Massage after Gynecomastia Surgery: understand the purpose, and Go Gentle

My Massage recommendations, in a nutshell:

Set aside 5 minutes, twice daily, to work on massaging the area.

Use your hands/fingers/palms, this will help control the hardness/pressure

Rub the area with moderate pressure. Moderate pressure should indent the skin to reach the lower sections but not be painful.

Rub in circular fashion. Try to move the skin and slide the skin back and forth (massage guns and rollers do not do this well, only a hand can). This is the step to promote tissue mobility

Move your hand around to target all the surgical areas

You may spend a bit more time on harder areas

Repeating twice daily, a period of 2 months is perfect.

Introduction:

one of the most common questions I get is regarding need and timing of massage after gynecomastia surgery. In this page, I will summarize my thoughts on what the goals should be, what I feel the mechanism of improvement is, and what things to avoid.

One word, many meanings:

We speak of massage, but it is just one word, with different techniques that patients undertake, from self gentle massage, to “massage guns”, and finally to professional massages. Massage differs from patient to patient in terms of pressure applied, hardness of object used (massage guns /rollers vs hands), duration of treatment, and frequency of treatment.

Therefore, in addition to when to massage, we need to figure out what intensity and technique to use.

Is there such a thing as too much or too hard?

A misconception is that massage can’t hurt and may help. Unfortunately, that is not true.

When I am dealing with gynecomastia patients,, the patient has been bothered and affected for years on the appearance of their chest. Surgery is such large expense and such a relief that the patient feels they might as well go all in to ensure best results and best outcomes. So sometimes they feel less is more, and do much more aggressive massages than is recommended.

Below is an example of an email I will on occasion get from an overzealous patient. Note the new bruising around the areola where he was trying to “work” off scar tissue. Fortunately, this resolved without permanent issues, but it could have led to tissue disruption/fat necrosis. He was doing great prior to starting his “massage gun” sessions that he read about on the internet.

What is happening to tissues? And what is the theory behind massaging.

Post surgery I feel there are three types of processes that need help:

Tissue that is viable but swollen with fluid (lymph). Note that is different than a seroma (fluid outside the tissue). A seroma needs to be drained, not massaged.
Tissue that is mainly viable, with some nonviable parts that need to be resorbed/repaired by the body: This is especially true of the fat layer that is located right under the skin. This fat layer is very sensitive to surgical trauma, and some of the cells there will need time to heal or for the body to replace them. Often these are the hard areas that need massage.
Loose debris mainly coagulated blood/protein rich fluid that is within the layers of dissection, cellular fragments.
Fibrosis is a term of hardening of tissues post-surgery. Note some degree is to be expected, but excessive fibrosis can be helped by massage

Why I feel my surgical technique has less trauma and requires less vigorous massaging:

Every surgeon has different techniques.

My surgical technique has two elements that I have migrated to over the years that enhance the results, and with the same mechanism, reduce the need to massage via the same mechanisms, and they are as follows

Sharply excise rather than liposuction where it is feasible. Liposuction back and forth of the cannula is much more traumatic to tissues than a sharp dissection with scissors or blade. Therefore in the region that I can reach and visualize thru my incision, I will rely on direct excision of any fat and gland tissue, and I reserve liposuction to the areas that are too far from my incision, which conveniently happen to be the more fatty areas away from the areola.

B) Because I do quilting sutures, or sutures that reattach the overlying skin back to the muscle and help me position the fat where I wanted, there is less potential space for fluid and blood to accumulate in the immediate postop period. This leads to less massage needs

Goals of massaging:

Adding a mechanical force to break up biologic debris that needs to be absorbed by the body
Keeping relative mobility of tissue planes with respect to each other
Increase blood flow temporarily to the area to promote the influx of helpful cells
Working swelling fluid out of a specific region and back to the lymphatics
Desensitizing skin sensitivity to touch (helps the body deal with nerve regeneration)