if you have any of the following:
• Do you have any relatives with breast cancer?
• Klinefelter’s Syndrome?
• Hodgkin’s Lymphoma
• Estrogen therapy for prostate cancer?

Too Much Estrogen May Produce Breasts

Males have both male and female hormones with the male hormone more dominate. If something is blocking or reducing the male hormone, testosterone, it will make the female hormone, estrogen more dominate, possibly allowing the development of breasts.

If the doctor can’t determine the cause of gynecomastia, it may be recommended that the patient sees an endocrinologist for further testing.

Breast cancer in men is very rare, but it does occur so any unusual changes in either breast should be checked out.

What to Watch For

Some concerning symptoms that you should see a doctor about immediately would be:
• A mass that is fast growing on one side of the chest
• A bloody or milky discharge from the nipple
• Changes of the skin on the breast

The risk for men in getting breast cancer is about 1 in 1,000 and mostly for men between the ages of 60 and 70. African American men seem to be at a higher risk than Caucasian men.

Breast cancer in men can be more serious than for women because it usually is not detected as early and the cancer may have already spread to the lymph nodes.

Do Not Wait if You Have Symptoms

Dr. Miguel Delgado advises men if they have any unusual symptoms to seek medical attention right away. Call now (415) 898-4161 for a consultation with Dr. Delgado to discuss any issues or questions you may have about your breasts.

Gynecomastia Consultation Questions

Gynecomastia questions

For men who have hidden the embarrassing condition of female type breasts, making an appointment to see a gynecomastia specialist is a big first step. It is understandable for gynecomastia patients to be anxious and therefore, Miguel Delgado, M.D. recommends writing down all questions as it is easy to forget what you want to ask. However, Dr. Delgado wants his patients to know that he is easily accessible and encourages his patients to call (415) 898-4161 anytime they have a question.

The following questions are some you may want to consider:

1. Is your gynecomastia specialist board certified?
2. Is the anesthesiologist board certified?
3. What type of anesthesia is used?
4. If surgery is to be done at a surgery center, is it accredited?
5. How many years has your specialist been performing male breast reduction, and how many each year?
6. What caused my gynecomastia?
7. How long will my male breast reduction last, and will it come back?
8. How would my surgery be done?
9. Will liposuction alone work for me?
10. Where will the incisions be? Will the scars show?
11. What prescriptions will I need? What are they for?
12. How long after surgery before I can go home?
13. Will I have drains?
14. How long will I need to wear a compression vest?
15. How much time do I need to take off work?
16. When can I start lifting weights?
17. What risks does the surgery have?
18. How are complications handled?
19. Can I see before and after pictures of gynecomastia patients?
20. What is the cost?

Getting answers to all of your questions will ease your anxiety and ensure a positive experience. Dr. Delgado states that the only complaint he has received from his male breast reduction patients is that they wish they had their surgery a long time ago! Start today by calling (415) 898-4161 for your initial consultation!

Planning for Your Gynecomastia Surgery

Gynecomastia Surgery Preparations

Marin Cosmetic Surgery Center

Marin Cosmetic Surgery Center

A frequent question that gynecomastia surgery patients ask is: “What do I need to do to plan for my surgery?” Gynecomastia specialist, Dr. Miguel Delgado, M. D. is always happy to hear patients ask this question as their participation is crucial to obtaining the best outcome for their procedure.

Understandably patients are nervous at the preoperative appointment, many times verbal instructions are soon forgotten. Dr. Delgado designed an informative booklet that is presented to all of his patients for reference. However, when in doubt the office and Dr. Delgado are just a phone call away.

The comprehensive booklet of almost 40 pages contains a table of contents divided into sections. Preparing for surgery has directions for; “Starting Now,” and “The Day Before Surgery,” and “The Morning of Surgery.”

“Starting Now” includes details on:

• Cessation of smoking,  multivitamin consumption, aspirin usage, vitamin E limitations, laboratory tests, prescription fills

“The Day Before Surgery” includes details on:

• Confirmation of surgery time, prescriptions, bathing, eating and drinking limitations

“The Morning of Surgery” includes details on:

• Special information, oral hygiene, cleansing, clothing, check in/preparation

The next three pages of the booklet list many medications, supplements and herbal remedies that must be avoided two weeks before and two weeks after surgery. The reason these must be avoided is that they interfere with healing and many slow down blood clotting which can cause complications during and after surgery. Keep in mind this is not a complete list, and any medications or supplements that you take must be cleared by Dr. Delgado. Tylenol is allowed for pain relief.

Many Medications Must be Avoided

Many patients are surprised to see some of the things that need to be avoided. For example, on the list are:

  • Alka-Seltzer, Pepto-Bismol, Vanquish, Sine-off, Sinutab, Motrin, Midol, Actifed, Vitamin E, Raw Garlic, Vitamin-boosted Drinks, Fish Oil, Ginkgo Biloba, Melatonin, Echinacea, St. John’s Wart and many more.

In the next section “Going to Our Operating Facility,” there is a description of the operating suite and the recovery room followed by post-surgery arrangements. Dr. Delgado’s patient coordinator would be happy to give patients a tour of the surgery center.

Surgical Risks and Complications

Included are general surgical risks and complications, and then risks that are specific to the procedure(s), whether it is for a face lift, breast augmentation, gynecomastia surgery or any other cosmetic procedure.

There is a copy of the surgical consent form for the patient’s record.

There are detailed post-operative instructions that include; dressings, drains, compression vest, bathing, ice packs, diet, driving, follow up appointments. Additionally, what the patient can expect as they heal.

Policies regarding insurance coverage, financial arrangements, cancellation and revision surgeries are addressed.

Directions to the surgery center with a map are included.

The Importance of Nutrition for Surgery Patients

Lastly, there is a four page guide that gives detailed information and recommendations on nutrition and the effect it has on wound healing.

Dr. Delgado believes prepared patients have an easier surgery and faster recovery. Call (415) 898-4161 or email info@dr-delgado.com today for a consultation for your desired cosmetic plastic surgical procedure.

Gynecomastia Surgery and the Danger of Smoking

 

Planning for gynecomastia surgery can be an exciting time. To get the best possible results, the patient needs to follow all directions given by their surgeon. Miguel Delgado, M.D. gives all of his cosmetic plastic surgery patients a detailed information booklet to guide them through all pre-operative and post-operative instructions.

Some Things Must be Avoided

There are many important guidelines that need to be followed such as; avoiding blood thinners that can cause complications during and after surgery. The information booklet gives a detailed list of herbs, vitamins and supplements that must be stopped two weeks before and two weeks after surgery.

In addition to avoiding blood thinners, one of the most important warnings given to patients is the mandatory abstinence from smoking. Two weeks before and two weeks after surgery would be the minimum, however, longer or permanently would be better.

No Smoking in San Francisco

Smoking Danger for the Surgery Patient

Many patients who have a hard time quitting smoking may decide a little bit won’t hurt, or if having just one who will know? Cigarettes are incredibly addictive, and it is understandable why patients have such a hard time stopping.

There are several reasons it is imperative that the patient quits smoking before surgery. Cigarette smoke is known to have more than 250 toxins including; carbon monoxide, hydrogen cyanide, nitric oxide and of course nicotine. These toxins all interfere with wound healing.

Oxygen is delivered to the tissues via the blood vessels. Oxygenated blood fights infection and is the means of transport for antibiotics and other medications through the body. Nicotine causes blood vessels to constrict, when this happens it is possible for blood clots to form affecting blood flow to the capillaries. When there is a reduction in blood flow to the tissues, the cells may die causing what is known as necrosis. When necrosis occurs, the surrounding tissue becomes inflamed requiring debridement which is surgical removal. When debridement is necessary, the surgical outcome may be less than optimal.

There have been many studies done showing surgical results between patients who smoke versus the non-smoker. The studies show that smokers are much more likely to develop pneumonia, have a stroke, cardiac arrest or a heart attack. Additionally, smokers need more anesthesia and pain medication.

There is Help for the Smoker!

For a patient not to disclose that fact that they smoke to their surgeon would be a serious mistake, far better would be to enlist the help of your surgeon. Miguel Delgado, M.D. has helped many patients quit smoking by prescribing prescriptions such as Chantix. Remember, Dr. Delgado’s main goal is the safety of his patients so they can move forward with their gynecomastia reduction goals.

Help is a Phone Call Away

For any gynecomastia concerns, call Dr. Delgado today (415) 898-4161 or email info@dr-delgado.com for a consultation.

Gynecomastia Revision is Needed Should I go to the Same Surgeon?

Miguel Delgado, M.D.

Miguel Delgado, M.D.
Gynecomastia Specialist
★★★★★ Ratings: 4.74 -118 Reviews

 

 

 

 

 

 

 

 

 

 

 

Change Surgeons?

This is a good question and needs thoughtful consideration. The answer should depend on what type of revision is needed and why. Highly trained Board Certified Plastic Surgeons that specialize in gynecomastia surgery will explain risks and complications, prior to surgery.

There are Risks

All surgeries come with some risks; the main ones are, infection, bleeding, blood clots, and adverse events related to anesthesia. Although rare, patients need to be aware of the possibility. Additionally and specifically to gynecomastia surgery would be where the original surgeon tried to correct gynecomastia by liposuction alone, without removing breast tissue by surgical excision. Almost all gynecomastia cases need both liposuction and surgical excision; the only exception would be for men that have pseudo-gynecomastia (only fat, and no breast tissue). The second main reason for revision would be; under or over resection of the breast tissue. This would require re-excision for under resection or fat injections or fat flaps for over resection. How complications are managed has a direct relationship to the outcome.

Crater Deformity

Over Resection Causing Crater Deformity

Post Surgery for Crater Deformity

Post Surgery for Crater Deformity

Miguel Delgado, M.D. Gynecomastia Specialist

Miguel Delgado, M.D. has years of experience with revision gynecomastia surgeries, in fact up to 40% of his gynecomastia practice is revision surgeries that come to him from other practices.

If what is needed is a minor adjustment after the initial surgery, such as minimal skin tightening, this should not be considered unusual. If men are not prepared for the possibility of a secondary surgery, it can be very disconcerting, and may cause them to question the capabilities of their surgeon.

Second Opinions Advised

The first step is to have a frank discussion with your surgeon. If you do not feel convinced that your surgeon can correct the issue; it might be of value to get one or two second opinions. Corrective surgery can be very challenging and requires the skill of a gynecomastia specialist. Revision surgery is not as straight forward as the initial surgery, as now the surgeon must deal with scar tissue that has formed from the first surgery and possible loss of some elasticity of the skin.

Contact us!

If you are in need of gynecomastia revision surgery, email (info@dr-delgado.com) or phone (415 898-4161) to meet with Miguel Delgado, M.D. to learn what options are available to you.

Gynecomastia Surgery Redo Now at 40%

 

pics Male patient before and after Gynecomastia Surgery

This 49-year-old man had gynecomastia surgery twice with other physicians. He sought my help wanting to undergo a third procedure as he was still unhappy with his result. He underwent glandular excision and suction-assisted lipectomy of the chest.

San Francisco, California-On August 17, 2010, I published a blog “Liposuction for Gynecomastia”. At that time,  I stated the percentage of redo surgeries that were originally done by other surgeons was at 25% to 30%.

Today, the percentage of redo male breast reduction surgeries in my practice has increased to 40%! This is due to the same reason as before. There are many surgeons that believe the desired results of a well sculpted male chest can be attained by liposuction alone. When liposuction alone is used, breast tissue remains and it can actually look more prominent than before the fat was removed.

True gynecomastia is a combination of fat and breast tissue. The fat can be removed very well by liposuction; however, the breast tissue is too dense to come through the cannula. Breast tissue needs to be removed by excision, and it needs to be done by a gynecomastia specialist who has the expertise to give a masculine contour to the chest.

If the breast tissue is removed too aggressively, the result can be a crater deformity, another cause for redo. This is an extremely frustrating situation for the man who has finally had surgery to correct his moobs. The good news is that almost all of these cases can be corrected, but just emphasizes the fact that men need to do their homework in picking a Board Certified Plastic Surgeon for gynecomastia reduction surgery. Ask a lot of questions, request to see before and after pictures, ask how many male breast reduction surgeries are performed each year, you want to be sure to pick a gynecomastia specialist so that a gynecomastia redo surgery will not be necessary. A good source for Board Certified Plastic Surgeons is www.gynecomastia.org.

 

Crater Deformity - image

Crater Deformity

 

After Surgery for Crater Deformity Correction - pic

After Surgery for Crater Deformity Correction

Why did the Nipple/Areola Change Color After Surgery?

Before and After Gynecomastia Surgery, dark areola  - photo

Before and After Gynecomastia Surgery, notice the darker areola

 

Gynecomastia surgery often causes the areola to shrink in size. The gynecomastia breast gland causes the areola to be stretched. When the breast gland is removed or reduced the areola shrinks and becomes smaller in diameter. This shrinkage causes the melanocytes (the pigment of the areola, which creates the darker color) to become more concentrated and this causes a more concentrated color or darker.

What are the Surgical Risks for Gynecomastia Surgery?

Many San Francisco Bay Area men have asked what the risks for gynecomastia surgery are. One way of reducing risks is having surgery in a private surgery center such as Marin Cosmetic Surgery Center where quality control and less ongoing surgeries means less chance of infection. Risks for all surgeries  include:

• Bleeding (hematoma)

• Infection

• Blood clots

• Adverse events related to anesthesia

Pre op gynecomastia - photo

Pre operative gynecomastia

 

Post operative hematoma - photo
Post operative hematoma

 

Postoperative gynecomastia - photo

2 months after evacuation

Specifically for male breast reduction surgery, the most common complication would be a hematoma, the additional risks would be:

• Breast asymmetry

• Nipple inversion

• Loss of sensation

• Scarring

• Seroma

• Loose skin

It is imperative to keep your gynecomastia surgeon informed of any noticeable changes such as excessive swelling, bleeding or bruising. It is how complications are managed that determines the outcome. When treated immediately there are almost no permanent negative results.

After Gynecomastia Surgery…Will Nipple Sensation be Lost?

The importance of nipple sensation varies greatly between men. If there is some sensation loss after male breast reduction surgery, many men are not concerned because the trade off of getting rid of their “man boobs” outweighs this consequence. But for some men the nipple sensation is very erogenous and the thought of losing this is enough to negate surgery. It is very important to discuss all of the pros and cons with your surgeon before proceeding with surgery.Gynecomastia Surgery - Process, Pic

The vast majority of San Francisco Bay Area gynecomastia patient’s have temporary loss of fine sensation of the nipples and surrounding skin, this is normal. This is referred to as neurapraxia. In neurapraxia, there is no alteration in the structure of the nerve; however conduction of impulse is interrupted due to injury or surgery. This type of injury can be recovered from completely. Blood supply disruption and nerve compression are the effects of such nerve injuries. Nipple sensation usually returns within a few weeks, but for some it can take a long time even 6 to 12 months. Nerves regenerate slowly, how it returns is extremely variable depending on the surgical techniques used and the extent of surgery. Return of sensation is typically preceded by dysesthesia/paresthesia (pins and needles sensations).

Dr. Delgado advises his Marin County cosmetic surgery patients to massage during the recuperation phase which helps reduce hypersensitivity of the skin as sensation returns.

Gynecomastia.org has comments by post surgical patients regarding changes they have experienced with nipple sensation. In order to read posts you need to sign up, but there is no charge to become a member and the site has a tremendous amount of valuable information.

What is “Crater Deformity” and how can it be corrected?

In the hands of a less experienced surgeon doing male breast reduction surgery, all too often we see unacceptable results. That’s why it is imperative that you seek a Board Certified Plastic Surgeon that specializes in gynecomastia surgery.

About 35% of my gynecomastia cases are for corrective surgery. One common problematic result is referred to as “crater deformity”. This is where the surgeon has removed too much breast gland underneath the areola without blending in the surrounding tissue smoothly.

Crater deformity prior surgery  - photo

Crater deformity 1 week post op photoFortunately there are procedures available that can help correct this. Once the patient has fully healed from the first surgery, fat transfer, (also called fat injection or fat grafting) is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. In the fat transfer procedure fat is harvested from one part of the body where an excess exists and then places it in another part of the body.  Another popular technique is a fat flap.  This is fat tissue that is attached to its blood supply and can be rotated into the crater deformity.  The fat flap is a very useful technique. It would be optimal to avoid having to go through this process (avoiding extra surgical costs and down time) by doing your homework and finding the right surgeon the first time.

Click on the links below for a short video on before and after Crater Deformity Correction.

             Crater deformity prior surgery                                       Crater deformity 1 week post op

before and after photo - banner

 

__ Contact Us For a Consultation

To schedule a consultation with Dr. Delgado in San Francisco, California or Novato in Marin County call 415-830-8883. You may also send us a e-mail at info@DR-Delgado.com or fill out our quick contact form. Send photos of your chest for a complimentary virtual consultation TODAY. We have a complimentary travel package for out of town patients that include travel to and from the airport, four nights stay at the Novato Oaks Inn and travel from the hotel to the office.

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Dr. Delgado has offices in Marin and San Francisco for your convenience

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450 Sutter Street Suite 2433
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(415) 989-2221

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