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• Indications • Method of Operation Information delivered to: Version 4 October 2019 Patient’s name: ____________________________ Date: ___________________________________________ Signature: This document has been created under the authority of the French Society of Plastic Reconstructive and Aesthetic surgery (Société Française de Chirurgie Plastique Reconstructrice et Esthétique - SOFCPRE) to complete the information that you received in your first consultation with your Plastic Surgeon. It aims to answer all the questions that you might ask, if you decide to undertake this surgery. The aim of this document is to give you all the essential information you need in order to make an informed decision, with full knowledge of the facts related to this procedure. Consequently, we strongly advise you to read it carefully. • Indications If the examination did not reveal any objective reasons for breast enlargement and if the patient has a large breast is a Gynecomastia is manifested problem, then surgery may be offered to eliminate by breast enlargement in gynecomastia, provided that the patient is in good physical men with hypertrophy of the and mental shape. This operation is called "surgical mammary glands and treatment of gynecomastia". adipose tissue. There is unilateral and bilateral Given that this operation saves the patient from significant hyperplasia. As a rule, it is physical and mental suffering, it can be considered not just idiopathic, i.e. the cause of an aesthetic procedure, but a real therapeutic act, and in its occurrence has not been some cases covered by health insurance. identified, but in some When gynecomastia occurs excessive growth of breast cases, it may be associated tissue centred in the nipple, often bilateral and symmetrical, with abnormal hormone production or with taking some dense consistency and sensitive to palpation. medications. To identify a possible cause, it is necessary to conduct a survey, including the production of hormones, as Gynecomastia should be distinguished from adiponectin, well as to exclude tumours of the testicles or pituitary gland. which is much more common and represent a local To analyse the density of the breast or exclude the diagnosis accumulation of fat. In adipomastia, the nipple is not of breast cancer in the elderly, especially in the case of necessarily located in the centre, its consistency is soft, it is unilateral form, the doctor may prescribe mammography or insensitive to palpation, often bilateral and symmetrical. ultrasound. If the cause is found, appropriate treatment Both diseases can coexist in one patient, then we are talking should be prescribed. Indeed, when the underlying cause of about adipo-gynecomastia. gynecomastia is found, treatment can lead to complete In adolescents, transient gynecomastia is sometimes regression of gynecomastia. observed, it is associated with a hormonal imbalance in Breast enlargement in men, especially in adolescence, can favour of oestrogen and passes within a few months. cause many psychological problems. This physical defect in Breast cancer looks different, it is a relatively rare form of adolescents, at the very moment when they create for cancer found in men, usually after 40 years, in the form of themselves their ideal of a man, can lead to closure in unilateral, hard, insensitive seals, which are often themselves, and even to a real complex. In addition, accompanied by deformation or retraction of the nipple, gynecomastia can be painful. sometimes accompanied by bloody discharge. From an anatomical and pathophysiological point of view, a • Method of operation normal man has a mammary gland, but it is underdeveloped The purpose of corrective surgery is to restore the normal and looks like a small lump. In some cases, the mammary anatomy of the patient in accordance with the following gland in men can grow, especially if it is favourable to the principles: hormonal background. Clinique des Champs Elysées, 61 avenue Franklin D. Roosevelt, Paris-8 | www.esthetic-clinic-paris.com | +33609808955 page. 1 from 4 Reduction of breast volume by direct surgical exeresis before surgery and then before the sutures heal (usually 15 (subcutaneous mastectomy) for the glandular form of days after the procedure). The e-cigarette should be treated gynecomastia or by liposuction - for the fatty form. In cases in the same way. of mixed forms of gynecomastia both methods are used On the day of the operation, in the slightest doubt, a urine together; test for the presence of nicotine can be done, and in the case Elimination of excess skin: as a rule, after reducing the of a positive test result, the operation can be canceled by the volume of the gland, the skin itself normally shrinks. surgeon. Lipoaspirate also stimulates contraction of the skin. However, the above applies, rather, to young patients with • Type of anesthesia and hospitalization skin that has retained its density and elasticity, and on which Type of anesthesia: usually the operation is performed there are no stretch marks. Sometimes a simple massage under General anesthesia. However, in some cases, local helps the skin shrink well. anesthesia, enhanced by intravenous tranquilizers, or even simple local anesthesia may be sufficient (this issue is In some cases, when there is too much excess skin, reduction discussed in advance with the surgeon and plastic surgery may be required, after which scars remain. anesthesiologist). Such plastic surgery is performed either during the main operation to eliminate gynecomastia, or during a Methods of hospitalization: subsequent separate operation. This operation is most often performed on an outpatient • Before surgery basis, that is, with discharge on the same day after several We have already mentioned the need for a thorough hours of observation. However, sometimes a 24-hour or examination of the patient to identify the possible cause of even 48-hour hospitalization is desirable. The duration of gynecomastia. hospitalization depends on the surgical tactics used. Indeed, simple lipoaspiration will require a shorter hospitalization Men who are obese or overweight are prescribed diet and than a subcutaneous mastectomy. exercise, as weight loss can lead to a decrease or even disappearance of gynecomastia (adipomastia). • Operation Each surgeon has their own preferences for the operation, Considering the details of the anatomical structure of the patient, the preferences and habits of the surgeon, as well the technique may vary depending on the specific case and as the wishes of the patient, determine the operational the desired result. However, there are General basic principles. strategy. The technique of the operation and the location of future scars is chosen. In a typical operation, an incision is made along the lower edge of the areola. Through this incision, the surgeon can The doctor prescribes preoperative tests and examination. Consultation with an anesthesiologist is mandatory, it must remove the breast (make a subcutaneous mastectomy) and take place at least 48 hours before surgery. The patient excess fat. Often in addition to this, liposuction is done, should inform the doctors about all currently taken especially around the enlarged breast, so that the entire medications, as some of them may affect the course of operated area looks harmonious, lipoaspiration also contributes to a good reduction of the skin. anesthesia or cause bleeding. In the case of predominantly fatty gynecomastia, exeresis Except in special cases, no medication containing aspirin or anti-inflammatories should be taken for ten days prior to can sometimes be performed only by liposuction. The scars surgery. remain very small and can be located at some distance from the gynecomastia itself, for example, under the breast or in About the negative impact of tobacco on the result of the axillary area. surgery. When gynecomastia and excess skin are very significant, The scientific evidence that we have today, conclusively longer incisions may be required, hence more visible scars indicate that Smoking for several weeks, before and after will remain. These scars can be located around the areola, surgery is very negative. The negative impact takes a variety be horizontal and continue both sides of the areola. In of forms and can lead to serious violations of the healing extreme cases, it may be necessary to transplant the nipple- process of sutures, to unsatisfactory aesthetic result of the areolar complex. operation. There are other types of cuts (vertical, in the form of a In the case of operations with the use of skin detachment, racket...), it depends on each case. smoking can cause dangerous skin complications. Depending on the technique used and the surgeon's In addition to the risk directly associated with surgery, preferences, drainage tubes are sometimes installed to Smoking can lead to respiratory or cardiac complications remove blood and lymph residues that may accumulate in during anesthesia. the area of surgery. At the end of the operation, a In this regard, the community of plastic surgeons agrees to "modelling" bandage is applied, often with elastic bandages. request a complete cessation of Smoking at least one month The duration of the operation varies depending on the surgeon and the technique used, from a few minutes in the Clinique des Champs Elysées, 61 avenue Franklin D. Roosevelt, Paris-8 | www.esthetic-clinic-paris.com | +33609808955 Page. 2 from 4 case of isolated liposuction to two hours for complex forms the breast (adiposity) and this is the more common forms of
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