Gynecomastia Revision Surgery in Boston

Initial Male Breast Surgery Performed Using Solely Liposuction Without the Excision (Removal) of Breast Gland

Liposuction, in essence, only eliminates fat cells and decreases the volume of fatty tissue. It is, however, inadequate when addressing gynecomastia symptoms arising from the growth of glandular tissue. Excess breast gland tissue plays a significant role in this condition and can either be solid and firm, or be constituted of a softer, fibrous tissue network. Regardless of the form it takes, the surgical removal of this tissue is indispensable for achieving successful results after a male breast reduction procedure.

Pseudogynecomastia, a condition in which the excess breast tissue is primarily composed of fatty tissue instead of glandular tissue growth, can sometimes be addressed solely with liposuction. However, many instances of pseudogynecomastia also involve surplus skin that necessitates surgical excision. Modern liposuction techniques, which encompass ultrasonic liposuction, tumescent liposuction, smart liposuction, and sharp liposuction cannulas, are highly sophisticated and excel at removing fatty tissue. However, these techniques cannot extract the breast glands, which are often implicated in male breast tissue growth and gynecomastia symptoms.

Previous Male Breast Reduction Surgery Involving Gland Excision and Liposuction Was Overly Conservative

Several physicians adopt a “do-no-harm” approach, given that rectifying the over-removal of tissue presents a more significant challenge. In some instances, this conservative approach to plastic surgery can result in residual breast fullness. Our surgeons are always open to consulting with previous gynecomastia patients about their unique scarring situations and objectives to deliver the most appropriate advice for their condition.

Crater Deformity Following Gynecomastia Surgery

A crater deformity, also referred to as “sunken nipples,” is a recognised complication of gynecomastia treatment. This deformity often necessitates revision gynecomastia surgery due to the following contributing factors:

Excessive breast tissue was excised beneath the nipple-areola complex, leading the nipples to “sink” below the chest contours. Insufficient tissue was removed from around the nipple-areola complex. The nipple-areola complex has adhered to the underlying pectoralis muscle. Any combination of the above three factors. Treatment for a crater deformity will depend largely on the root cause of the issue. However, the use of fat grafting with fat injections can often rectify the problem, creating a smooth and proportionate chest structure. If the deformity arises from the skin adhering to the muscle, revision surgery can liberate the skin from the scar tissue. In certain cases, a combination of all three techniques may be required.

It’s important to wait at least six months after your initial gynecomastia procedure before considering revision surgery. This allows the post-surgical swelling from the initial procedure to subside and the scar tissue to heal. 

However, due to the nature of the procedure, some of the swelling can often take up to a year to completely dissipate. Therefore, many surgeons recommend waiting a little longer (around 10-12 months) before having a gynecomastia revision. 

There are several other circumstances under which gynecomastia revision surgery may become a necessity. The most prevalent among these include:

1. Excess or sagging skin necessitating further excision: Post-initial surgery, some patients may still be left with an excess of skin that is loose or sagging, requiring further surgical intervention for a taut and smooth appearance.
2. A poor blend of fatty tissue in the armpit area with chest contours: If the fatty tissue in the armpit area stands in stark contrast to the contours of the chest, it can create an unbalanced and unnatural appearance. This is another reason for considering a revision surgery.
3. Unrealistic expectations from the patient: In certain situations, the outcomes of the initial surgery may not meet the patient’s expectations, primarily if these expectations were impractical or unrealistic to begin with. This can lead to patient dissatisfaction and prompt the need for revision surgery.

The central elements of gynecomastia revision surgery involve the additional excision of breast glandular tissue, fat tissue, and, in some instances, surplus skin. This process aims to engineer a harmonious, natural-looking, and well-contoured chest. In all instances, Dr. Ishoo will discuss your expectations in-depth, tailoring your corrective procedure to ensure the most favorable result is achieved.

Scar tissue formation is a natural aspect of the tissue healing process. This tissue can initially be firm and tight, leading patients to believe their gynecomastia may be recurring. The maturation of scar tissue can take upwards of four months, during which consistent massage can help soften it. If the scar tissue remains firm, a steroid injection administered by your surgeon can help soften it and lessen its visibility.

Scar revision procedures are seldom required, given the plethora of ways to lessen scar visibility without needing to excise and resuture the original scar. Should scar revision become necessary, it is typically performed under local anaesthesia.

The recovery period after corrective gynecomastia surgery is usually similar to the recovery time associated with the initial gynecomastia procedure. However, patients who only require a small amount of fat removal and additional breast gland may find the process a little quicker and more straightforward. 

Most patients tend to return to work and their daily routine within a couple of weeks, while post-surgical swelling and bruising will significantly decrease afterfour to six weeks. 

It’s normal to feel temporary numbness in your chest during the first few months of the initial or primary gynecomastia surgery. However, full sensation should return to the nipples and surrounding area within nine to 12 months of revision surgery. 

Similar to the initial gynecomastia procedure, you will have a noticeably flatter chest immediately after revision surgery. However, the full results become visible once the residual swelling has completely subsided, which can sometimes take up to 12 months. 

The cost of gynecomastia revision surgery is variable and largely depends on the intricacies of the complications that require rectification. Most plastic surgeons are willing to perform revision surgery in the first year following initial gynecomastia surgery if the patient is not content with the results. We recommend consulting your initial plastic surgeon before reaching out to us in our office, under local anaesthesia, which generally costs less than a procedure performed under general anaesthesia. Gynecomastia revision surgery at the Boston Gynecomastia Specialists starts at $6,500 which includes the cost of anesthetic administered, the compression garments and all follow-ups. However, the exact cost for each patient will depend on their specific condition and treatment plan necessary to achieve the desired improvement, which will be discussed by Dr. Ishoo at the time of your consultation..

Gynecomastia is a condition that can have a significant effect on a man’s self-esteem and quality of life. This effect can be exacerbated if gynecomastia surgery leaves you with unsatisfactory results.
Fortunately, gynecomastia revision surgery helps to resolve these cosmetic concerns, providing you with a flatter, more contoured chest. For this reason, many patients consider it to be a worthwhile procedure as it helps them to achieve their ideal figure.

Patient satisfaction rates vary considerably and heavily depend on the surgeon’s expertise. At the Boston Gynecomastia Specialists, Dr. Ishoo has performed numerous revision demonstrating high proficiency in correcting complications or unsatisfactory results.