Why medical treatment does not work for Gynecomastia?

Steps of surgery are well synchronized for both local anesthesia as well as General anesthesia

The steps of all surgeries are:

Local anesthesia

• Marking and infiltration of local anesthesia solution – in every patient we need to do marking of the area to be operated
• Local anesthesia is then infiltrated using needle and syringe. The injection is first made on the areola at the point of incision. A second shot of anesthesia is then made at the outer part of the chest where the drain is to be placed. Further infiltration is done with a multihole cannula over the entire area to be operated. 
• Wait for 10 minutes
• Liposuction  –  to remove fat. This can be with hand or with liposuction machine
• Gland removal – removal of gland is done while keeping 5-7% of gland intact to maintain shape
• Drain insertion – we insert drains in all cases of local anesthesia to make sure there are no hematomas
• Skin stitches
  Fine stitches are put in 2 layers to make the healing almost scarless

General Anesthesia

Marking and infiltration of local anesthesia solution – in every patient we need to do marking of the area to be operated. During infiltration , the first shot is made near the upper arm, at the point of infiltration. We do the majority of infiltration from this point. The 2nd point of infiltration is at the areola. This is from where we remove the gland.

Introduction

Planning the  technique and all the steps involved in the surgical process is essential to get a great result. Gynecomastia definitely requires a great deal of planning since  there are many types of grades and there are so many patient Expectations in order to get the best result

What are the steps of the planning

• Anesthesia – the decision is whether to do the procedure under local anesthesia or general anesthesia –  grade 1 can be done in LA only
• Whether skin lift  is required – if  there is any skin then it is likely that the post surgery result will be compromised and in this situation it is better to perform a skin lift procedure
• How long is the procedure – usually grade 1 and grade 2 take 45 minutes , while grade 3 takes an hour. Grade 3b, and 4a can take 90 minutes
• Measuring the pressure garment – should be done in pre surgery period
• Ordering blood tests – the entire list of blood test is given to the patient and the test must arrive at least 48 hours prior to surgery
• Payments –  it is always recommended That all the payment formalities are completed prior to the surgery
• Ruling out any contraindications – like heart stent, cardiac problem, use of blood –  thinners, brain disease cancers, lung disease – any medical problem that can be a contraindication to surgery should be discussed before the procedure itself. 
• Informing patient about follow up procedures – when Does the patient have to come to the clinic for bandage removal and other follow up
• Consent Planning –  informing patient about the surgery,  the alternatives,  the risks and benefits,  and the right of refusal for the procedure.
• Photography  –  photography at correct angles is necessary because this can prevent any patient disputes after the surgery.  this can also be essential if any medical legal issue comes up 

Gynecomastia surgery is not to be taken lightly. There are many important safeguards to get best results and ensure safety

Before Surgery

Patients perspective

• Ensure surgery only with Plastic Surgeons
• Check the facility
• check EMI options
• Check if you have option of VASER – is not not needed in Grade 1, and most of Grade 2a. Above that grade it is very useful
• Get correct grade assessment
• Dont plan larger grades of anesthesia under local anesthesia, it should be done under general anesthesia
• Plan your follow up programme
• Get your pressure garment measured
• Communicate your blood tests with doctor
• Fill medical  records form and give correct information always

Doctors perspective

• Check the grade
• Rule out any medical problems
• Check for any medicines or supplements
• Ensure pre operative instructions for surgery
• Instrument sterilization
• Operation theatre fumigation
• Pre anesthesia check up

During Surgery

• Check anesthesia equipment
• Antbiotics
• Check expiry of medicines
• Test dose of local anesthetic
• Dont over liposuck
• Dont remove all the gland
• Ensure bleeding is in control
• Get proper pressure with bandage
• Check for asymmetry
• Ensure equal removal of fat

Post Surgery

• Observe for any bleeding in the post op period
• Observe vital – BP, Pulse, Oxygen saturation
• Follow up the patient for possible complications  – seroma , infection, skin damage, nipple damage etc