Posted on: November 11th, 2009 Posted by Dr. Miguel A. Delgado Jr., MD
THE ART OF ANESTHESIA
Dr. Randy Gaynor Anesthesiologist
Many patients voice a concern over what type of anesthesia is to be used for the gynecomastia surgical procedure. Most surgeons will opt for general anesthesia unless the patient objection is great and even then unless a medical condition prevents it, most surgeons will not concede. It is important for the patient to understand why general anesthesia is the best in almost all cases. Gynecomastia can be a three to four hour procedure or longer if the patient decides to have additional surgery at the same time such as liposuction of the flanks (love handles) and or abdomen. Keeping the patient comfortable is of utmost concern, and general anesthesia is the best way to achieve this.
General anesthesia has come a long way in recent years, risks have been greatly minimized. You hear of surgical procedures on babies that can last for hours, this is possible because of the great advances in technique and the drugs involved. Of course it is important to verify that the anesthesiologist is board certified as is Randy Gaynor, M.D. who is the anesthesiologist on staff at Marin Cosmetic Surgery Center.
At your initial consultation with Dr. Delgado, he will discuss anesthesia with you, he will want to know if you have had any other surgical procedures in the past, and if so what type of anesthesia. If you proceed with scheduling surgery, Dr. Delgado will discuss anesthesia with you again at your pre operative appointment which is usually two weeks prior to surgery. If you have a history of any possible complications you will also receive a call from Dr. Gaynor, who will ask questions in detail and may want reports from other physicians who have treated you. If you do not present with any known complications, you will still be receiving a call from Dr. Gaynor the night before surgery. He will go over your medical history in detail and will explain what to expect during surgery.
Posted on: May 10th, 2016 Posted by Dr. Miguel Delgado
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Miguel Delgado, M.D. Gynecomastia Specialist
In a Patient’s Own Words
You can read reviews, read blogs, research multiple websites, but getting the story of what gynecomastia surgery is like straight from a patient is incomparable! An out of town gynecomastia patient of Miguel Delgado, M.D.’s did just that. The patient documented his surgery experience from his arrival to the hotel through to the third day after surgery.
This documentation may not be state of the art video, but it lends to the authenticity of it! See the video here.
Our patient starts his video with his arrival to his hotel and is describing how he is feeling. Since his surgery is scheduled for later in the day, what seems to be causing him the most anxiety is being hungry! All surgeries that are performed under general anesthesia need to have the patient NPO, which is a Latin term “nil per os” and means nothing to eat or drink by mouth for several hours before surgery to ensure that the patient has an empty stomach. The anesthesiologist will call the patient the day before surgery and review all instructions.
Anxious but Happy!
Our gynecomastia patient describes that besides being hungry, he is anxious and nervous but very happy that he is finally having male breast reduction surgery so that he can get on with his life.
The next topic the patient presents is reviewing all the types of medication that he will be taking. All of the pill bottles are lined up as he describes them. First are his VitaMedica vitamins that he started two weeks before surgery, then he shows his antibiotics and anti-nausea pills that are started just prior surgery and then his pain pills that are for after surgery. Most patients find they only need the pain pills for a day or two.
After taking a shower our patient heads to the surgery center and after his pre-operative preparations he is wheeled into the operating room.
Ready to Live Life
After three days we see our patient again when he is ready to get his drains removed, he is very happy and says he is glad he had his surgery and is ready to live life!
Hopefully, this man’s story will help you make the decision to go ahead with a life changing surgery and once and for all get rid of those man boobs!
Posted on: February 13th, 2015 Posted by Dr. Miguel Delgado
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Miguel A. Delgado, M.D. Gynecomastia Specialist
★★★★★ Ratings: 4.74 -118 Reviews
Gynecomastia Surgery Center of Excellence
Gynecomastia surgery is not “one size fits all”, each patient is individual and surgery is specific for that patient. However, the surgery process is fairly standard with additional surgery time allowed as needed.
On the day of surgery, you are to arrive 2 hours prior to the start of surgery. You will be greeted by the nurse who will escort you to the “Gynecomastia Surgery Center of Excellence”. You will be assigned a locker where you may store your clothing; all valuables are to be left at home or with the adult who accompanies you.
You are then taken to a pre-operative exam room where the nurse will review your post-operative instructions. Dr. Delgado will meet with you to see if you have any further questions and at this time he will be making surgical markings to guide him in surgery.
After Dr. Delgado completes his pre-operative preparations, Dr. Gaynor, a Board Certified Anesthesiologist will meet with you. Dr. Gaynor will have called you the night before to review your
Dr. Randy Gaynor Board Certified Anesthesiologist
medical history and discuss any previous surgeries you may have had. Dr. Gaynor will then start an IV, and you will be going into the operating room shortly. At this point, patients remember very little as the general anesthesia kicks in, and you go into a very comfortable sleep. As you wake up you are happy to find out the surgery is over, and you are wheeled into the recovery room. For standard gynecomastia surgery, the procedure lasts about 3 to 3.5 hours.
Once in the recovery room, you will be attended by our recovery nurse who will be monitoring your vital signs and making sure you are kept comfortable. Most patients are ready to go home in an hour and a half. For safety purposes, you will be taken down to your car via a wheelchair by the nurse, and released to a responsible adult who will care for you at least 24 hours.
The purpose of this blog is to give you an overview of what to expect the day of surgery. You will be given a detailed instruction booklet at the time of scheduling surgery that will answer many questions. However, Dr. Delgado and his staff are always available to you to guide you through the process with ease.
Posted on: September 2nd, 2013 Posted by Dr. Miguel A. Delgado Jr., MD
San Francisco, CA-Men who have quietly suffered for years with female type breasts, known as gynecomastia, are surprised to discover how many men have the same condition also known as moobs and man boobs. Information now readily available on the internet educates men about gynecomastia that only a few years ago were unknown, they are able to research and find the best top plastic cosmetic surgeons. In addition to the internet, there has been a lot of exposure through other media outlets such as television, radio and magazine articles that have led to further investigation on gathering information on costs of gynecomastia surgery and male breast reduction treatment.
What a relief it has been for men to find that it is a common condition, and there are options available that until recently were unheard of. Looking through the search engines, one site comes up repeatedly as the “web’s best resource for information about gynecomastia”, www.gynecomastia.org.
This website was started in 1998 by psychologist Merle Yost, who counseled many men with gynecomastia. He had great empathy for his patients as he was a sufferer of the condition himself. Understanding how important it was for men to have support, the site offered many different forums for men to reach out to each other, share stories, pictures and ask questions. As the popularity of the site grew different needs became evident. A section was added where questions could be asked directly to gynecomastia surgeons who monitor the site.
Gynecomastia is not confined to the United States; men all over the world are plagued with the condition. In order for men to get support in their own country and even correspond in their own language, there is a section on gynecomastia.org “Local forums/find a Surgeon in your area”.
The first country represented is the United Kingdom (UK), it appears that one of the main issues is trying to get their government insurance to cover the surgery which entails waiting several months to even more than a year to see a psychologist who then needs to recommend the patient for surgery. Of those who have experienced this, they report that they cannot choose their surgeon and some are more experienced than others, making it quite risky. According to the posts, it is recommended that guys from the UK save their money and have the surgery done privately. What a great advantage for a man to get this information from men who have already experienced it, instead of finding out by trial and error.
The next country is Canada; again a big concern there is trying to get coverage from their government insurance for male breast surgery. They also discuss the difference between local and general anesthesia, and post-operative scars.
In Asia, men are asking about the comparison of liposuction versus liposuction and excision. It is encouraging to see that contributors to the forum have learned that for the majority of all male breast reduction cases that liposuction alone will leave the patient very dissatisfied and they advise all readers of this. Also, Asian men discuss issues with the compression garment and trying to hide their man boobs from friends.
From the land “down under”, Australia/New Zealand; there are discussions about; what is the best time of year to have surgery, experiences with drains and changes the patient will deal with in adjusting to a new “body image”.
Europeans seem to be gravitating to Poland for surgery; there are many posts about this. In addition, they discuss the benefit of seeing before and after pictures of a surgeon’s own patients and wisely ask why some will not show photos.
South America/Latin America/Spain/Africa and the Middle East have their own forum with stories to share.
Sweden has an active site where members can converse in their own language.
The common thread with all the forums from the different countries is finding the right surgeon and hopefully one close to home or easy to travel to in a major city. In addition to asking about specific surgeons, men want to know how they do the procedure, where it will be done, the cost and the surgical results. It is most encouraging to see how men educate each other by sharing their personal experiences.
Posted on: June 18th, 2013 Posted by Dr. Miguel A. Delgado Jr., MD
Paulus of Aegina Physician and Surgeon
What is the History of Gynecomastia?
Men suffering from moobs, or male breasts have asked “What is the history of gynecomastia?” First introduced in the second century A.D., the term “gynecomastia” means; woman “gyne” and breasts “mastos”.
The first known record of a physician to address the issue of male breasts was Claudius Galenus also known as Galen, a famous physician, and philosopher of that time. Galen was a physician to five Roman emperors. He produced over 500 books on medical science and philosophical subjects. He became a very famous physician and had his own pharmacy stocked with medicines he made from extracts of vegetables and animals.
Galen’s influence remains today; the word “galenic” describes medicines and drugs from animals and vegetable ingredients. While he was the physician to the emperors of Rome, he treated wounded gladiators giving him a wonderful opportunity to study the anatomy of man and perform surgery. It is not recorded that he actually attempted male breast reduction surgery, but he has the earliest record of describing the condition as an abnormal amount of fat in the male breast. History does not report any attempts at surgical correction of gynecomastia until five centuries later.
During the later years of the Roman Empire, it is believed that the seventh-century Byzantine physician Paulus of Aegina (625-690AD) was the first to attempt a surgical treatment of gynecomastia, believing it to be caused by the formation of fat and advocating excision through a single sub mammary lunar incision or in more severe cases through two lunar incisions extending well beyond the areola. This procedure had been used extensively, but the resulting scars were broad and conspicuous causing almost as much embarrassment as the original condition itself. Paulus is best known for writing a collection of books known as “Medical Compendium in Seven Books”, containing the sum of all Western medical knowledge. It was unrivaled in its accuracy and completeness. As a competent and skilled surgeon, the sixth book was devoted mainly to surgery, and he may be known as one of the originators of plastic surgery as we know it today. In the book, he describes the different surgical processes and techniques including his personal experiences and observations. He conveyed plastic surgery experience and knowledge for such procedures as, nasal and jaw fractures, and gynecomastia, etc. that have been passed down through the ages. He was the first to describe physical characteristics that is still significant today such as the prevalence of gynecomastia in the adolescent, and the presence of fat deposits in many but not all patients, and that some patients will need secondary surgery.
Advances in the procedure continued through the eighteenth and nineteenth centuries, but the most notable progress was by Jerome P. Webster, M.D. There was an article published in the Annals of Surgery by Dr. Webster in September 1946 called “Mastectomy for Gynecomastia Through a Semicircular Intra-Areolar Incision” whereby he describes an operation he devised with a semicircular intra-areolar incision and he first performed it in 1934. It was done under general anesthesia by two surgical teams, one on each side, in order to keep the surgical time as short as possible, and then hope the surgeons had a similar technique. Webster’s procedure made the greatest impact on gynecomastia surgical treatment.
With the exceptional advances in surgical technique and anesthesia that we have today, men have more surgical options that include minimally invasive procedures, for outstanding results with little or no visible evidence of surgery performed.
Posted on: August 23rd, 2010 Posted by Dr. Miguel A. Delgado Jr., MD
MORE TO CONSIDER PRIOR MALE BREAST REDUCTION SURGERY
Below is a continuation of the last blog that addresses frequent asked questions to Dr. Delgado by his patients.
Question #6: Is it painful?
Answer: Gynecomastia reduction surgery is not particularly painful. Most men find they need pain pills for only two or three days. Drain removal can be a little uncomfortable, but recent, improved techniques have made it less so.
Question #7: Will the nipple sensation be lost?
Answer: With surgery, it is always possible to have a change in nipple sensation. Some patients have reported changes in sensation, but most do not mention it. Merle Yost of gynecomastia.org has surveyed men who had gynecomastia surgery and a change in nipple sensation is one of the subjects addressed in his survey. If you sign onto the site, gynecomastia.org, you can read comments by post-surgical patients regarding the changes they have experienced with nipple sensation.
Of patients who underwent the combination of liposuction and surgical excision of gynecomastia, the approach most often used by Dr. Delgado, 21 reported no change in nipple sensation and 29 reported there was a change in nipple sensation. Two of the patients who reported a change said that they had an improvement in nipple sensation. Twenty-seven patients reported a loss of sensation ranging from 0.5% to 100%, with the average loss being 37%.
Remember, this is a survey and not a scientific controlled study. It does, however, offer interesting information.
Question #8: How much does it cost?
Dr. Randy Gaynor, anesthesiologist
Answer: Costs depends on the complexity of the surgery. Gynecomastia reduction surgery at Marin Cosmetic Surgery Center is always done with a board-certified physician anesthesiologist, never under local anesthesia. Our facility has national and state accreditation as an outpatient surgery center. These are important facts to consider when comparing costs with various providers. Cost usually falls between six and eight thousand dollars.
Question #9: What could go wrong?
Answer: This is real surgery and the risks associated with that cannot be overstated. Bleeding under the skin is one of the most common complications. It used to occur in about 8-9% of patients, but over the past three years we have been able to reduce that figure to approximately 5-6%. We now require blood clotting tests and prescribe a regimen of Vitamin K to boost the body’s clotting mechanism. We advise patients to stay at a local hotel if they live over an hour away.
Complications do occur. This is a fact in the practice of medicine. It is how the complications are managed and handled that determines the outcome. Dr. Delgado has vast experience with gynecomastia surgery and is very comfortable in treating any complications that might occur.
Over or under resection of tissue can occur. Under resection can be handled with re-excision, but over resection requires fat injections to the involved area.
Question #10: When can I go back to work?
Answer: After gynecomastia surgery a person can drive a car within a few days and can return to school or work within a week. (If a person’s work is physically demanding, two weeks of recovery will be needed.) Formal exercise regimens should not be resumed until six weeks after surgery.
Question #11: What is the policy if I am not happy?
Answer: Dr. Delgado’s goal is to have you be extremely satisfied with your results. If a revision is needed, and it can be performed in the office, he will do it at no charge. If general anesthesia is required, Dr. Delgado does not charge the patient for his services, but there may be a fee for the surgery center and the anesthesiologist’s services.
Posted on: July 25th, 2018 Posted by Dr. Miguel Delgado
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22 year old male presents for unilateral right gynecomastia. Hormone testing proved normal. He had gland excision on the right with liposuction. He is seen here 4 weeks post op.
No one has a perfect body, most men carry some extra weight, some are barrel-chested, or some may have a somewhat concave chest. Like women, a lot of men may have one breast larger than the other. It is unknown why some people have more of a propensity to form scar tissue than others. All of these factors can contribute to moob surgery results.
Moob Surgery Complications are Rare
Complications are infrequent, but when they do occur they usually are minor, and most can be treated as an office procedure. However, all surgeries come with some risk such as:
Specifically for gynecomastia, there can be pigment changes, some asymmetry of the breasts or nipples, loss of sensation or numbness in the nipples which is possible to last up until a year, rarely is it permanent.
Under or Over Resection
Men who are seeking gynecomastia revision surgery usually have not had enough tissue and/or fat removed; this is referred to as “under resection.” Under resection is a common outcome when the surgeon only uses liposuction for moob reduction. Another complication is “over resection” where too much fat and tissue has been removed, also known as a “crater deformity.”
In some instances, men complain that a few weeks after surgery they have “puffy nipples” for most, this is due to the development of scar tissue which generally takes a few weeks to develop. Many times the scar tissue can be resolved with steroid injections done in the office.
Common Conditions After Moob Surgery
Dr. Miguel Delgado, M.D. states that after the trauma of surgery, moob patients will find that there will be swelling, and bruising, but when, where, and how much can’t be determined. Additionally, scar tissue will form, but again how much can’t be predicted.
After obsessing about their man boobs for a long time, some men will be looking for perfection. Plastic surgery is not a perfect art; however, significant improvement can be expected.
Find an Experienced Moob Surgeon
In the hands of an experienced board certified plastic surgeon that specializes in gynecomastia, many steps can be taken to assure a great outcome. A general surgeon and even some board certified plastic surgeons do not have the skills that a gynecomastia specialist has for a very complex surgery.
It is the expert gynecomastia surgeon who understands possible complications and how to treat them. This is the surgeon who does 100’s of male breast reductions surgeries a year, not just a few. View many before and after pictures and select a surgeon with impressive results.
Dr. Delgado has 100’s of before and after pictures available for viewing, call today (415) 898-4161 for a consultation.
Posted on: November 30th, 2009 Posted by Dr. Miguel A. Delgado Jr., MD
HOW MUCH DOES GYNECOMASTIA SURGERY COST?…..
AND HOW DO I PAY FOR IT??
For many patients, a large factor in deciding if they will proceed with surgery will be its affordability. However, this is not a surgery that has a flat fee, it is a very personalized procedure and many factors need to be taken into consideration for each patient. Ideally the best way to receive a quote is to come in for a personal consultation with Dr. Delgado. Sometimes men want to know ahead of time what the cost will be especially if they live a distance away or due to the fact that they really have no idea and want to know if it is something they are even able to consider. Dr. Delgado understands this hesitancy and therefore offers a free phone consultation if the patient is able to email photos and provide a phone number, Skype is also an option. The patient would then be given a quote and would know exactly what to expect. Having a phone consultation not only provides the patient needed information but will also give him the opportunity to get to know Dr. Delgado and feel comfortable with his vast knowledge of gynecomastia as well as his compassion for men with this condition.
The cost for the surgery usually begins at about $7000; this would include all office visits, surgery center fees and anesthesia. Depending on how severe the case is would determine how involved the procedure will be. For more severe cases, sometimes a small breast lift may be needed to achieve the best result. In even more severe cases, a secondary procedure may be needed ….this is information that will be provided to you when consulting with Dr. Delgado whether in person or on the phone.
Deciding how to pay for the surgery can be a challenge. Some are fortunate enough to have the money on hand, but many do not. Sometimes a close friend or relative who understands how important this is to the patient may be in a position to help. Generally though, that may not be the case. Since this is such a private matter, most men do not want others to know about the surgery. We do not offer “in house” financing but we do accept MasterCard and Visa. We have referrals to companies that specialize in loans for surgical procedures. They have various payment plans and you may find one that works into your budget. We will be happy to work with you on this once you decide to move forward.