SCAR TISSUE AFTER GYNECOMASTIA SURGERY
Gynecomastia is the overgrowth of naturally occurring breast tissue in men. All of us have breast tissue, and in all of us it will grow in response to high levels of the ‘female’ hormone estrogen.
In men the balance between the ‘male’ hormone testosterone and estrogen favours testosterone, meaning breast tissue remains small and man boobs do not develop. If anything changes this balance, the breasts will respond to the relatively higher levels of estrogen and grow. The man sees this as the growth of man boobs or gyno.
Gynecomastia is much more common at certain times in life (male babies, teenagers and the elderly). It is also much more common in men who are overweight – both because fatty tissue builds up on the chest wall forming pseudogynecomastia, and because fat encourages the body to produce estrogen.
For many men no treatment is needed, and simple reassurance and time will allow the swelling to go away on its own. If treatment is wanted or needed, several options are possible:
- Observation and time
- Surgery – liposuction
- Surgery – mastectomy
Surgery for true gynecomastia involves a mastectomy, which is the operation to remove the breast glandular tissue. In some men this may be combined with liposuction to suck away an excess fatty tissue from the chest and improve the appearance of the chest.
A mastectomy can be performed as a traditional open procedure or using minimally invasive or ‘keyhole’ techniques. Where the scars are positioned and how big they are depend on the techniques used by the surgeon.
Sadly, although some may suggest it, there really is no such thing as scarless gynecomastia surgery.
A traditional mastectomy is performed through a curved scar that follows the lower edge of the ‘areolar’ – that is the coloured area surrounding the nipple – allowing all breast glandular tissue to be removed.
Minimally invasive or keyhole techniques are achieved by inserting instruments away from the breast itself, and passing them under the skin to the breast area.
The scars formed by this technique may be across the chest or in the front of the armpit, and there can be more than one depending how many instruments were necessary. Each scar is generally around 5-10mm in length.
In addition some surgeons propose removing breast glandular tissue through an incision made in the centre of the nipple itself.
Each of these techniques leaves scars, and they differ in size, number and location. No matter what, scars will be present. Each surgeon and each man considering surgery will have their own opinion which technique leaves the best appearance after the procedure.
This is something to think about and talk through with the surgeon carrying out the procedure.
Scar tissue after gynecomastia surgery
Whether a single central scar disguised by the colour change between the edge of the areola and the chest or scars away from the central chest but sited on a clear area of skin produce a better cosmetic result is a matter of personal opinion.
Surgery carried out through the nipple itself may be virtually invisible and scarless, but this technique is always combined with keyhole surgery, so other scars will also be made.
Any surgical scar is bulky and red at first. The healing process happens during the months after surgery, and over time this tissue will feel thickened. In some men the thickening may be felt to extend across the chest away from the actual scar.
This is usually just healing tissue under the skin and does not normally indicate that breast tissue has been left behind. Over several months the scar should settle down to a thin white line which is flat against the skin.
In general, scars do not ‘tan’ when exposed to the sun, so they may become more obvious if the surrounding skin is tanned.
As well as the surgical scars, following gynecomastia surgery the area of the areola may shrink. This is completely normal and nothing to worry about.
Complications with gynecomastia surgery scars
Problems or complications, although rare, are possible with any surgical procedure. In the early days after a procedure the wounds can bleed or become infected. These problems may need a visit back to the surgical team, but are usually easy to deal with.
While in most people scars heal to a thin white line, occasionally scar tissue can become thickened and bulky over time. These are called hypertrophic or keloid scars, and they can be very unsightly.
Some people are more likely to form this type of scar than others, and it sometimes runs in families. In most cases, there is no way to predict their formation, and sadly they can be very hard to treat.
Further treatment for problem scars
Treating problem scars can be very difficult. Some people advise the use of creams such as arnica during the healing phase, but there is very little evidence that they make any long-term difference.
Hypertrophic or keloid scars can be treated in a variety of ways, ranging from compression dressings, to ‘freezing’ or cryotherapy treatments, to further surgical excision of the bulky scar tissue. Sadly none of these is guaranteed to produce a good result.
A man who worries they are more likely to form these unsightly scars should discuss this with the surgeon, as there may be things that can be done at the time of the operation to reduce the risk. However in some cases, this may cause the man to reconsider surgical treatment.
Depending on the techniques used, surgery for gynecomastia leaves scars which are in different places, and they may be more or less visible or acceptable to the man. There is no such thing as truly scarless surgery for gynecomastia. Given time most scars heal well and will be barely visible.
The choice of which technique is used and where the scars should be discussed with the surgeon carrying out the procedure. Each surgeon and each man considering surgery will have their own thoughts and preferences, so the options should be discussed and all parties can agree on one approach.
Although uncommon, some men do unfortunately have problems with their scars, either during the early phase – such as bleeding or infection – or later after the procedure if the scars become hypertrophic or keloid.