My Clothing Size Went Down One

Two things worried this person before surgery. That this was their first major operation involving anesthesia, so the surgery itself was frightening — and that the result might not turn out as they hoped.

Let me answer first: these two are the concerns I hear most often in gynecomastia consultations. And they are different in nature. The first usually resolves itself once you have been through it; the second is one that has to be settled beforehand.

Concerns about the result are narrowed considerably at the pre-operative examination. How developed the glandular tissue is, how much fat is mixed in, where the case falls on the Simon grading scale — these determine the extent of excision and the shape that remains. So rather than saying how much will improve, I first explain what is achievable and where the limits begin.

This person wrote that their satisfaction has remained high from the surgery until now. That said, satisfaction appears differently from person to person depending on the pre-operative condition and expectations, so it is difficult to state categorically that it will turn out this way for everyone.

When I asked what moment stayed with them from the surgery, they wrote this: they had been very nervous before the operation, but on the way from the waiting room to the operating room, the nurse eased a great deal of that worry. Then they opened a parenthesis and added a line — that from the moment they lay on the table and the anesthesia began, the next thing was opening their eyes in recovery.

That is the normal course. Anesthesia is handled by the anesthesiology department, and as the operating surgeon I enter the room after anesthesia is complete. So what a patient actually remembers of the operating room is generally the few minutes before anesthesia, and nothing more.

For those few minutes, the person beside them is a nurse. It is also why the highest point of pre-operative tension is neither the consultation room nor the surgery itself, but that short walk from the waiting room to the operating room.

When I asked what they most wanted to do after surgery, they wrote about something they had already done. They had gone to buy clothes and found their size had dropped by one, and said they intend to wear nicer things from now on.

When volume at the front of the chest is reduced, the silhouette of a top changes first. Immediately after surgery, though, swelling and the compression garment make this hard to see, and many people only feel it once the swelling has largely subsided. How quickly swelling settles also varies from person to person with the extent of excision and liposuction.

When I asked what they would say to someone facing the same concern, they did not praise the clinic. Instead they gave this answer: it is a procedure with high satisfaction, but complications do occur from time to time, so it would be good to choose a clinic that provides sufficient experience and aftercare.

I say the same thing. Gynecomastia surgery is still surgery. Seroma or hematoma can occur, asymmetry can remain, and the area beneath the areola can appear depressed. Most of these resolve with monitoring and treatment, but I cannot say they will not happen. That is why how the first few weeks after surgery are spent often determines the result more than the surgery itself.

This person left one more line: that, for reference, they would not recommend the summer months. A compression garment has to be worn for a period after surgery, which can feel uncomfortable in hot weather, and that clearly stayed with them. But that is the discomfort they experienced, and the season does not determine the surgical result. You can set the timing to fit your own schedule and condition.

To summarize: the experience of surgery passes more quickly than memory suggests, the change is confirmed in clothes before mirrors, and it is better to begin knowing that complications are possible. Whether and when to have surgery is something to decide after confirming your own condition through an examination.