Tag Archive for gynecomastia

Breast Reduction Surgery

Although many women desire bigger breasts, there is also a significant number of women whose large breasts cause them both physical and psychological harm. According to the American Society of Plastic Surgeons (ASPS) 84,780 women underwent breast reduction surgery, also called breast reduction mammaplasty, in 2000. The ASPS says that breast reduction surgery has increased 111% since 1992.

Benefits of Breast Reduction

In a study conducted by the University of Pennsylvania School of Medicine and reported in 1999, women who had undergone breast reduction mammaplasty gave the following reasons for wanting the surgery:

  • back pain
  • shoulder grooves from bra straps
  • trouble finding clothing that fit properly
  • breast pain during exercise
  • skin irritations
  • shoulder pain
  • personal embarrassment

The same women reported these improvements after the surgery:

  • 83% improvement or elimination of breast pain during exercise
  • 83% improvement or elimination of shoulder grooving
  • 78% improvement or elimination of back pain
  • 78% improvement or elimination of shoulder pain

Eighty-four percent of the women said that they were very satisfied with the results of their surgery, 92% would have the surgery again, and 98% would recommend the procedure to others.

Several other studies have found similar results. For example, a recent review and analysis of 29 studies involving more than 4,000 patients notes that reduction mammaplasty decreased back, neck, and shoulder pain, headache, breast pain, and numbness and pain in the hands. This review was published in the May 2001 issue of Mayo Clinic Proceedings. In addition, a study presented at the ASPS annual meeting in October 1998 found that breast reduction surgery can also improve breathing and lung function.

Breast reduction is generally not recommended for women who intend to breastfeed, says the ASPS, because the surgery removes many of the milk ducts that lead to the nipple.

Reconstructive vs. Cosmetic Surgery

According to Plastic Surgery Update (summer 1996), a publication of ASPS, “the following definitions of cosmetic and reconstructive surgery are approved by the American Medical Association and the American Society of Plastic Surgeons.

Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem.
Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate appearance.”
Procedures such as facelifts and breast augmentation, which are done for non-medical reasons, are cosmetic procedures—also called aesthetic surgery—and are therefore not covered under most medical insurance plans.

Reconstructive procedures, however, are often covered by insurance. In many cases reduction mammaplasty may be covered if it is done for physical, rather than cosmetic, reasons. Women considering this surgery should therefore check with their insurance provider. The ASPS generally considers reduction mammaplasty to be reconstructive surgery, calling it the fifth most common surgical reconstructive procedure performed in 2000.

Surgical Procedure

There are several surgical techniques that can be used in reduction mammaplasty. The most commonly used procedure involves an incision around the areola (the pigmented circle surrounding the nipple) that extends downward over the breast and then follows the crease where the breast joins the chest. Through this incision the surgeon removes excess glandular tissue, fat, and skin. The surgeon then moves the nipple and areola into their new position and places the skin from both sides of the incision around the areola to shape the breast’s new contour.

If possible, the surgeon will probably leave the nipple and areola attached to their blood vessels. However, if the breasts are very large and pendulous (hanging downward), the surgeon may have to completely remove the nipple and areola and graft them onto a new position higher up on the breast.

Reduction mammaplasty usually requires two to four hours (although some cases may take longer) and can be done in either an outpatient surgery center, an outpatient surgery department of a hospital, or a surgical suite at a doctor’s office. The operation is usually done under general anesthesia (being “put to sleep”).

After the surgery there will be stitches around the areola, along the vertical incision below the areola, and along the lower crease of the breast. The patient will be wrapped in an elastic bandage or a surgical bra over gauze dressings covering the incisions. There may be a small tube in each breast to drain off blood and fluids for a couple of days after the surgery.

The surgeon will provide detailed instructions about resuming normal activities after reduction mammaplasty. Most women will be up and about within a day or two after surgery, and most return to work (if the job is not too strenuous) and to social activities in about two weeks.

Reduction mammaplasty leaves noticeable permanent scars, although these scars are in areas usually covered by a bra or bathing suit. The surgery may produce slightly mismatched breasts or unevenly positioned nipples. Some patients experience permanent loss of feeling in their nipples or breasts. In rare cases, the nipple and areola may die because of loss of blood supply to the tissue. (If this happens, the nipple and areola can usually be rebuilt with skin taken from elsewhere on the body.)

Breast Reduction in Men

Men with over-developed breasts, a condition known as gynecomastia, may desire breast reduction surgery. According to the ASPS, gynecomastia affects an estimated 40% to 60% of men, and breast reduction surgery in men increased 84% between 1992 and 2000. Breast reduction in men involves removal of excess fat and glandular tissue and, sometimes, excess skin. The best candidates for male breast reduction are men with firm, elastic skin.

Being overweight may cause an increase in breast size in men, so overweight men with gynecomastia are usually advised to lose weight before deciding on surgery. Other possible causes of gynecomastia include heavy use of alcohol, marijuana, or anabolic steroids. Discontinuing use of these drugs may eliminate the gynecomastia and, therefore, the need for surgery.

Adolescents and Cosmetic Surgery

n an earlier article about breasts and self-image during adolescence, we looked at a couple of news articles about the increase in cosmetic surgery for young girls eager to improve their bodies. Since writing that article, I’ve found three press releases from the American Society for Aesthetic Plastic Surgery (ASAPS) that present the other side of the issue.

(ASAPS is devoted to education and research in cosmetic surgery. Its members are plastic surgeons certified by the American Board of Plastic Surgery.)

In a release dated January 3, 2000, ASAPS says that media reports of “a significant increase in teen cosmetic surgery are not supported by current statistics”:

  • Results of a December 1999 survey of a representative sample of member surgeons of ASAPS show there has been no unusual increase in the number of teens seeking or receiving aesthetic surgery over the last 12 months.
  • Statistics compiled by ASAPS in 1997 and 1998 show an increase of only 0.2% in the total number of procedures performed on individuals 18 and younger. These individuals represented 2.9% of the total number of cosmetic procedures performed in 1997 and 3.1% of procedures in 1998.
  • Comparison of additional statistics compiled by the American Society of Plastic Surgeons (ASPS) for 1992 and 1998 shows that the percent of liposuction and breast augmentation procedures performed by board-certified plastic surgeons on those 18 and younger had either remained constant (liposuction, 1%) or had gone down (breast augmentation was 3% of the total procedures in 1992 and 1% of the total in 1998).
  • Surveys of public confidence in cosmetic plastic surgery have consistently shown growing acceptance of elective procedures, yet data so far conclude that those 18 and under are not seeking these procedures in disproportionately rising numbers.

The ASAPS further identifies the following procedures as “among those most commonly performed for patients 18 years of age and younger”:

  • Rhinoplasty: Nose reshaping is the most common aesthetic procedure requested by teens. It can be performed when the nose has completed 90% of its growth, which can occur as young as 13 or 14 in girls and 15 or 16 in boys.
  • Otoplasty: Cosmetic ear surgery can be performed in children as young as 5.
  • Breast reduction: Can help girls as young as 16 with overly large breasts, who may experience back and shoulder pain as well as restriction of physical activity.
  • Correction of breast asymmetry: Surgery can help girls as young as 16 when one breast significantly differs from the other either in size or shape.
  • Treatment of gynecomastia: In some teenage boys, excessive breast development can become a significant psychosocial problem. Excess tissue can be removed in boys as young as 16.
  • Chin augmentation: Often addressed with rhinoplasty to achieve facial balance.
  • Lipoplasty (liposuction): Recommended for patients of normal weight with localized fat deposits resistant to diet and exercise, often a hereditary condition. Those 18 and younger represented 1.4% of the total number of procedures performed in 1997, and 1.3% in 1998.

Finally, the ASAPS says that while the overall number of aesthetic (cosmetic) surgeries has increased, the rate of teens having cosmetic surgery has remained constant. “Additionally, most experts agree that for appropriately selected teenage patients, cosmetic surgery can have a positive impact on physical and emotional development.”

The society offers the following guidelines about teens and cosmetic surgery:

  • Assess physical maturity: Operating on a feature that has not yet fully developed could interfere with growth or negate the benefits of surgery in later years.
  • Explore emotional maturity and expectations: The young person should appreciate the benefits and limitations of proposed surgery and have realistic expectations.
  • Check credentials: State laws permit any licensed physician to be called a “plastic” or “cosmetic” surgeon, even if not trained as a surgeon. Look for certification by the American Board of Plastic Surgery. If the doctor operates in an ambulatory or office-based facility, the facility should be accredited. Additionally, the surgeon should have operating privileges in an accredited hospital for the same procedure being considered.
  • Explore risks and expected recovery times: Teens and their parents should understand the risks of surgery, postoperative restrictions on activity, and typical recovery times.