• You are physically healthy and at a relatively normal weight,
• You have realistic expectations,
• Breast development has stabilized,
• You are uncomfortable with the feeling that your breasts are too large.

Adolescents may benefit from surgery, although secondary procedures may be necessary in the future due to continued breast development.

• Men whose condition cannot be corrected through alternative medical treatments;
• Healthy individuals who do not have a life-threatening illness or medical conditions that could impair healing;
• Non-smokers and non-drug users;
• Men with a positive outlook and specific goals to improve the physical symptoms of gynecomastia.

• The reason why you want to undergo surgery, your expectations and the desired result;
• Medical conditions, drug allergies and medical treatments;
• Current use of medications, vitamins, natural medicines, alcohol, tobacco and drugs, including steroids;
• Previous surgeries.

• Assess your general health status and any pre-existing health conditions or risk factors;
• Perform diagnostic tests to determine the underlying cause of gynecomastia, which may include testing your endocrine function;
• Examine your breasts and take detailed measurements of their size and shape, check the quality of the skin, the position of the nipples and areolas;
• Take photos for your medical records;
• Discuss your options and recommend the most appropriate treatment;
• Discuss the likely results of gynecomastia correction and any potential risks or complications;
• Discuss the type of anesthesia to be used during the procedure.

Before surgery, it may be necessary to:

• Take laboratory tests or medical evaluation;
• Taking certain medications or adjusting your current medications;
• Stop smoking well before surgery;
• Avoid taking aspirin, anti-inflammatories and natural medicines, as they can increase bleeding.

• What to do on the day of surgery (fasting time, medications, bath),
• Post-operative care.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

Be sure to ask someone to accompany you and stay with you for at least the first night after surgery.

The decision to undergo gynecomastia surgery is a personal one and it is up to you to decide whether the benefits will meet your goals and whether the risks and potential complications are acceptable. Your plastic surgeon and/or assistants will explain, in detail, the risks associated with the surgery.

You will be asked to sign the consent form to ensure that you fully understand the procedure you will undergo and any potential risks or complications.

• Unfavorable scars;
• Bleeding (bruise);
• Infection;
• Poor healing;
• Changes in sensitivity in the breast or nipple, which may be temporary or permanent;
• If liposuction is used, additional risks include irregular contours, residual skin laxity, irregular pigmentation, fluid accumulation (seroma);
• Anesthetic risks;
• Irregular contour and shape;
• Changes in pigmentation, swelling and bruising;
• Damage to deeper structures such as nerves, blood vessels, muscles and lungs, which may occur temporarily or permanently;
• Allergies to tape, suture materials, glues, blood products, topical or injectable medications;
• Breast asymmetry;
• Adipose tissue necrosis;
• Accumulation of fluid (seroma);
• Deep vein thrombosis, cardiac and pulmonary complications;
• Pain, which may last;
• Possibility of a new surgical procedure (touch-up).

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

If you experience shortness of breath, chest pains, or an abnormal heartbeat, seek medical attention immediately. If any of these complications occur, you may need hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve the best results with a single surgical procedure, requiring a new surgery.

Following your doctor's recommendations is essential for the success of the surgery. It is important that surgical incisions are not subjected to excessive force, abrasion, or movement during the healing time.

It is important that you ask all your questions directly to your plastic surgeon. It is natural to feel a little anxiety, to have expectations about the result or pre-operative stress. Discuss these feelings with your plastic surgeon.

What happens during gynecomastia correction surgery?

Plastic surgery to correct gynecomastia is technically called reduction mammoplasty, it reduces the size of the breast and improves the contour of the chest.
In severe cases of gynecomastia, excess breast tissue can cause the breasts to become saggy and the areola to become enlarged (dark skin around the nipple). In these cases, the position and size of the areola can be surgically improved and excess skin removed.

Medications are administered for your comfort during the surgical procedure. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

In cases where gynecomastia is mainly the result of excess adipose tissue, only liposuction techniques can be used. Such a situation requires the insertion of a cannula, a thin hollow tube, through a small incision. The cannula is moved back and forth in a controlled motion to loosen excess fat, which is then removed from the body using vacuum suction.
There are several liposuction techniques that can be used, the most suitable one for your case will be defined by your surgeon.

Excision techniques are recommended where breast glandular tissue or excess skin must be removed to correct gynecomastia. Excision is also necessary if the areola needs to be reduced, or the nipple repositioned to achieve a natural contour. Incision patterns vary depending on the patient's anatomical particularities and the surgeon's preference. Sometimes gynecomastia is treated with liposuction and excision.

After surgery, a dressing will cover your incisions and elastic bandage or mesh may be used to reduce swelling and support the operated breast.
A drain may be temporarily placed under the skin to drain any excess blood and fluid that may accumulate.

How to care for your breast after surgery, medications to take by mouth to help reduce the risk of infection, specific concerns to look for at the surgery site or in your general health, and when your return appointment with your plastic surgeon will be.

• Where will I remain in recovery after the surgery ends?
• What medication will I be given or prescribed after surgery?
• Will I have bandages after surgery? When will they be removed?
• Will the stitches be removed? When?
• When can I resume normal activities and physical exercise?
• When will the return appointment be?

It is very important to follow your plastic surgeon's recommendations and attend follow-up appointments as scheduled. In many cases, the end results of breast reduction in men are permanent. However, if gynecomastia is the result of medication use, drugs including steroids, or weight gain, withdrawing offending drugs and maintaining a stable weight may help maintain results. Talk to your doctor before starting new medications. All scars are permanent, but they can be hidden in the natural contours of the breast.

Cost is always a consideration in elective surgery. A surgeon's fees may vary depending on their experience and the type of procedure to be performed.

The cost may include:

• Surgeon's fees;
• Hospital and surgical center costs;
• Anesthetist's fees;
• Prescribed medications;
• Post-operative meshes;
• Medical exams.

When choosing a plastic surgeon for gynecomastia surgery, remember that the surgeon's experience and your good relationship with him or her are just as important as the final cost of the surgery.

• Areola: Pigmented skin around the nipple.
• Bilateral gynecomastia: Condition of developed or large breasts in men that affects both breasts.
• Endocrine system: A group of glands that produce hormones that help control activities in your body such as reproduction, metabolism, growth and development. Tests of your endocrine system may be done to look for signs of diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, high blood pressure, and obesity.
• Excision: Removal of the skin.
• General anesthesia: Drugs and/or gases used during surgery to relieve pain and reduce consciousness.
• Hematoma: Accumulation of blood beneath the skin.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Liposuction: Procedure that vacuums fat deep into the skin.
• Local anesthesia: Drug injected at the site of an incision to relieve pain.
• Reduction mammoplasty: Surgical removal of breast tissue to reduce the size of the breasts.
• Sutures: Stitches used by surgeons to hold skin and tissue together.

Use this list as a guide during your consultation:

• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Is the installation of the surgical center in the office authorized by the Health Surveillance of your city?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• Which surgical technique is recommended for me?
• How long can I expect to recover, and what kind of help will I need
during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications treated?