| Mastectomy - Male Subcutaneuos
What is it?
Everyone has some breast tissue. In males this normally does not grow. However, in your case this tissue has started to grow. It is commoner in young men. It does not mean that you are having a sex change. It can be very embarrassing, but it is not serious.
You will have a general anaesthetic, and will be asleep for the whole operation. The surgeon normally makes a cut around part of the nipple. He takes out the breast tissue. The overlying skin and nipple stay there. The cut is stitched up. Afterwards the chest looks pretty normal for a male. The operation can either be done as a day case, which means that you come into hospital on the day of the operation and go home the same day, or as an in-patient case, which means spending one or two nights in hospital. Your surgeon will have discussed with you which operation you will be having.
You can leave things as they are. In your case the breast will stay more or less the same, probably for years. There is no good drug treatment. X-ray treatment is not a good idea.
Before the operation
Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you.
On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Please tell the nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special pre-admission clinics, where you visit for an hour or two, a week or so before the operation for these checks.
After - In Hospital
Some patients feel a bit sick for up to 24 hours after the operation, but this passes off. You will be given some treatment for sickness if necessary. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. You may have a drip tube in an arm vein and also one or two fine plastic drainage tubes in the skin near the wound. These last tubes are each connected to a plastic vacuum container. You will find these vacuum containers lying near you under the sheets. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions, drive a car, use machinery, or even boil a kettle during that time.
There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. By the end of one week the wound should be virtually pain-free. The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be exchanged for a clean one which stays until the drain tubes are removed after 1 to 3 days. There are no stitches in the skin. The wound is held together underneath the skin and does not need further attention. There may be some purple bruising around the wound which spreads downwards by gravity. It fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 2 to 3 days. The wound gradually improves for one to two months after the operation. You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. You can shower and take baths as often as you want. The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged. Some hospitals arrange a check up about one month after you leave hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rests 2 to 3 times a day for a week or more. You will need to continue arm and shoulder exercises to prevent getting a stiff shoulder. You will gradually improve so that by the time a month or so has passed you should be able to return to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days. You can safely wear a seat belt. You can restart sexual relations within a month or so, when the wound is comfortable. You should be able to return to a light job after about 4 weeks and a heavier job within 8 weeks.
Complications are minimal and seldom serious. If you think that all is not well, please ask the nurses or doctors. Bruising may be troublesome. Occasionally some old blood collects under the wound, but this can easily be removed. Occasionally the wound edge and nipple do not heal well in places. This always settles down but may take 2 or 3 weeks to do so. Infection is a rare problem and settles down with antibiotics in a week or two. There may be some numbness around the nipple. This gets better over a month or more.There may be some flatness of the chest, but this improves over 6 months or so.
The operation can be quite an undertaking if there is more than an egg-cup sized amount of breast tissue. Overall, patients are very pleased with the final result. These notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
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