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Gynecomastia Surgery - Male Breast
Reduction
No matter
how hard you work out, no matter how rigorous your training, you have what
appears to be fatty breasts. You may be embarrassed to remove your shirt
in front of others and you don't quite understand why you have fatty breasts to
begin with. After all you are a man, not a woman. Well, the truth
is, it's more common than you think and it is definitely nothing to be
embarrassed about. There are many causes and our bodies are all
different, but, there are treatment options if you wish to
have
What
Is Gynecomastia?
The word gynecomastia
stems from the Greek word, gyne, meaning woman, or female and mastos (mastia
), meaning breasts. Which together seem harmless unless you are a man
who doesn't want them. Gyncomastia is the presence of larger than
"normal" breasts on the male form.
What
Causes Gynecomastia?
The condition is normally from abundant growth in glandular and fatty tissue in
the male breast, giving the appearance of small to medium breasts and occurs in
roughly 40 to 60% of men. The causes can range from hereditary factors,
hormonal imbalances, obesity, steroid use, marijuana use, benign or malignant breast
tumors, fibrosis, genetic disorders, Klinefelter Syndrome, testicular atrophy
and/or failure, supplemental hormones and other medications, and lastly, liver
disease.
Gynecomastia may be
present at birth, occur during the onset of puberty, throughout life due to any
of the above reasons or from something as simple as the normal aging process
toward the end of our lives.
Do
You Have Gynecomastia?
Although gynecomastia can
and does occur in persons of normal weight or body fat composition, it may occur
simply from being overweight. If this is the case, you may wish to follow
a sensible diet and exercise program to see if this corrects the problem.
If you presently adhere to a good diet and healthy exercise regimen and you
still feel as though you have fatty breasts, you may have gynecomastia. If
you suffer from any of the causative factors in section 2 (What Causes Gynecomastia?),
and feel as though your breasts are larger than they should be, it is quite
possible you may have gynecomastia.
"Gynecomastia is divided into
four grades: grade I: small enlargement, no skin excess; grade IIA: moderate
enlargement, no skin excess; grade IIB: moderate enlargement with extra skin;
and grade III: marked enlargement with extra skin. Grades IIB and III require
some skin excision. Letterman and Schuster simplified the classification into
three types of gynecomastia based on the required correction: (1) intra-areolar
incision with no excess skin; (2) intra-areolar incision with mild skin
redundancy corrected with excision of skin through a superior periareolar scar
only; and (3) excision of chest skin with or without shifting the nipple.One can
reduce the gland through a periareolar incision and perform a skin correction at
a later date if necessary.
For surgical planning, there
are three classifications of gynecomastia.
Grade I: A localized button of tissue that is concentrated around the
areola. These buttons are usually easy to remove; the chest is not fatty,
and there is no skin excess.
Grade II: Diffuse gynecomastia on a fatty chest where the edges of the
tissue are indistinct. This tissue is difficult to taper. Dishing was
common before the addition of suction lipectomy.
Grade III: Diffuse gynecomastia with excessive skin. These patients
require external (outside the areola) skin excisions or nipple
repositioning, or both." (Source: Yale Medical Core Curriculum)
What Are My Options?
Your options depend upon
the cause, however you may choose to have breast tissue and fat removal at any
time as long as you are in good health and have realistic expectations. If
you wish to tackle the cause rather than the symptom, then determining the cause
is your first course of action.
If you choose to
have the tissue removed it can be done by liposuction (traditional liposuction,
internal or external ultrasound-assisted liposuction, tumescent liposuction, and
ultrasound lipolysis), manual fat extraction or mesotherapy. Liposuction
options and nonsurgical lipolysis can be researched on
www.lipocentral.com,
while mesotherapy is the reduction of fat and other tissues by the use of localized
injections of medications.
What
To Expect At Your Gynecomastia Consultation
Arrive at your
consultation on time, although be prepared for the office to possibly be running
a little late--consultations are time-consuming and some patients ahead of you
may have needed a little more time than others. You will bring with you
your folder of questions,
photos and anything else you can think of.
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You will meet
with the surgeon (at least you should. I have heard where you
don't even meet the surgeon until the day of surgery and I find this poor
practice as you should be able to meet up with the surgeon before he
performs your surgery). You will interview him or her as though your life
depended upon it, because it does. Not all surgeons are created
equal.
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You will address
all your questions, concerns, fears expectations, etc.
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You will discuss
your medical history completely.
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You will discuss
your options in technique, incision placements, anesthesia and more.
Anything that you wish you should discuss during this time.
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Your surgeon
might determine a rough cc amount he or she believes should be removed to
give you your desired result.
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Your surgeon may
even ask you to exercise and diet before undergoing your procedure so please
know that this appointment is very important all around.
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You will discuss
risks at length.
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You may be given
an informed consent sheet at this meeting
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You will discuss
the anesthesia risks. Just make sure that the surgeon does address the
risks. This is surgery, not getting a tooth pulled.
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Ask to see the
surgeon's before and after photo albums or discs.
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Ask if you may
speak to any of his patients which may be listed on a referral sheet.
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You may also
request to tour the facilities if your surgery will be performed on site.
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You may receive
literature regarding the surgeon's education and training (curriculum vitae)
or any other pertinent information.
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You may even
discuss costs and fees with either the surgeon during your meeting or with a
financial planner towards the end of the consultation.
The Physical
Examination
You will be asked to remove your shirt and possibly told you may cover yourself with a gown. After you are finished your
surgeon and a nurse will come in to examine your skin condition, type, thinness
and elasticity. Your surgeon may possibly take measurements. He may
pinch or tug on your skin gently to test your laxity, and determine the
density of fat or breast tissue accumulation. You may feel uncomfortable during this time
so prepare yourself for it.
Scheduling
Surgery & Pre-op Appointments
You may or may not schedule a surgery date at the end of this consultation, you
are by no means obligated but this is generally the next step. If you
should choose to schedule a surgery with a particular office you will usually
give a deposit to hold your date. You will also make a preoperative
appointment for lab work, preparation, medications, etc. etc. After
your preoperative appt. Your surgery should take place within 2 weeks of
the last meeting and/or lab work.
You should go away with enough to go on and request a second meeting if need be,
should you feel that more could have been covered. You will notice that
intuitions will kick in about judgment of character, trust and faith in one's
abilities. This is important so listen to any instinct triggers which may
become apparent during the meeting.
Your
Pre-operative Appointment
If you schedule a surgery
date you will more than likely schedule a pre-operative visit appointment,
as well. This will entail another trip to the surgeon's office or an
independent lab for "bloodwork"
to check your red and white blood cell counts (a CBC test), among other
things. For a better understanding of just what a CBC is for and
means, I suggest this link: Understanding
Your Complete Blood Count (CBC) Test And please quit smoking now.
It will highly reduce your risk of necrotic tissue. Do not take any chances
with this. Smoking can significantly alter
your body's ability to re-vascularize the treatment area and not heal well at all.
You will also be
given (or should be given) a list of medications that you must cease or
avoid taking. These medications will mostly be aspirin-containing products
and supplements that may inhibit clot formation or cause problems with
anesthesia. However medications which may cause clotting (such as Vitamin
K) may be prohibited, do ask your surgeon. Please visit the Medication
& Supplement List page for more information or Click
Here to view a Printable List of Medications To Avoid.
You will also be
given a list of things to buy or have around you in your healing room.
Things like frozen peas, raspberries or blueberries for icing you down to ease
the swelling and bruising. You may be asked to buy antibacterial soap,
perhaps Hibiclens, or it will be given to you for cleansing a few days
before surgery (to kill Staph and other surface bacteria). Some surgeons
simply suggest Dial antibacterial soap. You may even be asked to purchase
gauze, "maxi-pads" and other types of dressings to tend to your
incision areas.
Preparing
For Your Gynecomastia Surgery
Now is the time for you to
have second thoughts, run around looking for supplies, experience anxiety and
have your life in an emotional upheaval. For many, this is a very stressful
time, but it doesn't have to be. It is perfectly natural for you to be
"freaking out" now that surgery is a few weeks away. Just
following the advice composed with the help of real patients and things will
go much more smoothly.
We have provided a
few lists for your convenience below:
Swelling
& Bruising Recommendations
Want help in the swelling and
bruising department? Maybe some Arnica montana
or Bromelain. Some patients even drink
fresh pineapple juice, although with juice comes high amounts of sugar. Please read
the linked sections for more information
and always ask your surgeon before taking any medication or homeopathic
remedy.
Surgery
Day Is Here
Sometimes with our
pre-operative jitters we forget what we did to prepare and what we read that we
would feel like or look like, what to bring and how to act. With the below tips
and information I hope that you will be more at ease and know what to expect
today. This list is just an example, as you should have received a similar
list from your own surgeon. Always abode by your surgeon's instructions.
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Arrive on
time. You should
have the arrival time in your information packet or at least confirm the
night before and make the proper notation. If you are late, the
surgeon may cancel your surgery and charge you for it anyway. Then the
surgery fee is non-refundable.
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Arrive
Clean. This means
freshly-scrubbed with your instructed soap, clean DRY hair, NO lotions,
deodorant, powders, cologne--zilch!
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DO NOT
eat
or drink anything after midnight on the evening prior to your surgery.
Unless your surgery is an evening surgery, which you should abide by
your surgeon or anesthesiologist's instructions, which is usually 6-8
hours beforehand.
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DO NOT
bring
rings, watches, chains, or other jewelry or large sums of money to the
surgery center or hospital; leave these items safely at home. If they
become lost the hospital or surgeon is not responsible.
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Wear your
surgery gear; comfortable, easily-accessible, loose-fitting clothing
with slippers are great items to have.
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Ask
about Vitamin C capsules or tablets, or medications such as Vicon-C to
be taken a few weeks prior to surgery. This is thought to promote good
healing and ward off colds. Although Vitamin C promotes healing
and helps with bruising it is possible that excessive Vitamin C
consumption can cause over-production of collagen (excess scar tissue
formation) so adhere to your own surgeon's instructions.
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Also,
discuss with your doctor the use of arnica montana or Bromelain,
a pineapple extract, for added anti-bruising and anti-swelling
properties. Even drinking pineapple juice for 3 days pre-operatively is
reported to help, however juice contains a lot of sugar so please abide
by your surgeon's instructions.
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Vitamin A
has been recomended by many surgeons, but as with any drugs, supplements
or remedies ALWAYS check with your surgeon before you take anything.
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Take any
medications you were instructed to take with only a few sips of water.
Such medications may be Catapres (blood pressure), prednisnone,
anti-inflammatory, valium, antibiotics, blood thickeners, etc.
You should been given your medications and instructions at the pre-op
appointment unless your surgeon gives you your medications when you get
to his office.
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Prior to
surgery, should you develop any fever, chills or other signs of a cold
or other infection, call your surgeon's office immediately. If you do
not and HAVE to cancel it is possible you may lose a significant portion
of your money, or at least your deposit. You should never be
operated on with already stressed immune system.
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Bring with
you any instructed meds for after surgery, your garments or any
instructed bandages, etc.
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Bring a
bucket or can, with a lid (like an empty and clean coffee can) and some
cool, bottled water to sip and rid you of the nasty taste you get after
vomiting. Besides cool water really helps keep the nausea at bay.
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Maybe bring
a few packs of crackers to help with the nausea. Ritz crackers always
seem like the best although plain saltines are fine. Low Sodium is
recommended. Increased sodium levels can cause more water retention,
hence more swelling.
They will ask
you to change into your gown and have the gown close from the front.
Your doctor will come in to talk to you and you will feel a little
nervous. He may begin to make the surgical markings with a single-use
surgical felt tip pen on your breast area which may resemble circles like
tree trunk rings, with your nipple in the center. This will help your
doc determine how much to remove and where to begin feathering if using a
liposuction cannula. Feathering assist in making a smooth transition
from removed tissue to non-treated tissue.
You will ask any
last questions before your surgery, discuss anything that concerns
you. It is almost time!
On To
The Operating Room...
If you had been given an oral sedative or valium
prior you usually could care less what they are going to be sticking in you,
namely IV's, which you will more than likely have. If you haven't been
given a sedative, it can be more stressful for some patients. It feels
sort of like blood being drawn, but for a shorter period of time. It's the
initial placement of the IV catheter that may sting a bit. After the needle
is injected into the vein it is pulled out and a little plastic tube is left
in your vein. The catheter is taped to your skin so it is not knocked out
and is ready to be used as a sort of doorway for anything they deem suitable
for your body. This is usually done before you get into the actual O.R. by a
nurse and you will have a saline bag hooked up to you. Any medications will
more than likely be given via a drip system with this saline. Most
patients usually get their IV in the crook of the elbow, some the hand. I
personally dislike the hand ones as it's a nasty place for a bruise to be,
at least with the arm you can hide it, but it all depends upon your
veins. If you have difficult veins, any place they can insert your IV
will be used. The saline will keep you hydrated both during and
directly post-operatively.
You are then brought
to the O.R. if you aren't on the table yet. If you are going to have IV
sedation, they insert a hypodermic into the tube for your IV or they attach a
bag of sedative/cocktail with a drip system to add a few drops every few minutes
and when they spring open the stopper and it starts heading towards your body.
The the effects of the anesthesia are felt soon after injection or opening the
stopper, a few seconds in fact. It feels like heat going into you veins
then creeping up your arm, then it jumps from your shoulder to a metallic-like
taste under your tongue and then you are blissfully anesthetized.
Gaseous-state
anesthesia (Twilight, Gaseous General):
If
you are getting gaseous sedation, all this entails for you is breathing through
a mask. Some types fit over your mouth and nose usually and force air into your
lungs. With intubation you will have a tube down your throat but you don't
usually remember it going in because you are asleep first via IV sedation or
gaseous sedation. You may wake up with a raw throat because of the tube.
*Also be advised
that if you have bronchospasm, asthma or other disorders such as this,
intubation is contraindicated. Please make sure you read the risks
associated with Anesthesia and discuss and respiratory issues with your
surgeon or anesthesiologist.
What To Expect: The mask is
placed over your face and you are basically told to count down from 100, and see
how far you can make it -- usually 96 or 97. Or they talk to you to
distract you while you are going under. After the gas hits the aveoli in
your lungs, your blood is saturated by the anesthesia gases where they are
carried to your central nervous system (CNS) and then out you are! If they
intubate you it will be about now, if not, they will begin your surgery.
How
Gynecomastia Surgery Is Performed
Your frontal torso area is swabbed and
scrubbed with a Betadine solution to remove surface bacteria such as Staphylococcus
aureus, or simply 'staph' for short. This will cut down on the risk of
infection. Your surgical markings will be lighter but still visible.
The treatment area is then injected with Lidocaine and epinephrine and possibly
saline for tumescent liposuction.
Incisions are made near the nipple
and either a liposuction cannula is inserted for fat removal only or if removal
of excess breast tissue is needed, it is excised manually. The area is
recontoured to a more pleasing appearance.
Your surgeon
may close the incisions with tissue glue, surgical paper tape like Steri-Strips by 3M Corp., or other bandages and
dressings or close your incisions with one to three sutures or more if the
incisions require it. You are then gently woken up.
Coming
out of Anesthesia
This transition
period can be very rough for some patients. You may experience
sickness, dizziness, crying, depression, anxiety, haziness, etc.
It is generally like drinking a lot of alcohol and feeling as if you've
had too much alcohol, or very little sleep, but with even less control over your body's movements
at first. You may also be cold and shaking and this is usually
from the epinephrine and cold O.R. This will pass. Your throat may be sore if
you were given General anesthesia via intubation.
Recovery
Room
You will be taken
to the recovery room, which is usually located right off of the
operating room, and more than likely placed in a recliner, or hospital
bed. You will usually still be hooked up to the monitors so that
your recovery can be properly tracked. If you do feel sick or are
in pain, alert the recovery nurse. He or she may give you a pain
reliever and possibly some sickness relief medication or a few sips of
cool water to ease your stomach.
If you were
given Light Sleep Sedation (a lighter form of IV Sedation) you may be
allowed to go home within 2 to 3 hours, depending. If you were
given General the office will want to keep you around for a bit longer, plus you may get a little sick. They can give you medication to
remedy this but it may or may not work for you. Ask your surgeon
at your consultation if he gives medications which will help alleviate
post-operative nausea. You may have to urinate directly after
surgery due to the amount of intravenous fluid. In fact the surgeon may
insist that you do before releasing you. You may need assistance
in doing so, so be prepared for an audience of at least one.
You MUST
have someone to drive you home and care for you for the first few days.
This person must be dependable as he or she will need to help you to the
bathroom, dressing, walking, eating, etc. Hopefully you will have
prepared your home and recovery area as we have suggested in our
preparation list.
The
Road To Recovery
You may not remember your
surgery, or at least as the days go by you may forget the details as well as
lose track of time. This is because of the amnesiac properties of the
anesthesia which is covered in the All About Anesthesia
Section.
If a drain was
inserted to allow the fluids an exit from the incision sites or from the
bottom most portion of the treatment area, this may be removed withina few
days, so be sure to ask your surgeon about them if he opts to insert these.
You will be swollen and possibly bruised and may be asked to wear a
compression garment. If you are bruised, don't panic. We've all
had bruises before, it will subside.
Your chest may
feel tender, stiff and/or sore for a few says and will more than likely not
want to move too much. But, listen to your surgeon's
instructions as for when you should move around for a few minutes, even if
it is around your house. Sitting around all day increases your risks
of blood clots which is very dangerous, so if you have had liposuction with
your gynecomastia procedure you may be asked to move about a bit. If
you have stitches they are removed within the first 5 - 10 days. Be
sure to take your required medications and follow the precise instructions
provided to you by your surgeon.
You may also
experience sharp pains, burning sensations, heat, tingling, prickling, etc.
This is from minor nerve damage and the sensations of the returning function
of the nerves will result in the physical descriptions above.
Asymmetry may be
a fact of life for you until you are fully healed. The body does not heal
equally on each side of the body so oneside may seem larger than the other.
Be patient and wait it out before looking into revision surgery.
Swelling can alter the appearance of your body and mask the true results.
This goes both ways, - a good result or a bad result (lumps). Patience
is the only remedy until you are able to make a true judgment. And
this judgment cannot be made until you are healed. Prepare yourself
beforehand and know what to expect lest you hurl yourself into a depression.
You will be
instructed not to exercise or engage in strenuous activities for at least 2
to 4 weeks. You may be swollen for up to 4 months, although this could
be very slight and only noticed by you. Drinking plenty of water can
significantly help with edema and help flush your system clean of
medications. Almost 85% of the population is dehydrated, drink more
water! Please know that diets high in sodium will assist in prolonging
swelling and general fluid retention. Drinking caffeine may seem like
a good idea for a diuretic effect but if your body is balanced naturally and
you are drinking enough water your body will expel the excess.
Overall
Improvement will be appreciated in just a few weeks. The majority of
the swelling will have subsided by this time and the results will be
apparent. It takes about 3 to 4 months for the rest of the swelling to
subside, although it can remain up to 6 months.
Also you should
be taking your temperature regularly, a raised temperature could mean an
infection so please alert your doctor to fevers over 101F.
Please be
patient. Visit our
Male
Surgery Forum for support from real patients.
Remember to
keep your chin up, you may be very uncomfortable and regret having had
your surgery but in a few weeks it will be at the top of your "Best
Things I Have Done For Myself" list!
Risks
& Complications Of Gynecomastia
As with all surgeries, there are
risks - please read this section thoroughly so you are well informed.
Anesthesia
There is a risk of a negative reaction to the anesthesia and other
medications and products used in this procedure. Epinephrine
sensitivity can be an issue. Please see our anesthesia
section for more information.
General Risks &
Complications
There may be asymmetry, hyper-pigmentation (permanent dark spots) from the
bruising. Hematoma, seroma and infection are possible issues.
Fat & Tissue Necrosis
Fat and its surrounding tissues can become necrotic (dead tissue) if
significant amounts blood vessels are severed. If the fat becomes
necrotic from lack of blood supply, the fat tends to turn orange-ish clear
and drain from the incision, however some drainage will be normal. If the
tissue becomes necrotic, it must be taken care of immediately. If this
is the case you will need to have the tissue removed before a major
infection develops, possibly causing gangrene. Necrosis resembles very
black, and discolored skin (different from a normal bruise) which spreads
and does not clear up. Necrosis will cause the need for excision of all
affect tissue. Hyperbaric treatments can significantly improve
problematic wounds and prevent further spread of necrosis. Hyperbaric
Oxygen Therapy also may significantly decrease your healing time.
Risks As Associated With UAL-assisted
Procedures
With the ultrasonic technique, patients have been known to receive actual
burns from the ultrasonic sound waves. Although ultrasound is not a
form of heat, the high frequency radio waves excite the fat molecules and
fluids. The fat cell is literally ruptured with ultrasonic energy.
If the ultrasonic cannula or external ultrasonic pads/paddles are are not
kept mobile burns and untargeted tissue damage can result. Blisters can form
if the tip of an ultrasonic cannula gets too close to the under part of the
skin. Skin thinning can also happen if there is too much undermining.
Permanent irregularities can develop from excessive undermining.
Irregular Contour Deformities
Dents, bumps and waves may appear after your procedure which may require
additional surgery, deep tissue massage, subcision or fat grafting.
This can be from lack of skill of the surgeon, failure to comply with some
post-operative protocol such as massage and walking, etc. Fibrous scar
tissue formation can naturally happen and be the fault of no one - merely
happenstance.
General Dissatisfaction
Please be sure to convey, and re-convey your desires and expectations with
your surgeon. Lack of communication can easily ruin your chances of a
good result the first time around. Also, unreasonable expectations or
emotional problems can
severely impact a patient's perception of their results.
The
Average Costs Of Gynecomastia
The costs of gynecomastia surgery varies
significantly between surgeons, medical facilities, and regions of the country.
Patients who need additional or more extensive surgery will require more
intensive and expensive treatment. In non-private Surgery Centers or
in-office Operating Rooms the prices may include the following. However,
in hospitals, surgery charges can usually be separated into five parts:
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the surgeon's fee
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the anesthesiologist's fee (if
applicable)
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the hospital charges, which
includes nursing care and the operating room
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the medications (antibiotics,
topicals, dressings)
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and any additional charges
All fees are averages;
out-patient charges, including surgeon fees, anesthesia, Operating Room charges,
unless otherwise noted. Lab fees, such as routine blood work (CBC), are
normally an extra $35. - $75., plus medications are usually an additional $120.
If you are to be staying in a hospital or are opting for home healthcare, these
expenses are additional.
Financing Your Surgery
Of course, surgeries can be financed. There are many companies out there
who will offer financing for your procedure although not many are
plastic-surgery or surgical-specific. I recommend companies that do deal
in plastic surgery-only financing as they are more aware of the time you need to
recover and seem to have more empathy for the patient and not only their pocket
book. Just be sure to read the fine print in regards to what you receive
or what the particulars are before signing with a finance company.
Related
Links
eMedicine - Gynecomastia : Article by Venkatesh Babu
Segu, MD
eMedicine - Gynecomastia : Article by Fawzi Ali, MD
MedlinePlus Medical Encyclopedia: Gynecomastia
Gynecomastia and Systemic Mastocytosis
eMedicine - Klinefelter Syndrome : Article by Harold Chen, MD, MS,
FAAP, FACMG
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