GYNECOMASTIA ?>

GYNECOMASTIA

GYNECOMASTIA

(Male Breast Reduction

OBJECTIVES:

Gynecomastia is a medical term that comes from the Greek words for “women-like
breasts.” Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one
breast or both. Though certain drugs and medical problems have been linked with male
breast over development, there is no known cause in the vast majority of cases.

For men who feel self-conscious about their appearance, breast-reduction surgery can help.
The procedure removes fat and or glandular tissue from the breasts, and in extreme cases
removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

CANDIDATES FOR MALE BREAST REDUCTION:

The best candidates for surgery have firm, elastic skin that will reshape to the body’s new
contours.

Surgery may be discouraged for obese men, or for overweight men who have not first
attempted to correct the problem with exercise or weight loss; and in individuals who drink
alcohol beverages in excess. Some drugs, along with anabolic steroids, may cause
gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if
the breast fullness will diminish before surgery.

CONSULTATION & PREPARATION:

We will need a complete medical history, so check your own records ahead of time .The
cause for gynecomastia has to be determined if possible, such as impaired liver function, use
of estrogen-containing medications, or anabolic steroids.

The extent of fat and glandular tissue contained within the breasts determines the surgical
approach.We will give you specific instructions on how to prepare for surgery. Smokers
should plan to stop smoking for a minimum of 1-2 weeks before surgery and during
recovery. Smoking decreases circulation and interferes with proper healing.

RISKS & COMPLICATIONS:

As with any surgery, there are risks. These include infection, skin injury, excessive
bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. In cases
where there is too much excess tissue there might be the need for a second procedure to
remove more tissue after the skin has retracted.

HOSPITAL STAY/OUT-PATIENT:

It is most often performed as an outpatient procedure, but in extreme cases, or those where
other medical conditions present cause for concern, an overnight hospital stay may be
recommended.

ANESTHESIA:

Performed under general, or in some cases, under local anesthesia plus sedation.

OPERATING TIME:

An hour and a half. However, more extensive procedures may take longer.

THE SURGERY:

If your gynecomastia consists primarily of excessive fatty tissue, liposuction is used to
remove the excess fat. A small incision, 3 – 4mm, is made around the edge of the areola (the
dark skin that surrounds the nipple) or, the incision may be placed in the underarm area.

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised,
with a scalpel alone or in conjunction with liposuction. An incision is made in an
inconspicuous location on the edge of the areola. The excess glandular tissue, fat and skin is
cut from around the areola and from the sides and bottom of the breast. The liposuction
cannula if required is inserted through the existing incisions.

In extreme cases where large amounts of fat or glandular tissue have been removed, excess
skin may have to be removed. Occasionally, a small drain is inserted through a separate
incision to draw off excess fluids.

THE RECOVERY PERIOD:

Whether you’ve had excision or liposuction, you will feel some discomfort for a few days
after surgery which can be controlled with medications. Swelling & bruising will persist for a
while. To help reduce swelling, you’ll be instructed to wear an elastic pressure garment
continuously for a week or two, and for a few weeks longer at night. It may be three months
or more before the final results of your surgery are apparent.

You can return to work as early as a day or two after surgery. Stitches will generally be
removed about 1 to 2 weeks following the procedure. Avoid heavy exercise for about 3
weeks. In general, it will take about a month before you’re back to all of your normal
activities.

You should also avoid exposing the resulting scars to the sun for at least six months.
Sunlight can permanently affect the skin’s pigmentation, causing the scar to turn dark. If sun
exposure is unavoidable, use a strong sunblock.

THE NEW LOOK:

The results of the procedure are significant and permanent. If your expectations are
realistic, chances are good that you’ll be very satisfied with your new look.

BACK TO TOP

Cleveland Face Transplant Patient Is Pleased to Feel a Nose

CLEVELAND, Dec. 17 — Surgeons here replaced 80% of a woman’s face with tissue from a deceased donor in a 22-hour procedure, they said.

The procedure involved transplanting nearly 80 square inches (500 cm2) of tissue to restore facial features that were severely damaged in a trauma several years ago, Maria Siemionow, M.D., leader of the transplant team, said during a news conference.

The patient gave a thumb’s up after awakening from anesthesia. It was the world’s fourth partial face transplant, after two in France and one in China.

Dr. Siemionow and plastic surgeon Frank Papay, M.D., described the procedure as replacing the woman’s cheeks, lower eyelids, nose, and upper lip. In addition to skin and soft tissue, the transplant included cheek and maxillary bone and some upper teeth.

The recipient’s own lower lip, chin and forehead were retained.

The hospital said the recipient wished to remain anonymous, as did the donor’s family, and many potentially identifying details were withheld.

For example, Dr. Siemionow said only that the recipient’s face was severely damaged by trauma several years ago, but would not say what caused the trauma or exactly when it occurred.

Dr. Siemionow also declined to give the patient’s age or hometown, saying only that she and the donor were both from the United States.

However, some details of her medical situation were disclosed. The trauma was said to be so extensive that the woman could not breathe, smell, taste, or eat normally.

Following the injury, she had no nose or palate, according to the hospital.

One eye was permanently lost and her vision in the other remains limited.

Clinic surgeons had attempted several previous reconstructions, but could not restore normal function, let alone normal appearance.

The Cleveland Clinic team said they expect the transplant will allow her to eat, speak, and breathe normally.

A total of 10 surgeons took part in the operation, which was also supervised by a medical ethicist.

It took place sometime within the past two weeks. Doctors did not reveal the exact date.

The team spent nearly 10 hours recovering skin, muscle, nerve, vascular, and bony tissue from the unidentified donor.

It took another two hours and 40 minutes to connect blood vessels to the recipient’s circulatory system. Nine additional hours were spent to complete the graft attachment, including nerves and additional vessels.

Dr. Papay said they paid special attention to the facial nerve. “It will allow her to smile,” he said.

The donor was matched to the recipient for sex, race, and approximate age, in addition to the blood type and immunological matching needed for any type of transplant, Dr. Siemionow said.

She said the woman’s face remained very swollen. Dr. Siemionow declined to speculate on when the patient could be discharged, saying the team would evaluate her condition in “a couple weeks.” There were no early signs of rejection.

She has not seen herself in a mirror because of her limited vision, but expressed pleasure when she ran her fingers across her new face, particularly when she felt a nose, Dr. Siemionow said.

She emphasized to reporters several times that the woman “will never look like the donor.” She explained that facial appearance depends heavily on underlying structures that differ between donor and recipient. The patient was not shown a photo of the donor.

The Cleveland Clinic has been planning such a procedure since 2004, before the first partial face transplant was performed in France.

Dr. Siemionow and the hospital’s ethicist, Eric Kodish, M.D., said they had set stringent criteria for candidates for the procedure.

In addition to severely disfiguring and extensive abnormalities, patients need to have exhausted more conventional treatment approaches, and must have enough healthy skin elsewhere to provide grafts if transplanted tissue is rejected.

Also, they must pass a battery of psychological exams to be sure they can withstand the stresses of the procedure. Dr. Kodish said that, among other things, patients need to be mentally stable enough to adhere to the immunosuppression regimen that is expected to be lifelong.

The doctors added that it takes time for an appropriately matched donor to become available.

Dr. Siemionow said the recipient had waited several months for a donor.

The transplant team had been permanently on call during this period, she said.

No other candidates are waiting, she said, in part because the team is now focused on their current patient’s recovery.

Dr. Siemionow indicated that the hospital hoped to use procedures like this to restore faces to Iraq and Afghanistan war veterans severely injured in roadside bomb blasts.

http://www.medpagetoday.com

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