Gynecomastia Surgery in Lebanon: Who Is a Candidate?

What gynecomastia is

The American Society of Plastic Surgeons (ASPS) defines gynecomastia as overdeveloped or enlarged breasts in men, which can occur at any age. It can follow hormonal changes, heredity, obesity or the use of certain drugs, and it is characterised by excess localised fat, excess glandular tissue, and sometimes excess skin, in one breast or both.

The NHS adds that gynaecomastia is common, harmless in many cases, and does not always need treatment. How to tell it from chest fat is in gynecomastia or chest fat?, and what the operation involves is in male breast reduction in Lebanon.

Who is a good candidate

ASPS lists these features of a good candidate for gynecomastia surgery:

• A condition that cannot be corrected through alternative medical treatment.
• Good health, with no life-threatening illness or condition that impairs healing.
• A non-smoker and non-drug user.
• A positive outlook and specific goals for improving the physical symptoms.
• Physically healthy and of relatively normal weight.
• Realistic expectations.
• Breast development that has stabilised.
• Being bothered by the feeling that the breasts are too large.

Weight and chest fat

The NHS states that male breast reduction surgery is not suitable for men whose large breasts come simply from being overweight. It lists being overweight as one cause of gynaecomastia and weight loss as one of the treatments a GP can recommend. A chest that is mostly fat is assessed separately from one with a firm gland behind the nipple, and the examination tells the two apart.

Medicines, drugs and other causes

The NHS lists several causes of gynaecomastia: hormone changes in puberty or in men over 50, being overweight, certain medicines, conditions such as an overactive thyroid, kidney disease or cirrhosis, and drug use including anabolic steroids. The European Academy of Andrology guideline (2019) states that the purpose of assessment is to detect underlying pathological conditions and reversible causes, such as the use of aggravating substances, and to tell gynecomastia apart from other breast lumps, particularly breast cancer.

ASPS lists non-drug users among good candidates. Every medicine and supplement is asked about at the consultation, because treating a cause can change the plan. If a medicine or a condition is behind it, the cause is dealt with first.

Teenagers and young men

The NHS states that gynaecomastia caused by puberty goes away by itself over time in the majority of cases. ASPS says adolescents can benefit from surgery, although secondary procedures can be needed later if breast development continues. At this practice, when the onset is recent in a young man, waiting is sometimes the right advice rather than operating.

When to see a doctor first

The NHS advises seeing a GP for a lump in the breast or nipple, pain that does not go away, skin changes such as dimpling, a rash or redness, or discharge or bleeding from a nipple. These need to be assessed before gynecomastia is assumed. The NHS also says surgery can reduce the breasts if other treatments have not worked, which is why hormone-acting medicines, weight loss and the treatment of an underlying condition come into the picture first.

The operation and recovery, in brief

These are NHS ranges for male breast reduction, not figures for this practice. The NHS describes general anaesthetic for the operation, with local anaesthetic and sedation in some cases. It takes about 1.5 hours, with an overnight stay in many cases. A cut around the nipple allows fatty tissue to be removed with a scalpel, with liposuction, or with both. An elasticated compression garment is worn day and night for 1 to 2 weeks, strenuous exercise and heavy lifting are avoided for about 3 weeks, and about 6 weeks pass before normal activities fully resume. The NHS gives 6 months as the longest wait for the full result. The detailed timeline is in gynecomastia surgery recovery.

Risks, in plain words

• Thick or obvious scarring, and unevenly shaped breasts or nipples (NHS).
• Wound healing problems, and loss of nipple sensation (NHS).
• Bleeding inside the breast tissue (haematoma), which the NHS places in the first 24 hours after the operation, though not in every case.
• Lumps, bruising or swelling (NHS).
• The risks of any operation: excessive bleeding, infection, an allergic reaction to the anaesthetic, and a blood clot in the deep veins (NHS).

At this practice

Dr. Vincent ElKhoury, a board-certified plastic and reconstructive surgeon, examines every patient himself and operates on every gynecomastia case himself, at Hayek Hospital or Bellevue Medical Center, after a consultation at his clinic in Mansourieh, Metn. What the operation changes and the printed patient information sheet are on the gynecomastia surgery in Lebanon page, and the questions worth asking are in questions to ask before gynecomastia surgery in Lebanon. This page is information, not advice, and it does not replace the examination in person.

Questions

FAQ

Sources

• American Society of Plastic Surgeons — Gynecomastia surgery: candidates
• American Society of Plastic Surgeons — Gynecomastia surgery
• NHS — Gynaecomastia
• NHS — Breast reduction (male)
• Andrology 2019 — European Academy of Andrology clinical practice guidelines: gynecomastia evaluation and management

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