Revision gynecomastia comprises 25 percent to 30 percent of my surgical procedures performed each year. Secondary gynecomastia is an option for a patient who has had gynecomastia surgery done once, but is dissatisfied with the outcome. These patients present to my office for a "redo," or secondary procedure. A secondary revision is most often needed as a result of the initial surgeon using liposuction alone.
The techniques used today include tumescent liposuction, ultrasonic liposuction, and sharp liposuction cannulas. The sharp liposuction cannula technique is meant to break down the glandular tissue and enable the gland to be suctioned. While this does not always happen, it does effectively break through the fibrofatty tissue and allow sufficient fat extraction. Similarly, ultrasonic liposuction cuts through the fibrofatty tissue extremely well, though it does not break down the glandular tissue. Ultrasonic liposuction adds the dimension of heat production to the procedure, which has been shown to improve skin contraction. However, in some cases, I have noticed an increased rate of seroma formation and poor healing of the areola, and as such, I have abandoned this approach.
Revision gynecomastia is a difficult procedure to perform. The scar tissue left over from the first procedure makes the dissection much more difficult. Liposuction alone is hardly ever the solution unless it is merely a "touch-up" procedure, a minor procedure that can be done in the office under local anesthesia to extract and/or inject fat, or to revise a scar. Another difficulty with secondary gynecomastia is that the skin does not contract as well due to the scar tissue. This is unpredictable, and is always something I explain to my patients in great detail.
I strive to avoid any problems in my private practice, and even just one complication is one too many. Yet in the unfortunate circumstance that a problem does occur, I have experience, compassion and dedication to correct any such issues should they arise. Secondary gynecomastia takes a great deal of skill; when selecting a surgeon, make sure he/she has the experience and confidence necessary to give you the results you desire.
All men with enlarged breasts are candidates but the more extreme cases of gynecomastia will require more extensive surgery and possibly skin excision. It is important for the patient to be healthy and emotionally stable. Men whose gynecomastia is exacerbated by drugs should take this into consideration prior to surgery.