Where will you see me for first consultation?
I will see you at my clinic in JBR/Dubai Marina area called Life Line Medical Centre located on First floor of Al Fattan Marine Tower. Please check the location map on the home page "contact".
Is there a consultation charge or is it free ?
The first consultation is charged 400 AED (100 $) dirham but its refunded at the time of surgery.
Further consultations for the same problem are fee and follow-ups after surgery are free.
Where will the surgery be performed?
I operate in several internationally accredited hospitals in Dubai like Lifeline Hospital near Ibn Battota mall and Al Garhoud Hospital near Airport. Each Hospital has different level of facilities comfort and expertise at various levels like anesthesia and nursing. Each hospital has different rates for each activity. Therefore the total package deal will also depend upon which hospital the patient wants me to operate and also the severity of the issue.
Are any finances available for Medical purposes of this kind?
Yes, 100 % finance is made available to resident visa holders of United Arab Emirates on 1 % interest rates.
Such arrangements cannot avail any discounts even if there are more them 2 surgeries performed at one time.
Gynaecomastia is usually secondary to the normal hormonal imbalance that commonly occurs in boys during puberty
and it affects up to 40% of adolescent boys by the age of 14. Boys suffering from Gynaecomastia form breast tissue
that is usually less than 4 centimeters in diameter. That breast tissue usually disappears, without treatment,
within two years in most case, while in fewer cases it could take up to three years. Although Gynaecomastia is common,
if the child suffers from the disorder he should be evaluated by a doctor. It is important for you and the doctor
to reassure the teenager that this is a normal occurrence.
Gynaecomastia after puberty
Men who have developed gynaecomastia later in life from steroid abuse body building, use of Tribulus terrestris
(herbal android - testosterone precursor) or some other cause may have little to no psychological distress.
However, for some in this situation, it can leave them feeling out of control of their body or emasculated in
some matter. Hopefully, corrective surgery will resolve these feelings, for some it will not and therapy will
needed to relieve the distress.
Gynaecomastia and the plant product "Tribulus terrestris". Jameel JK, Kneeshaw PJ, Rao VS, Drew PJ.
Academic Surgical Unit, Castle Hill Hospital, University of Hull, Nottingham, East Yorkshire HU16 5JQ, UK.
Gynaecomastia is the commonest benign breast condition seen in men. It is well recognized that certain drugs
that alter the normal sex hormonal profile in the body can induce gynaecomastia. Recently, an increasing use
of androgenic-anabolic steroids among young men especially body-builders has increased the incidence of gynaecomastia. We report a case of a young weight-trainer who developed gynaecomastia due to oral intake of a herbal tablet which he used as a steroid alternative for body-building.
PMID: 15454201 [PubMed - indexed for MEDLINE]
What is the best way to find a Plastic Surgeon?
The best way to find a Plastic Surgeon in your area, is to contact the American Society of Plastic and Reconstructive
Surgeons at their toll-free number for referrals (1.800.635.0635 ) or online at www.plasticsurgery.org.
One can also search the name of the given plastic surgeon with ISAPS The International Society Of Aesthetic Plastic
Surgery which is one of the largest body in the globe listing all certified plastic surgeons.
Causes of Enlarged Breasts in Men
In most cases, the cause is unknown. Sometimes it is an imbalance of the sex hormones estrogen and testosterone.
But heredity conditions, diseases including certain endocrine disorders, tumors, and chronic diseases or certain
drugs such as anti-depressants, blood-pressure medicines, marijuana, and steroids may also cause the condition.
Some men or boys have fat on their chests that makes it look as though they have breasts. This is not gynaecomastia,
but is called pseudo gynaecomastia and may go away with diet or exercise. Some men or boys will need treatment for
this, as these fat pockets can be resistant to the effects of diet and exercise. In contrast, true gynaecomastia will
not usually improve with diet and exercise.
Excessive use of chicken in diet especially farm breed of chickens which are fad with estrogens to increase the
productivity can result into increased levels of estrogen in man which can cause gynaecomastia. This is one of the
hypotheses where junk food is much in use.
While not a serious medical problem, enlarged breasts can cause pain. They can also cause embarrassment - especially
among young boys who may be teased as a result of their male breasts. It is especially common in teen boys.
Up to 65 percent of 14-year-old boys have enlarged breasts, according to the American Academy of Family Physicians.
This is largely due to the fluctuations in sex hormones that occur during puberty. The excess breast tissue
disappears without treatment in two years in 75 percent of these boys, and within three years in 90 percent of them.
A different view: (Excerpt from paper on cause of Gynaecomastia) This is not the view of this site and this site
bears no copyright impingement responsibility in sharing this information. It's mentioned here only in the interest
of the victims of this problem. http://www.wellmanclinic.org/paper2.htm
From this information it was discovered that there is also a lower ratio of weaker adrenal androgens
(delta 4-androstenedione and dehydroepiandrosterone) found in youths with this disease. It was once believed that
there was an imbalance in the ratios of testosterone to estrogen or estradiol, but this is now known to be untrue.
Repeated use of products containing lavender oil or tea tree oil may spur breast growth in prepubertal boys,
according to a study in The New England Journal of Medicine. The effects fade when boys stop using the products.
More than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen.
This typically disappears within two to three weeks after birth.
In older men, gynaecomastia often results from decreasing levels of the male sex hormone testosterone, which occurs
with advancing age. In addition, men experience an increase in body fat with age and a resultant rise in the ratio
of estrogen to the male sex hormones (androgens).
List of common causes of Gynaecomastia steroid abuse - body building
chronic liver disease
side effects of many medications
Drugs that can cause Gynaecomastia
There is an every increasing list of medications in this list o ADALAT and ADALAT XL
- Cimetidine (Tagamet) I am hearing a lot about this drug causing severe gynaecomastia. I know of no studies.
- Another source of information. Adverse Reactions.
- Fluphenazine Decanoate
- Prostate Cancer Drugs InfoLink
- ZANTAC¨ Information:Safety
In cases of obesity, weight loss can reduce the gynecomastic condition, but for many it will not eliminate it rather the breast will hang which is called as Ptosis in medical terms. For all other causes, surgery is the only known answer. Surgery by plastic surgeons is performed with minimal size of the scar at the junction of areola to the normal skin of the breast and if treated well postoperatively then after one year the appearance of scar is as good as hardly seen. Almost 95% normal appearance. For large gynaecomastia in an obese patient it's almost a breast reduction similar to what is done for female breast and this leave a T shaped scar. One must come to terms with one's body, accept it, and heal the scars from within. Once the physical encumbrance is lifted, psychological scars still need to be addressed.
Male Breast Cancer
when men begin developing gynaecomastia they are often afraid that they have breast cancer. A certain percentage of men do get breast cancer and it is important that men be aware of this. The incidence however is very low.
What blood tests should be done before surgery?
A "CBC," or complete blood count, is required of all our surgical patients. For GRS patients, a "PT/PTT" may possibly be requested if you have been using any type of aspirin-containing medications or certain types of vitamins/supplements. This test measures your "clotting mechanism". Herbal remedies such as St. John's Wort, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding and must be informed to your doctor if you have been taking them for some time. For Obese patients and for smokers a "CXR" chest x-ray and ECG above the age of 40 years are mandatory to have as a base line investigations. For patients coming to us from African countries we also so sickling test to see the red cell morphology and 6 GPD deficiency test .For all surgeries Hepatitis profile and HIV test are mandatory in Dubai by orders from Ministry of Health.
Who should do the testing and evaluation of blood tests?
You can have the testing done at any lab convenient for you. The results should be faxed to your surgeon and
anesthesiologist for evaluation before surgery. If not they will be done on the day of admission depending upon your
hospital of choice for surgery. Since professor Dr. Ashok operates at several hospitals in Dubai you need to indicate
to him your choice.
Does it matter what causes Gynaecomastia?
Yes. Gynaecomastia can be drug induced (i.e. steroids, excessive marijuana or alcohol use). Medications such as Propecia (prescribed for hair loss) can also cause Gynaecomastia. Herbal medications if in use since long must be informed to the doctor and should be discontinued 6 weeks before surgery. It is highly advisable to discontinue the use of these substances prior to surgery.
Will there be any scarring?
If the surgeon removes glandular tissue, he/she will make a small periareolar
incision, a half-circle incision around the lower half of the areola. In most cases the surgeon will also perform
liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses,
there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot
distinguish them from your normal skin.
What is the most common technique for GRS?
The most common technique for GRS is where the surgeon makes a periareolar incision to remove glandular tissue and then performs liposuction of the area for definition. Some surgeons only use liposuction, but in most cases I think this is a mistake unless it is pseudogynaecomastia (all fat content). This is most often due to the technique of liposuction only. This leaves the glandular tissue behind.
I understand that there are several types of liposuction like dry, tumescent and ultrasonic and laser.
Is one better than the other?
The tumescent technique is the standard one used by many for liposuction. Basically, the surgeon enlarges the
area to be suctioned with a large amount of sterile fluid combined with a vasoconstrictive agent such as epinephrine to reduce bleeding. The fat and the fluid are then suctioned out. Dry liposuction is one when no liquid is injected. A lot of blood gets sucked out with fat and is not recommended. However it has better control on final shape of the breast that is going to be. Ultrasonic liposuction uses sound waves to break up fat which is then suctioned out, it takes more time and complication rates are higher especially with the beginner. In my opinion, there is no advantage to this technique and I do prefer tumescent.
I have large pendulous breasts. How do you remove them and how much scarring will there be?
This is a very different and often more complicated problem. The skin has a tremendous ability to contract, especially if a patient is young. Professor Ashok has his own technique to address hanging breast after weight loss and for larger lady like breast hypertrophy .In this technique only priarolar incision is given and no additional scar like a large Inverted T scar used by several plastic surgeons is avoided.
I usually do an aggressive sub-cutaneous mastectomy (breast removal) with liposuction. At the end of the procedure, I usually place drains in the area to allow fluids to drain for a few days following the surgery. Foam padding and a compression garment are also used as part of the post-op care.
My goal for surgery: is to make my patient feel comfortable shirtless or at the very least be comfortable in a light t-shirt. If a patient has noticeable scars after surgery then he will most likely not feel comfortable without a shirt on.
I am 30 pounds overweight. How will this impact my surgery?
Gynaecomastia does not react to either weight loss or gain. The breast is composed of breast glands and fatty tissue.
The change in body weight can affect the fat content of the chest. The breast gland will increase in size due to hormones or other drugs, like steroids.
What do I need to do in preparation for surgery?
It is absolutely necessary to quit smoking starting at least 2 weeks prior and continuing until four weeks after
your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote
excessive bleeding. Herbal remedies such as St. John's Wort, Ginkgo biloba, Fish Oil, Flax Seed Oil and excessive
amounts of Vitamin E can cause excessive bleeding. Bottom line is it is best to avoid all medications/vitamins/supplements such as these for two weeks prior and two weeks after your procedure. In my practice we supply the patient with a comprehensive booklet of pre-operative instructions before the surgery, clearly outlining these recommendations.
What is the recovery time following GRS?
The initial recovery period is the 5 to 7days right after your procedure. If drains are used, they will typically remain in for about three days after which they will be removed at your first post-op appointment. Total recovery time can vary from patient to patient. I advise my patients to wear a compression garment for 6 weeks post-operatively.
Most patients can expect to be fully healed by 3-6 months. At this point most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. Sometimes, it may take as long as a year to completely heal to the point where the scars are no longer visible.
How long will I be in the hospital? Will I have to stay overnight?
This is a same-day outpatient surgical procedure. The actual surgery takes about 2½ to 3 hours. After your surgery, you will be taken into recovery for at least one to one and a half hours to be observed and attended to by a nurse. If you like to stay overnight It's not a bad idea since during hospital stay you have a chance to be pain free and proper antibiotics that can be given into your vein. Once your surgeon feels you are in a stable enough condition, you are released to return home. Within first 24 hours of general anesthesia you are not advised to drive mainly from medico legal point of view. It is necessary to have a family member or close friend escort you home and stay with you for at least the first 24 hours.
How much pain will I be in post-surgery and for how long?
A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin
to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimum discomfort and most never complain of any severe pain, only soreness of the area. We always prescribe pain medication for you to have on hand should you need it for up to 3 days after going home.
Some doctor`s use drains and others do not, what is the difference?
The function of a drain is simple. It allows the fluid underneath the skin to drain into a small bulb/bottle, where it can easily be emptied by the patient. This prevents such fluid from collecting inside the body and needing to be drained by other means. I use drains in most of my cases when gynaecomastia is larger than 300 cc volume as my clinical assessment. Drains help reduce swelling and promote better skin condition following your procedure. When used then they are removed in 3 days` time perhaps with your first postoperative visit.
What kind of stitches do you use externally? How long will they be there?
I use very thin 6-0 self-dissolving sutures that need not be removed since they do not show outside skin. Do I need to avoid exposing my scars to the sun after my procedure? I have heard that it is recommended not to tan for a year, is this true? Early sun exposure to your scar after surgery is not advisable. To avoid scar pigmentation, you should use sunblock on your scars for 3 to 6 months following surgery. I also recommend mineral oil sheeting to be placed directly on the incisions for 6 months after surgery. I find the mineral oil gel sheeting improves the appearance of the scars by flattening them and decreasing the pigment. I also use a combination of mineral oil very specific to improve the appearance of all scars after any cosmetic surgery. Scars take up to one year to reach their unchangeable final appearance and those patients who are concerned with the appearance of the scar should continue treatment as long as the doctor feels its improving.
Do I need to wear a compression vest? What is it for? How long do I have to wear it?
After the gland is excised and liposuction is performed, a large open space exists. The compression garment helps
the tissue come together and close properly. The placement of the drains helps as well. Another function of the garment is to help reduce the initial swelling and contract the skin over the surgical site. It is necessary to wear a compression vest for about four to six weeks following the procedure.
When can I return to work?
Usually patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity then it is easy to return shortly after the procedure. If you do physical labor then it is recommended to wait at least 10 to 14 days or whenever you feel you are ready. Listen to your body! It will tell you when it is ready to return to your normal activities. Are there any post-operative complications that I should be aware of, i.e. painkillers, constipation, excessive swelling, etc.?
Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated
with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication,
this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood
underneath the skin, made noticeable by excessive bruising, swelling and pain, typically of only one side of the
chest. If this happens it is imperative to contact your surgeon immediately.
Man Boob Exercises
If you are trying to lose those unwanted man boobs try upper body exercises like weightlifting to tone. Try boxing
and incorporating upper body exercises into your session. If you are a runner try moving your arms more as you go. And, of course, remember to stay away from the fast food.
What is the cost of Male breast reduction?
The cost of surgery including pre-operative consultation , pre - operative anesthesia work up, surgical fees, anesthetist fees, pre-operative investigations , operation theater fees, room rent , hospital fees , post-operative follow up doctors visit and your visit to clinic after surgery until the wound heals will be $ 5000 to $ 6000 depending upon which hospital surgery is conducted.
The average total cost of GRS is around $5000 to $6,000, broken down as follows:
Surgeon's fee: $3,000 to $4,000
Certified Operating Facility fee: $1,500 to $1,800
Anesthesia fee: $275/hr. (Board Certified Anesthesiologist)
Room rent : $ 400
Miscellaneous costs: Compression vest, lab tests, pathology and prescriptions
Can I avail some kind of discount
Yes there is a method to avail discount. If you go for two surgical procedures one of them will be performed on
30% discount. Similarly if you come with your friend and both of them go for some surgical procedure both of them
are entitled for 20 % discount. If you are a member of Emirates Pilot club or Etihad Airline you can avail
20 % discount
Are there any payments plans like intallments?
Yes there are. One can pay 50 % payment by cash or card and rest as monthly installments (postdated cheques)
How Can I book a date for surgery staying outside Dubai and without consultation?
Yes it's possible provided you have sent detailed information about yourself along with pictures of the given
problem to Prof. Dr. Ashok Govila. And once a package deal has been agreed upon the professional fees that
is 50 % of the package deal is to be sent by money transfer of some kind to book a date for surgery. Money can be transferred directly to the Bank account of Prof. Dr. Ashok Govila, or by western Union Money transfer or using any other exchange facility. If there is enough time between the decision making and date for surgery and which means enough time for the clearance of the cheque then a cheque can be sent by courier service. The details of these methods can be directly communicated on emails (contact) to Professor Ashok.