Gynecomastia Surgery: What to Expect [Kyle Baltrusch, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After.

Dr. Baltrusch (00:03):
My name's Kyle Baltrusch. I'm a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon. Today we're going to be talking about male plastic surgery.

Eva Sheie (00:13):
So the solution, the actual plastic surgery for male breast reduction is pretty straightforward and kind of, I don't want to say it's not a big deal, it's still surgery, but it's pretty easy, isn't it?

Dr. Baltrusch (00:25):
There's a grading system for gynecomastia and it does kind of influence what you need to do as far as surgery. But typically most patients come in at a grade one. And so that means that there is minimal glandular tissue without excess soft tissue or ptosis or sag of the chest. And so with that, there's typically good skin quality and you can do a minimally invasive technique where the incision's just disguised on the underside of the areola, kind of at the areolar border. You can go in with a lighted retractor and just excise that glandular tissue through a very small incision using a lighted retractor. And so most people wouldn't ever know that you had chest surgery because that scar disguises quite nicely. Certainly liposuction of the chest is a nice adjunct as well. But then when you get into larger chest volumes, then you have to talk about skin excision as well so that when you resect, you're not just creating a lax skin envelope.

(01:25):
So then the incisions are a little bit more visible, but can be disguised by chest hair, which is nice.

Eva Sheie (01:32):
Oh, that is nice. So where would those incisions be and what might you see afterward in terms of a scar?

Dr. Baltrusch (01:38):
If there's minimal or minimal to moderate glandular tissue with some excess soft tissue or kind of a larger skin envelope, you can do techniques that are like a bat wing, meaning you're just kind of wedging a little bit out around the nipple areola complex and then kind of pulling that nipple areola complex up onto the chest wall because ultimately when things retract or rebound, you want that nipple areola complex to be above the pec border. But if it's grade 2B or three where there's significant glandular tissue, then you may actually have to do an amputation, which is very similar to my female to male transgender patients where you're amputating the breast. Typically, you try to disguise that incision along the inferior inframammary fold or pec border. And then you may have to do a free nipple graft, meaning you take the nipple areola tissue off and you put it back on in a more appropriate position as a skin graft.

Eva Sheie (02:36):
How long does it take to recover from gynecomastia surgery?

Dr. Baltrusch (02:40):
I do place drains, a small drain that comes out laterally. Those typically stay in just for a few days. Even though it may be a minimal amount of tissue, it often at rest expands a greater distance. And so we're creating a dead space that the drains do stay in for probably three to five days. And then I have patients wear chest compression garment. It's just a little crop top zip up the front garment for the first few weeks. And I have them take it easy for a few weeks. So no exercise, no heavy lifting, nothing that gets their heart rate or blood pressure up, and that's pretty much standard regardless of the procedure. But if everything's fine at two weeks, then I tell them to slowly ease back into their normal level of activity. So typically they're back to baseline between four to six weeks.

Eva Sheie (03:24):
Do you have them come in for post-op at two weeks? How often do you see them after surgery?

Dr. Baltrusch (03:29):
We usually see them within that first week and that's for drain removal. That may be with myself or my nurse. And then I see them at two weeks post-op. That's kind of where as long as everything's okay, then I lift my limitations and give them clearance to get back to normal. And typically there's no issue with them getting back to normal. And so I typically then see them somewhere between two to three months later once all the swelling, inflammation has gone down, and that's when we take final photos.

Eva Sheie (03:58):
What kinds of things do they say to you at that milestone?

Dr. Baltrusch (04:02):
The principles are very similar to liposuction. When you're debulking tissues, you're reliant on the patient's natural elastic properties to recoil or tighten. And so that happens pretty quickly. And you'll see even a big increase at that two week mark, but certainly by three months, things have tightened probably to the new baseline. All that swelling and inflammation have gone away as well. And I think there's a really large satisfaction with gynocomastia surgery. I just saw two post-ops, just the minimally invasive periolar technique last week and both at two weeks had seen great improvement and were very happy with their results so far. And so at three months when things are finalized, patients are typically very happy, feel very confident in wearing more fitted clothes or being shirtless outside.

Eva Sheie (04:51):
Where can we see photos of your male breast reduction cases?

Dr. Baltrusch (04:56):
Photos for before and afters can be typically seen on our website, also in office. So if patients come in seeking consultation to discuss it, oftentimes we have photos on our laptops where we can show or on the computer screens in the rooms that can show before and afters. Not all patients give us consent to put their photos on our website, and so there are others available at the office.

Eva Sheie (05:23):
Excellent. Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.