Let me start this scary webpage by reassuring you: Gynecomastia Surgery is amongst the safest surgeries and procedures out there, especially since I perform the procedure under local anesthesia without risks of general anesthesia. However, the only way to avoid risks of surgery is not to do the surgery. The surgery is very safe, but the risks can and do happen. In this page I am going to give you my honest assessment of the risks involved so that you may make a better informed decision. In most cases, even if a risk event does occur (example: hematoma), it is treatable and most patients will still be glad that they went thru with the surgery.
I sometimes get asked, “have you had any patients with any of these complications?” My answer is as follows: If any surgeon tells you they haven’t, they are straight out either lying to you to gain your business (and some patients just want to be reassured rather than educated),or simply have not done enough cases. So yes, these complications do occur, and have occurred on my patients. However as I state in the introduction, these risks are minor and even when they have occurred, patients have been glad that they had the surgery after we treated the complications.
I am sure I will have to revisit this list as I think of more issues that may arise, but here is the list of the most common issues with gynecomastia surgery.
A hematoma is a blood collection that occurs under the skin (between the skin and the muscle) and occurs due to bleeding after the surgery. The goal of a surgeon is to stop all bleeding during surgery. Unfortunately, small bleeders can sometime start and stop due to vessel spasms the rubbing of the stealing clot off the vessel. If that occurs, bleeding and oozing will happen forming a blood collection between the muscle and the skin.
a very small hematoma can be observed, massaged, and may resolve. However for the vast majority of hematomas, drainage of the hematoma is required to evacuate the blood. The old blood is evacuated and the surgeon looks for bleeding. If there is none, the incision is closed again. A drain is often used, even if one wasn’t used in the inital surgery.
I would estimate that a hematoma requiring evacuation occurs in about 1 out of 200 cases.
it firsts starts with your surgeon, and your surgeon will do everything possible to stop all bleeding and ligate aor cauterize any vessels. I do also believe that quilting sutures are more effective than drains at stopping a large hematoma. Once surgery is done, here is what a patient can do to decrease their risk of hematomas:
Infections after gynecomastia surgery are extremely unlikely. Generally, we prescribe antibiotics prophylactically to decrease that risk even further. It is important that any hematomas or seromas (fluid collection)are promptly drained if needed, as undrained collections are likely to increase the risk of infection. if an infection does happen, draining the infected area may be necessary, most likely thrtu the existing incision.
Your surgeon will discuss with you the expected scars from surgery. Sometimes, scarring may occur that is more than expected. This can be both at the original planned incision site, or it can be at an unplanned site of skin loss which leads to scarring. This risk is pretty small . the scars generally heal predictable well
The nerves that go to the nipple have to travel from the deep laters and course thru the breast tissue to reach the nipple. Invariably, a lot of these nerves are cut and injured as the gland is removed. This will lead to decreased nipple sensation. Fortunately some nerves travel from areas above or below the gland to also reach the nipple. These nerves will allow preservation of nipple sensation and some recovery when nipple sensation decreases.
This is a explanation is a bit tricky and where an experienced surgeon can help minimize that. And here it goes: for a smooth contour, the nipple/areola and the surrounding skin have to be on the same thickness/plane. under the skin is a fat layer on all chests, thinner in thin people and thicker in fatter individuals. When the surgeon opens up the areola, there is mainly gland underneath. Our goal is to remove as much of the gland as possible, without creating an obvious depression. There are tricks, mainly involving sliding some of the surrounding fat under the areola while removing the whole gland, thereby both eliminating the gyno while the thickness is kept even. Minor irregularities can still occur, but not be noticeable. Most patients will still like the results better than before.
This is actually pretty rare. unless there is a hormonal stimulus, caused by endogenous natural hormones or exogenous injected/injested substances, the gland cell remnants won’t grow back. I have only seen recurrence in a handful of patients, in over 1000 cases. Sometimes it is a small scar nodule that forms under the nipple, rather than. true reccurnce. Either way the treatment is the same: reexicison via a small touch up.
I perform this procedure under local anesthesia using tumescent techniques in over 95% of my cases. The risks of local anesthesia are related to the drugs used, which is mainly lidocaine and epinephrine. The doses are well within the safety range for tumescent technique, so the risk of anesthesia is very unlikely and would be related to an allergic reaction which is not very common.
In case your surgeon recommends General Anesthesia, or in case you are in the 5% of my patients who have a surgery that is extensive and that I cannot perform under local (or if you simply prefer to be asleep during the procedure), then there are additional risks related to general anesthesia. General Anesthesia is very very safe, especially at the age groups that we typically see for gyno surgery, but there are some risks associated specifically with that type of anesthesia relating to the management of the airway during the case or to the drugs used during the case.
You will have some acute pain in the recovery period. This pain should subside in a few days. rarely, patients experience more long lasting pain from this or other surgeries, leading to longer periods of pain. This is rare.
Every surgery includes the risks of inadvertent damage to surrounding or deeper structures. For gynecomastia surgery, this is extremely rare, but occasionally during any surgery, the instruments can migrate in a deeper plane and injure organs that are deep. Fortunately, experienced surgeons are very able at avoiding the deeper planes so this risk is again, like most risks , extremely unlikely
Any surgery can lead to the risk of DVT, or deep venous thrombosis, which can lead to cardiopulmonary issues. This risk is very rare, but even rarer with Awake Gynecomastia Surgery. This is because general anesthesia is a major contributor to the risk of DVT during surgery. By performing our procedures awake, we almost (not completely), eliminate this possibility.
No surgery is, unfortunately, without complications. But thankfully , Gynecomastia surgery is amongst the safest plastic procedures around. Performing them awake under local anesthesia further reduces this risk of an even lower degree. Surgeon’s experience with this procedure further suppresses some of the risks. For these reasons, we believe that our awake gynecomastia techniques with our experience lead to some of the safest and predictable outcomes possible.
External resources
ASPS Page on Risks of Gynecomastia surgery