What Happens After Gynecomastia Surgery

| Q&A with

Dr Hassan Nurein

1. How long does Gynecomastia recovery take and how long can I resume work and exercise? min 00:19

Basically I do these surgeries under local anaesthesia, the incision in most cases is done just on the lower part of the areola, or the border of the areola, and this incision takes about a week or two to heal.

And after that patients can start jogging, cycling, swimming. But for strenuous training and contact sports we advise to wait a month or longer before surgery.

In terms of work, it depends on what you do. A lot of people are working from home these days, so just a few days it’s enough before you can go back on to your laptop or computer. For office work, if you're commuting we advise you to take a week off just to be on the safe side.

If your work is physical we advise you to take just over a week off as you will be wearing a compression vest and we don’t want you to do anything that will cause pain and such.

So that is the immediate healing. You may or may not have bruising and swelling pain, these are not severe and in most cases they are temporary and go away within 2 weeks.

And for bigger cases where we do skin excision, that is on an individual basis, depending on what method you’ve had done, because if you smoke and if you have other conditions, that can affect your healing.

So it’s very individualised in terms of what to expect, but for most people immediate healing is two week.

And for the final results, it also depends on what grade you have. For the most common types of gynecomastia and mild cases you see the results straight away. For other cases where there is skin excess and we use skin tightening, it may take up to six months before you see the final results.

So don’t panic straight away after gynecomastia surgery, because you may have a bit of hardness and such and the skin may not be as tight as expected. We need to give it up to six months or so before all this healing is complete.

2. Do you use drains for Gynecomastia surgery? min 2:44

Most of our cases are grade 1 to grade 2 and because of the type of anaesthesia we use bleeding is reduced and hence complication rate is very low. We use double compression and don't see the need for drains but for very big cases occasionally drains are used.

3. Can the Gynecomastia gland grow back? min 3:08

A lot of patients ask me whether the gland, the breast tissue, that is causing gynecomastia can grow back. Sometimes it’s fat that is also causing the gyno look.

So if we remove fat and a bit of gland and you gain fat, sometimes the fat that has been left behind can grow, so it can give you a bit of fullness in the chest. But the main thing here is that we leave a bit of breast tissue under the areola, so that the areola doesn’t sink in. This means that what we leave behind is as important as what we take out.

So that’s the reason why the gland can grow back, because we’ve left behind a little bit of tissue to support the areola.

Some patients can get away with removing the whole gland. That’s another question, doctor, can you remove the whole gland? In some cases yes, but not in everyone. So if you have thick skin, if you have well-built muscles and very little fat, then probably yes, but I make that judgement during surgery.

So yes, the gland can grow back and yes, sometimes we can take out the whole gland.

4. Do you do revision surgery? min 4:24

Surgery can always lead to complications and sometimes you need revision surgery.

So for patients who come to us for revision surgery that was done elsewhere we always advise them to go back to their original surgeon who did the surgery.

But if we think that we can help you, achieve what you want or improve your results, then we discuss that after assessing you and for realistic expectations, because is not always easy to achieve what the patient wants to achieve.

But in my practice, my patients in the first six months if there's any correction usually mild correction of a little bit of tissue or touch-up then that is included in the treatment if it is within the six months.

5. How will the scar heal after Gynecomastia surgery? min 5:11

Immediately after surgery the scar is clean and without visible stitches. In the first 2 weeks you may have darkening of areola skin or scabbing and hardening of the incision area, this can take 2-6 months to go back to normal or soft as the skin is remodelling itself after the surgical trauma. That is one of the reasons we wait 6 months. Occasionally we consider medical steroid injection (Kenalog) if the scarring is causing some sort of distortion otherwise I prefer to have patience and to avoid injections as your skin is naturally remodelling the scar from hard to soft.

You will have access to our aftercare team if you have concerns about your healing.

6. What is the scarring like after Gynecomastia surgery? min 6:02

Scarring depends on what sort of surgery you’ve had.

This can range from just liposuction where the incisions are small, and in my practice these are less than half a cm incisions in the areola, one or two in the axillary crease, and depending on how much fat there is, I occasionally add one on the side, but these are all small scars, less than half a cm, which usually fade over time.

In my practice the majority of my incisions are generally in the areola where it’s less obvious after the surgery, and when I do liposuction I make the incision in the axillary crease, in the armpit fold, usually not obvious.

In severe cases, for grade 4 gynecomastia, meaning a lot of loose skin, you may need excising or cutting out the breast and relocating the areola and nipple, for these cases the scarring in my practice is horizontal across the chest and it is advisable to seek second opinion and know what options are available to you. Other skin excision methods depending on severity, patient/surgeon preferences a nipple lift with upper part skin excision is done with scarring in the upper half of the areola or where you can be left with a round scar around the areola, after a donut procedure, which can leave a bit of wrinkling or puckering. Or you may have what we call a t-scar or sometimes a longitudinal scar, this depends on what skin excision methods the surgeon has performed. For very severe cases I prefer to do excision of the breast with relocation of the areola and nipple to a normal or closer to normal position, which leaves you with a flat chest but with horizontal scars across each side.

In terms of scarring, this depends on the patient, because everyone is different. For most patients, the fact that this has changed their life, gynecomastia surgery has improved their quality of life, for many the scarring is usually a non-issue and in my practice most patients don’t notice that they have a scar. It is important you know what options are available and you are willing to accept before going ahead.

7. What is the patient journey for Gynecomastia surgery? min 7:41

Patients get in touch with the clinic and request for an appointment, we are able to offer initial video calls or telephone consultation after you submit your photos and a MQ and once you are happy with our initial assessment we arrange a face to face appointment but sometimes some patients prefer to come straight for the face to face appointment. During the f2f we revisit the medical history, do a physical examination and go through your goals and expectations. We then discuss what is realistically achievable. After the consultation it is advisable you get a second opinion to weigh your options and after a cooling off period you can book for surgery. It is important you do your research and do not rush into making a decision. Immediate 2 weeks after surgery recovery period is important and in our practice you will have access to aftercare support from Day 1 and answer your queries in case you have side effects of surgery. Remember gentle massage after the wound has closed up may prevent swelling or tissue hardness.

At 2-3 months there may still be residual tissue hardness or scar tissue that is resolving, you will have access to our aftercare team for support throughout your recovery. At 6 months we expect full healing and at this point we plan to discharge you after reviewing your results. It is important you come for the final check up or at least contact the clinic if we cannot reach you.

Day 1 after surgery that is 24 hours you will have an aftercare pack with dressings, a spare compression vest and paracetamol with written instructions.

Dr Hassan Nurein Gynecomastia Surgery London and Sheffield, UK

Dr. Hassan Nurein is an experienced board certified gynecomastia surgeon specialising in gynecomastia treatment. He is helping hundreds of patients every year change their lives through gynecomastia surgery.

Book a complimentary consultation with Dr. Nurein to discuss treatment for gynecomastia. We offer consultations at our clinics across the UK, including London (Harley Street) and Sheffield. We also offer video consultations. Contact us for more information.