Male Breast Surgery INFORMATION REGARDING MALE EXCESSIVE BREAST/CHEST TISSUE For various reasons certain men have excess tissue in the chest area. Tissue may appear in the chest that may be fat or actual breast tissue. In theory, all men have the potential to develop breast tissue. Whether or not this happens depends on heredity, amounts of various hormones, the presence of medications, percent of body fat and many other factors. In the early 1980's, the use of suction removal of fat made more extensive surgery on the breast possible with fewer scars in many cases. Depending on the extent of the problem, the operation can be done using a local anesthetic with the patient partially asleep, or the procedure can be done under general anesthesia (totally asleep) if the patient desires, or the surgery is expected to be extensive. This surgery is usually performed as out-patient surgery, which means you will have surgery in the morning, and return home in the afternoon. You will have a dressing in place, which should remain clean, dry and on until you are seen in the office. No showers are allowed, and you should rest and relax at home. You will be given medications for swelling, discomfort and infection, which you should take as directed. If you have any problems with medications, call the office. Usually incisions are made at the edge of the dark part of the nipple. These incisions heal quite well in most cases, although in rare cases the scars can be thick. There are treatments available if this occurs, but again, this is rare. Other incisions may be needed in the crease beneath the breast or under the arm. In some cases, the extra tissue can be removed by suction alone. This might mean that the incisions near the nipple might not be needed. In cases where there is more fat in the chest area than is desired the fat can be removed using suction lipectomy through small incisions. The Doctor will discuss this with you. The muscles of the chest have not been injured to any significant degree following this surgery, although it is not unusual to feel tenderness in the area due to temporary bruising. This has not been a permanent problem to date. During surgery, the contour of the chest is tailored to match the rest of the body. You should be aware that this tailoring is different for every person, and the Doctor will discuss this with you. As with any surgery problems and complications can occur but have been rare or have not happened in our experience. Problems such as bleeding, infection, irregularities, skin changes, depressions, elevations, pain, bad scars and so forth can occur, but have not been a problem in Dr. Capuano's experience to any significant degree. Some patients have had collections of blood and/or fluid underneath the skin, but these minor problems have not been permanent, and usually last a short time, if they do occur. Very minor skin infections in the area of the stiches have occurred, but this also has not been a long-term problem. Some tissue must be left so the skin doesn't stick down to the muscle. Some fat must also be left. Leaving just the right amount is our goal but it might be thought to be too little or too much by the patient. You may be depressed following surgery, which is not unusual. There is discomfort associated with surgery, and you will be given prescriptions for medicines to take following surgery. We ask that you not exercise vigorously following surgery, usually for a period of two to three weeks. This inactivity can lead to depression in some people. Further surgery could in theory be needed. Major disasters have not been seen. These would include anesthesia problems such as death, paralysis or vegetation. In most cases, swelling can last for three to six weeks, depending on the individual. This will be discussed with you. Please talk to Dr. Capuano regarding work, and return to same. If your job entails heavy lifting, you may need to stay out of work longer than if your job does not require lifting. Any estimates regarding return to work are only estimates, and no guarantees can be given about return to work and/or social activities. If you have any questions regarding this information, please ask. Thank you. INSTRUCTIONS FOLLOWING GYNECOMASTIA SURGERY If you plan on staying anywhere other than your own home following surgery, notify the office. We need to be able to contact you after surgery. Do not take aspirin or products containing aspirin until advised otherwise. Do not eat apples, as they contain an aspirin-like substance. You should rest and relax at home. Do not engage in any activity you would not do if you were a patient in a hospital. If you are unsure about any activity, please ask. Regarding dressings: You will have a dressing in place following surgery. Keep this dressing clean, dry and on. Usually the outermost dressing will be Ace bandages. These can be re-adjusted if needed. Leave the rest of the dressing on until you are seen in the office. No showers are permitted until after your first office visit. Regarding medications: You will be given prescriptions and asked to buy over-the-counter medications to take following surgery. It is VERY IMPORTANT that you take these medicines as directed. They will reduce swelling, discomfort, etc. If you have a problem with the medicines, call the office. Regarding diet: You may resume your regular diet as tolerated. Regarding expected consequences of surgery: You may feel tired following surgery. This is not unusual. You should take it easy and not do anything strenuous. A multi-vitamin is recommended daily. Some patients also may drink Gatorade or other mineral supplements if desired, usually a quart a day as tolerated. "Black and blue", swelling, localized areas of discomfort and/or numbness are to be expected following surgery. If you notice a sudden onset of discomfort or swelling, call the office right away. Regarding your first office visit: At the time of your first office visit, the dressing will be removed and replaced. You will be advised regarding wound care. You will need to continue wearing the Ace bandages until advised otherwise. Usually you may begin to shower, but your stitches should not be soaked or submerged. This means no swimming or tub baths until after the stitches are removed. PATIENT CONSENT FOR GYNECOMASTIA (MALE BREAST/CHEST) SURGERY I have discussed with the Doctor in detail any questions I might have regarding this surgery. While severe complications have not occurred in Dr. Capuano's experience, I understand there is a chance they could occur in my particular case. I understand: - the possible problems and complications involved with surgery which include bleeding, infection, swelling, numbness, contour problems and the possibility that further surgery may be desired to obtain a better result. - that there are more severe problems and complications involved with anesthesia and surgery which, while extremely rare, may occur and include death, paralysis, vegetation, mental difficulties, heart and lung problems, and so forth. - that the explanation I have received is not and cannot be exhaustive and that other, more remote risks and/or complications could occur in my particular case. - that a more detailed explanation can be given to me regarding possible risks and complications at my request. - that the costs of further professional and/or hospital fees are not included in current estimates for surgery. - that no guarantees can be given as to time away from work and/or social activities, and that estimates regarding return to usual activity are only estimates. - that failure to follow Dr. Capuano's instructions following surgery may change the eventual result of surgery. I acknowledge that I have had the opportunity to talk to Dr. Capuano about surgery, and to my satisfaction I understand the surgery planned. I know the expected results of surgery, but also understand that RESULTS CANNOT BE GUARANTEED. If I have any questions, or there is anything I do not understand I will call these things to the attention of Dr. Capuano BEFORE MY SURGERY. This information is provided for your general information. How such information exactly applies to an individual would depend on a face to face history, examination, perhaps laboratory exams and individual treatment plan. Further because of the nature of electronic media and information - there is no doctor - patient relationship but merely a general information display - THANK YOU.