Breast Reduction Surgery for Men (Gynecomastia) ~ ISTANBUL

Gynaecomastia surgery is carried out under a general anaesthetic and can be performed on a day case basis or may require a one night stay in hospital. There are various techniques to perform this operation. One approach is to make a half moon incision around or below the nipple, and then excess breast tissue, fat and/or skin is removed. Another method is the use of liposuction. A small incision is made under the nipple or towards the armpit. Using a fine cannula (a thin metal tube), the excess breast tissue and fat are broken up and suctioned away. Once the procedure is complete, any incisions are closed with sutures. Your plastic surgeon Dr. Emre Gönen,MD  will advise which is the most appropriate technique in your case.

After gynaecomastia surgery you are likely to have some pain/discomfort, swelling and bruising in the chest area. These are temporary and should subside after the first few weeks. It may take several months for your chest shape to settle.
Dr. Emre Gönen,MD will advise you as to how long you are required to wear your supportive compression garment and whether it is to be worn day and night.
You must avoid strenuous exercise, heavy lifting and swimming for four to six weeks after surgery. You should only resume driving when you are confident that you can safely perform an emergency stop without experiencing discomfort.
The length of time you will need to take off work will depend on your type of employment but is usually a minimum of one week.

CAUSES of GYNAECOMASTIA

     Common causes

• Idiopathic (no other diagnosis found) is most common
• Drug therapy is the second most common cause. Many drugs are implicated, and different drugs result in different modes of gynecomastia development. Some of those more commonly involved include:
• Estrogens and estrogen-like drugs: oral contraceptives, diethylstilbestrol, estrogen-containing cosmetics, estrogen-contaminated foods, phytoestrogens, marijuana, digoxin
• Drugs that cause enhancement of endogenous estrogen formation, either by increased aromatase activity or increased precursors: clomiphene, gonadotropins, hCG administration, anabolic steroids (usually illicit), testosterone replacement therapy
• Drugs that cause inhibition of testosterone action/synthesis: cimetidine, ranitidine, ketoconazole, metronidazole, spironolactone, alkylating agents (eg, cisplatin, busulfan), etomidate, anti-androgens (eg, flutamide, cyproterone acetate), finasteride, heroin, methadone, alcohol
• Drugs with unknown mode of action: methyldopa, calcium-channel blockers, statins, captopril, tricyclic antidepressants, diazepam, penicillamine, isoniazid, phenothiazines, amiodarone, phenytoin, omeprazole, highly active antiretroviral therapy (HAART) for HIV

     Rare causes

• Testosterone deficiency: Klinefelter syndrome (XXY), hyperprolactinemia, anorchia, defects of testosterone synthesis, pituitary/hypothalamic failure, testicular failure (due to trauma, mumps, orchitis, renal failure, granulomatous disease)
• Androgen resistance: complete or partial testicular feminization
• Increased estrogen production: testicular tumors, ectopic hCG production (germ cell tumors, bronchogenic carcinoma), true hermaphroditism (from ovotestis), feminizing adrenal tumors (adenoma or carcinoma)
• Enhanced physiologic conversion of testosterone to estrogens: liver disease, adrenal disease, starvation, thyrotoxicosis, increased extraglandular aromatase activity (eg, obesity)

     Serious causes

• Testicular cancer
• Bronchogenic carcinoma
• Liver failure/cirrhosis
• Renal failure
• Feminizing adrenal carcinoma

     Associated disorders

• Alcohol abuse
• Drug abuse
• Liver failure, hepatic cirrhosis
• Renal failure
• Cardiac failure
• Thyrotoxicosis
• Starvation/recovery from malnourishment
• Adrenal disease (adrenal adenomas/carcinomas)
• Complete or partial androgen insensitivity
• Testicular failure from chemotherapy, radiation, mumps, Klinefelter syndrome
• Testicular tumors
• Bronchogenic carcinoma

Breast Reduction Surgery (Reduction Mammoplasty)

A breast reduction procedure (also known as mammoplasty) is aimed at reducing the overall size, weight and volume of your breasts, and can profoundly improve your self esteem. After breast reduction surgery, you’ll be able to exercise more freely, without having to worry about the extensive support garments you may currently need. You’ll also be able to dress in the fashionable outfits you’ve always wanted, and the pain and discomfort you may have suffered from for years would disappear as a result of smaller, lighter breasts.

Before Surgery
Consultation between surgeon and patient is important to ensure that there is understanding and agreement with the expected final results of the procedure. Measurements and photographs may be taken. Your Plastic Surgeon Dr. Emre Gönen,MD may also recommend a mammogram to ensure that there is no cancer. Before the operation, you need to discuss a range of medical issues with your surgeon including:

• Physical health – an examination will help your surgeon to decide if the treatment is appropriate.
• Medical history – some pre-existing medical conditions and surgery you’ve had in the past may influence decisions about this operation, including the type of anaesthetic that is used. You need to tell your surgeon if you have a family history of breast cancer.
• Risks and possible complications – it's important that you understand the risks and complications so that you can weigh up whether breast reduction is right for you.
• Medications – tell your surgeon about any medications that you take on a regular basis or have recently taken, including over-the-counter preparations like fish oils and vitamin supplements.
• Past reactions to drugs – tell your surgeon if you have ever had a bad reaction or a side effect from any drugs including anaesthesia.
• Preparation for surgery – your surgeon will give you detailed instructions on what you should do at home to prepare for surgery. For example, you may be advised to take a particular drug or alter the dose of an existing medication. Follow all instructions carefully.

Surgery
Breast reduction is most often performed in a hospital, under general anesthetic. However, studies have suggested that an outpatient procedure, using local anesthetic and mild sedation, may be appropriate for some persons. The operation requires approximately two and a half to four hours. The most commonly made incision encircles the areola and extends downward and around the underside of the breast. This produces the least conspicuous scar. Excess tissue, fat, and skin are removed, and the nipple and areola are repositioned. In certain cases, liposuction (fat suctioning) is used to remove extra fat from the armpit area. A hospital stay of up to three days may be needed for recovery.

After Surgery
After the surgery, an elastic bandage or special supportive bra is placed over gauze bandages and drainage tubes. The bandages and tubes are removed in two or three days. The bra is worn around the clock for several weeks. Stitches are removed one or two weeks after the operation. Normal activities, including sexual relations, may be restricted for several weeks. Scars will typically remain red and perhaps raised for up to several months but will gradually fade and become less noticeable.

Breast Augmentation Surgery (Implant, Fat Transfer, Aquafilling)

Augmentation mammoplasty or breast augmentation is a surgical procedure to increase the size, shape or fullness of a woman's breasts. The surgeon places silicone, saline or alternative composite breast implants under the chest muscles or breast tissue.

Breast augmentation is done to:

• Enlarge breasts that are naturally small.
• Restore breast size and shape after pregnancy, weight loss or breastfeeding.
• Restore symmetry when the breasts are asymmetrical
• Restore the breast(s) after surgery as treatment for breast cancer or some other condition or event that affected the size and shape of the breast.

Breast augmentation surgery involves using;

• Breast Implants
• Fat referred to as Fat Transfer Breast Augmentation
• Aquafilling.

* IMPLANTS *

A breast implant is a medical prosthesis that is placed inside the breast to augment, reconstruct or create the physical form of the breast.
The outer layer of breast implants is made of firm silicone. The inside of the implant is filled either with salt water (saline solution), silicone gel, or a composite of alternative substances. Makers of breast implants say they should last for at least ten years. There are three main types of breast implants:

• Saline implants - filled with a sterile saline solution (biological-concentration salt water 0.90% w/v of NaCl, ca. 300 mOsm/L.) which is held within an elastomer silicone shell. These implants can be filled with different amounts of saline solution, which may affect the feel, firmness and shape of the breast. If this type of implant leaks, the solution will be absorbed and expelled by the body naturally.
• Silicone implants - filled with a viscous silicone gel which is held within an elastomer silicone shell. If a silicone-filled implant leaks, the gel will either stay in the shell or escape into the breast implant pocket. A leaking silicone-filled implant might not collapse. Patients choosing this type of implant should carry out more regular checks with their doctor compared to those on saline solution implants. The condition of the implants can be determined with an MRI or ultrasound scan. There are five generations of this type of implant. The latest one is made of a semi-solid gel that has virtually completely eliminated silicone gel bleed (filler leakage) and silicone migration from the breast to other parts of the body.
• Alternative composite implants - these may be filled with polypropylene string, soy oil or some other material.

BEFORE SURGERY

• Make sure you tell us about any and all medications (including, but not limited to, heart medication, blood pressure medication, insulin, antidepressants, etc.), vitamins and herbal or homeopathic remedies you are taking.
• Stop taking aspiring, aspirin-containing meds/products and all vitamins and herbs for at least 2 weeks prior to your surgery. Many types of vitamins, herbs, and meds will cause the blood to thin, which is why you do not need to take anything without your plastic surgeon Dr.Emre Gönen's approval.
• Do not drink alcoholic beverages for at least 24 hours pre-op.
• If your period is due around the time of your scheduled surgery date, make sure you let your surgeon know.
• You will want to practice sleeping on your back and/or propped up on pillows, because you will be sleeping like this for a few weeks (at least) after your surgery.

SURGERY
The procedure is done under general anesthesia. You could discuss incision options with your surgeon Dr. Emre Gönen. He will explain which are most suitable for you and your desired outcome.
The following incision options are possible

• Inframmammary incision - in the crease under the breast.
• Transaxillary incision - in the armpit (axilla)
• Periareolar incision - around the nipple

The choice of which incision to use depends on several factors, including the degree of enlargement, your anatomy, the type of implant, and surgeon-patient preference.

The breast implant is inserted into a pocket.
There is a choice between two types of placements:
A submuscular placement - under the pectoral muscle. When placed here the patient may take slightly longer to recover, compared to subglandular placement, and may also experience a little more post-operative pain.
A submammary (subglandular) placement - behind the breast tissue, over the pectoral muscle.

Then, the surgeon closes the incisions with layered sutures in the breast tissue and with skin adhesives, sutures and surgical tape to close the skin and keep it closed.
Initially, there will be evident incision lines. These will fade with time.

Breast augmentation results are visibly evident straight away. There will be some swelling caused by the surgery, which will resolve within a couple of weeks. As the swelling dies down and the incision lines fade, the patient will have a better idea of whether the procedure met her expectations.

AFTER SURGERY
As the anesthetic wears off, the patient will be given painkillers to relieve the pain.
Nobody should drive immediately after anesthesia, because it affects coordinating and reasoning skills for at least 24 hours.
In most cases, the woman should not engage in strenuous physical activities for about six weeks. She will probably be encouraged to do some post-operative exercises, such as flex and move her arms to relieve pain and discomfort.
Thanks to more advanced techniques today, including submuscular and subglandular placements, recovery times have improved considerably.
It'ss important to follow the surgeon's advice regarding what type of bra to wear, and when to wear it. If the surgeon used sutures that do not dissolve or placed drainage tubes near the breasts, the patient will need a follow-up appointment to have them removed in one or two weeks. Absorbable (dissolvable) sutures usually disappear within six weeks.

* FAT TRANSFER *

Many women feel that their breast size and shape affects their body confidence. Factors such as weight loss, breast feeding, ageing and genes can cause breasts to droop or lose their fullness. Now it's possible to improve the shape and size of your breasts without the need of implants.

Fat transfer to the breasts is performed under general anaesthetic and can take from 1 to 3 hours depending on the amount of fat to be transferred and the complexity of the particular case. Breast enlargement with fat transfer is a safe alternative to breast implant surgery and during the procedure, fat is taken from a donor site using a liposuction cannula (a thin, tube like syringe) and is then prepared for re-injection into the recipient site. Both shape and size can be enhanced and the result is very natural looking and feeling breasts. You're using your body’s own natural material to add volume back to the breasts, there is no chance of rejection or allergic reaction.

Advantages

• Bigger breasts using your own fat – the most natural alternative to implants available
• Two procedures in one, areas of the body are slimmed and the breasts enhanced in one session
• No silicone breast implants, no foreign bodies
• No general anaesthetic, no lengthy time off work
• Permanent results, unlike implants which may need replacing
• Soft natural looking results

* AQUAfilling® *

Larger, rounder and firmer breasts – every woman dreams of a beautiful, tempting bust that catches the eyes of men and arouses the envy of other women. They can do this without invasive surgery under general anaesthesia, no scars, or painful several week-long recovery. Recently, another treatment joined the non-invasive methods of breast augmentation – procedures with AQUAfilling®. Breast augmentation is the most popular procedure for women. In view of the unwaning interest of patients in breast augmentation, scientists have continued to develop other less invasive methods that look natural. One of the latest surgical techniques is a breast augmentation method using AQUAfilling®.

AQUAfilling® is a preparation designed for contouring and body shaping. It is an innovative hydrophilic gel, composed of saline (98%) and polyamide (2%), a salt binding substance that gives the preparation the appropriate volume. The gel is used to correct soft tissue imperfections, including eliminating deformations resulting from liposuction or plastic surgery. It can be used to shape the shoulders, rounder buttocks, and enlarge breasts.

AQUAfilling® breast augmentation is virtually painless as injections are performed under local infiltration anaesthesia. The gel is applied with very thin needles and the gel flows easily into the skin. You won`t even notice when the procedure is finished.

Advantages

• Non-surgical procedure with minimal trauma for a patient.
• Short-term postoperative recovery within 1-2 days. 
• The final aesthetic result is observed by the 7th day after the procedure (all postoperative reactions disappear). 
• Absence of infiltrations within the injection zones.
• Absence of any signs of inflammation or allergic reactions within the injection zone. 
• Absence of any gel migration from the injection zone.
• Absence of implant fragmentation.
• Natural consistency in the soft tissues.
• Natural look of the effected soft tissues.
• Long-lasting effct until five to eight years. 
• Possibility to perform reinjection.

AQUAfilling® is performed in MISSPLAST, Beauty Clinic by Emre Gönen with advanced technology in a sterile environment.

Breast Lift Surgery (Mastopexy) ~ www.istanbulcosmeticsurgery.com

A breast lift, also known as mastopexy, raises the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Sometimes the areola becomes enlarged over time, and a breast lift will reduce this as well. A breast lift can rejuvenate your figure with a breast profile that is more youthful and uplifted. A woman’s breasts often change over time, losing their youthful shape and firmness. These changes and loss of skin elasticity can result from:

• Pregnancy
• Breastfeeding
• Weight fluctuations
• Aging
• Gravity
• Heredity

Breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. If you want your breasts to look fuller, consider breast lift and breast augmentation surgery. If you want smaller breasts, consider combining breast lift and breast reduction surgery.


BEFORE SURGERY

Your Plastic Surgeon Dr.Emre Gönen,MD will explain how to prepare for the operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. Breast uplift surgery usually requires an overnight stay in hospital and it’s usually done under general anaesthesia. This means you will be asleep during the operation. So, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice. Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure.
Your surgeon will measure your breasts and assess their shape and the position of your nipples. He or she may also mark the position of the surgical cuts on your breasts. Your surgeon may also take photographs so that the results of surgery can be compared with your original appearance. You may need to have a mammogram (X-ray of your breasts) prior to your operation.

SURGERY

There are three common incision patterns:

• Around the areola
• Around the areola and vertically down from the areola to the breast crease
• Around the areola, vertically down from the breast crease and horizontally along the breast crease

After your surgeon makes the incisions:
The underlying breast tissue is lifted and reshaped to improve breast contour and firmness. The nipple and areola are repositioned to a natural, more youthful height.
If necessary, enlarged areolas are reduced by excising skin at the perimeter.
Excess breast skin is removed to compensate for a loss of elasticity.
After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed. Some incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time. Many women desire the smallest scar possible. However, your plastic surgeon Dr.Emre Gönen,MD will recommend the incisions which best suit your anatomy. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. 

AFTER SURGERY

After the surgery, your breasts will be covered and protected by gauze bandages and either an elastic bandage or a surgical bra. The bandages and drainage tubes will be removed during the first week after surgery, but you’ll continue to wear a soft support bra for several weeks. Your breasts will be swollen and bruised for a few weeks after surgery. During the first few days you’ll probably have some pain, and for a week or more you may feel discomfort when you move around. Medicines will control this. Your stitches will be removed within one to two weeks. You should be able to return to non-physical work about a week or two after surgery, though it will be several weeks before you feel completely up to speed. You’ll need to limit your exercise and activities during this time. You’ll also want to avoid sex for a week or so because arousal can cause your breasts to hurt. You may find that your breasts and nipples are less sensitive, or have no feeling at all. Sensation usually returns after several weeks or months.
This surgery does leave permanent scars. But they will fade in time and are easily hidden by clothing.