Gynecomastia Surgery in Toronto

What is Gynecomastia surgery?

This is surgery for men who have excess skin, fat, or glandular breast tissue. The most challenging aspect of this surgery is the presence of excess skin, as avoidance of a long scar from skin excision is often a priority.

Who is a good candidate?

We often see 14 – 16-year-old boys with true (glandular) gynecomastia. Most often this problem resolves over one to two years once the hormonal transition of puberty is complete. Occasionally we will be asked to assess a boy who is psychologically and socially handicapped by their gynecomastia, and with the endorsement of a pediatrician we will offer surgery.

We see many men with gynecomastia secondary to use of anabolic steroids. We would not want to offer surgery to someone who remains on steroids, as they are more likely to have surgical complications from bleeding, they are likely to form further gland if they continue supplements, and it is difficult to predict the changes in breast development that will occur with discontinuation of the drug.

Pseudo-gynecomastia describes breast enlargement from fat excess. If you are somewhat over-weight, or previously were over-weight, excess skin and fat will be present. Special techniques are necessary to correct problematic gland, fat and skin excess.

Consultation essentials

It is important to bring your complete medical and surgical history to the consultation, especially drug history and any history of urology or endocrinology consultations. We will need to be sure you do not have an underlying hormonal abnormality to account for your gynecomastia. Previous imaging or biopsy reports are also helpful, especially if only one breast is involved (we would need to rule out breast cancer).

Alternatives to Surgery

Vests are available that will hide breast enlargement. Drug therapy (e.g. Tamoxifen) has been described, but does not seem to work once breast tissue is established.

Costs of Gynecomastia Surgery

Fees for gynecomastia surgery at our Toronto Cosmetic Plastic Surgery office (including facility and anesthetist) range from $3000 for ‘puffy areola surgery’ to $11,000 for mastopexy in massive weight-loss patients. A fee of $6500-7500 should be anticipated for most patients to cover liposuction, a necessary component for safe and effective gynecomastia surgery. Gland excision if necessary in addition to liposuction is covered by OHIP.

Preparation for surgery

We need you to be healthy and at a stable weight before surgery. We will provide written instructions on all necessary steps, supplies to obtain, etc. Dressings and compression vests are easy to apply by yourself.

The Operation

Small procedures can be performed under local anesthetic. Liposuction is used to reduce excess fat, and tunneling with the cannula is very effective for triggering a contraction of the skin of the upper chest to correct for loose skin. Gland is excised through a 1-2 cm incision that is hidden at the edge of the areola.

Rarely, if there is dramatic excess skin, this can be excised (mastopexy- see figure below).

Safety and Risks

Bleeding is a concern after gland excision, so chest movement should be limited (no arm or chest exercise) for 10 days following surgery.

Recovery process

Rarely is pain a problem after surgery. Dressings are easy to apply, and consist of pads secured by a compression vest. Most people will return to work within four days, and sports may be resumed at three weeks.

Results

You can expect to see positive effects from your surgery immediately post-op, but a final cosmetic result may not be evident until a year after surgery, once contraction is complete and scar redness has fully settled. Gynecomastia surgery is one of our most effective and gratifying surgical procedures.

Bottom Line

We offer a complete armamentarium to correct your gynecomastia, and offer hospital surgery for patients with medical problems or other complexities that would benefit from over-night stay. Our expertise in managing major weight-loss patients has provided us great insight into managing excess skin problems. Come in for a consultation, and you will leave wiser, and perhaps scheduled for a rewarding transformation.