Q: What is gynecomastia?
A: Gynecomastia is a condition in males where there is enlargement of male breasts in varying degrees leading to loss of self esteem for which patients seek “gyno removal”.

Q: What is the incidence of gynecomastia in males?
A: Do not be depressed, this is an extremely common condition in males! Although the incidence varies among populations it is estimated that 3-6 boys out of 10 may harbor gynecomastia although all might not be large.

Q: When should gynecomastia be operated?
A: In patients having smaller degrees of gynecomastia, observation can be recommended till 18 years of age as many of these can resolve by themselves. Surgery after 18 years of age also has shown to have very little incidence of recurrence if done perfectly. However, in adolescents in whom there is advanced degree of gynecomastia, the surgery can be done in earlier years as it typically creates a social problem for individuals.

Q: What is the treatment for gynecomastia?
A: “Gynecomastia removal” can only be done by surgery. Medicines have not been shown to have any effect on gynecomastia.

Q: What is pseudogynecomastia?
A: In obese individuals, with accumulation of body fat, fat also tends to accumulate in the chest. This condition is known as pseudogynecomastia where it resembles a gynecomastia but there is only fat, no glandular element.

Q: What are the components of male breasts?
A: Male breasts can comprise of a mixture of gland and fat like females although the proportions vary. In some patients, the swellings can be seen to be comprised exclusively of glandular tissue.

Q: My gynecomastia is hard, am I having breast cancer?
A: No! The consistency of gynecomastia varies. In some patients, the swellings can be soft while in others with exclusively glandular component, the swellings can be quite hard. This can be different from breast cancer.

Q: How do I distinguish breast cancer from gynecomastia?
A: Breast cancer in males is quite rare and usually affects one side. The growth can be quite rapid and the swelling is not uniform. If you have breast swellings it is best to check with a surgeon.

Q: Is there a risk of breast cancer if I leave my gynecomastia alone?
A: No. Surgery is done only for cosmetic reasons.

Q: If I go in for gynecomastia operation in Kolkata will I have increased chances of breast cancer in future?
A: No. Surgery for gynecomastia does not increase chances of breast cancer.

Q: What are the components of gynecomastia operation?
A: Liposuction can be done to address the fatty component in gynecomastia followed by open surgical removal of the underlying glandular component known as subcutaneous mastectomy.

Q: What is the type of anesthesia administered?
A: Unless the gynecomastia is very large, most of the cases can be performed under local anesthesia as typically performed by Prof. (Dr.) Adhikari. He is a pioneer in this technique. In patients having advanced grades of gynecomastia general anesthesia may be required.

Q: Will it hurt if the surgery is done under local anesthesia?
A: You will feel the sting of injections which is quite mild but the surgical procedure is nearly painless.

Q: My skin over the chest is very loose. What can be done?
A: In many patients, the skin redundancy can be huge. In these cases, a different technique is employed by Prof. Adhikari whereby removal of skin is performed along with the above surgical procedures to address the same. Please note, a revision surgery may be required after 6 months to address any residual skin laxity.

Q: Will I be requiring any other surgical procedures in future?
A: Most cases do not require any further surgery. However, in a few cases, laxity of skin may need to be addressed 6 months after surgery.

Q: When will I expect to get final results?
A: 6 months after surgery although you will get an idea within 7 days of surgery when much of the swelling has subsided.

Q: What is my grade of gynecomastia?
A: Pictures may not be sufficient to classify the grade, you would need to meet your surgeon for this.

Q: Do I need any investigations prior to surgery?
A: Yes, blood tests are required prior to gynecomastia operation if the surgery is done under local anesthesia. General anesthesia entails additional tests in the form of chest X-ray and ECG.

Q: Any other preoperative preparations I need to follow?
A: You may be asked to clean your chest on the day of surgery. If the surgery is being considered under local anesthesia then you may have a light meal on the day of surgery.

Q: What do I expect in the surgery?
A: Pictures would be taken first, followed by markings. Next follows anesthesia of the chest and then surgery.

Q: What are the postoperative instructions?
A: Immediately after surgery the area would be dressed and a pressure garment applied. You would be asked to take antibiotics and pain killers after surgery. You can start working from the next day (light job).

Q: Can there be bleeding after surgery?
A: Since drains are there in place you may expect soakage of dressings with blood stained fluid. This is normal and of no concern. If you have excessive bleeding (which is rare), contact your surgeon.

Q: When do drains come off?
A: 3-5 days or as determined by your surgeon.

Q: When are stitches removed?
A: 8-10 days or as determined by your surgeon.

Q: What happens if there is a collection of blood in my chest after surgery?
A: In very rare cases there can be accumulation of blood in your chest after surgery, In these cases, 1-2 stitches are removed in the nipple area and the blood evacuated and the cavity washed.

Q: I have a hard lump behind my nipples after gynecomastia surgery?
A: This is very common and does NOT imply that any glands were left behind. This usually happens because of clot formation. Just keep massaging on a daily basis and this will resolve by itself.

Q: How long do I need to wear the pressure garment? Do I need to wear it 24 hours?
A: Yes, in the initial postoperative phase you would need to wear the pressure garment 24 hours. The duration of pressure garment use varies between patients, your surgeon will guide you regarding this.

Q: When can I start exercises after surgery?
A: Usually 3-4 weeks after surgery.

Q: I am a smoker. Do I need to stop smoking?
A: Yes, smokers are advised to stop smoking 3 weeks prior to surgery and 3 weeks thereafter to reduce any risks associated with smoking. Same applies to alcohol consumption.

Q: Why are drains given?
A: After removal of the glands, there is a large cavity in the chest. Blood and fluids may collect in the cavity and may delay healing. Drains are put in so that any collected blood and fluids are promptly evacuated outside to aid in healing.

Q: Is gynecomastia surgery covered under medical insurance?
A: You would need to contact your insurance provider regarding this.

Q: How long do I have to stay after surgery?
A: If you are operated under local anesthesia then you will be discharged after surgery. General anesthesia usually entails a stay of 1 day.

Q: Where is the surgery performed?
A: The surgery can be performed in a nursing home (cheaper) or in a hospital (more expensive) setting as per your choice.

Q: Do I need anyone to accompany me at the time of surgery?
A: Yes, someone should accompany you at the time of surgery in case any emergency situation arises.

Q: Can I board a train or flight after the surgery?
A: Yes, you usually can if the surgery is done under local anesthesia, your surgeon would guide you regarding this.

Q: Are there any complications after surgery?
A: Your surgeon will provide you with a consent form which will highlight all possibilities. Usually, the surgery is extremely safe with minimal incidence of complications.

Q: Will I have a scar after surgery?
A: Yes, you will have scars over the areolar area and drain sites. The scars tend to lighten over months. In extremely rare cases hypertrophic scars and keloids may occur.

Q: I’m afraid of getting a depression in my chest after surgery?
A: A small amount of breast tissue is kept behind the nipple to prevent it from sinking. However, this will not grow back!

Q: My gynecomastia was operated but it seems it was not completely removed. Can a revision surgery be done now?
A: Yes, it can be done although a revision surgery may be difficult.

Q: Can I have a recurrence of gynecomastia?
A: No! If the glands are completely removed, then no recurrence is possible as glands can never grow back. However, if you continue to gain weight, then you may accumulate fat again the chest region which would be akin to pseudogynecomastia.

Q: Can you do a minimal incision technique in my case?
A: Depends! It is usually done in select cases with smaller swellings.

Q: What is the cost of Gynecomastia Surgery in Kolkata?
A: The cost of Gynecomastia Surgery in Kolkata under Prof. (Dr.) Souvik Adhikari is less compared to most clinics in the city because the procedure is performed entirely under local anesthesia by him which offsets the higher cost of general anesthesia. In addition, special discounts are available in select patients, please contact with him directly.

Q: What is liposuction?
A: Liposuction is a procedure where resistant fat in the body can be made soft by injecting a special solution and then taking it out using special cannulae.

Q: What is meant by “resistant fat”?
A: If an individual resorts to moderate dieting and exercise then abnormal fat deposits will start going away. However, there are certain areas of fat deposits which are extremely resistant to this combined regimen. These areas of stubborn fat can be addressed by the procedure of liposuction.

Q: Can I get liposuction for weight loss?
A: Ideally, NO! Liposuction is primarily a body contouring surgery where areas of resistant fat are targeted. This is not advocated for weight loss. Performing liposuction primarily for the purpose of losing weight is considered as a misuse of liposuction and can lead to adverse effects.

Q: Who is the perfect candidate for liposuction?
A: An individual who is overweight but not obese, who is motivated to lose weight, who is disciplined enough to continue with proper dietary management and who can perform basic exercises on a daily basis and who is primarily looking for body contouring is a very good candidate for liposuction.

Q: How much fat can be taken out by liposuction?
A: In order to ensure that the process is safe, it is recommended that not more than 5 liters of aspirate should be targeted in one single session of liposuction. Higher volume liposuction entails risks to the patient, some of which can be quite serious.

Q: What are the side effects of liposuction?
A: Complications of the procedure include anesthetic and metabolic problems, contour irregularities from over and under-resection of fat, fat embolism, bleeding, which might be concealed and require blood transfusion, toxicity from local anesthetics, death and others. Many of these problems are associated with high volume liposuction, therefore, it is recommended to stay within limits.

Q: Can I go back home the same day?
A: For small volume liposuction where the procedure is performed by infiltration anesthesia only, patients can go back home the same day. However, especially in more than 2 liters of liposuction where the procedure is usually performed under general anesthesia, it is recommended that patients go back home on the next day.

Q: Is this a permanent procedure?
A: The loss of fat cells by liposuction is permanent. However, patients still need to follow a comprehensive dietary and exercise regimen as new fat cells can always grow back.

Q: Which areas can be targeted by liposuction?
A: Abdomen/ tummy, arms, chin, neck, chest, breasts, back, thighs, calves, mons pubis are usually targeted in liposuction.

Q: What about scarring?
A: Since only small ports are made during the procedure, scarring is minimal. Port sites would be made in discussion with you so that scarring is least and positioned in hidden areas.

Q: When will I see the effects of liposuction?
A: Liposuction causes continued fat loss from the targeted areas for quite a few months after the surgery. Therefore, the effects of liposuction can be properly assessed at least 6 months after the initial procedure.

Q: What is the cost of liposuction in Kolkata?
A: The cost of liposuction varies according to the areas targeted and the type of anesthesia. You can meet Prof. (Dr.) Souvik Adhikari for a check-up to find out if you are a good candidate for liposuction and the approximate cost of the procedure. He will provide you with one of the best rates in the city.

Q: Why does penis length vary among individuals?

A: The length and girth of the penis are genetically determined. Therefore, the size of the penis varies according to the races with Africans having the largest and Asians the smallest. There is a spectrum in the length of the penis and therefore one should not consider his own penis to be small based on compariso

Q: How do I know if my penis length is small?

A: As mentioned above, the penis length varies enormously among population groups. Therefore, the penis length in a particular population group is mentioned as an average. The normal range of penis length in a population can be considered as lengths which fall approximately 2 standard deviations from the average penis length. Smaller than 2 SD would be considered as a smal

Q: How can penis length be increased?

A: If the anatomy of the penis is reviewed then it would be seen that a considerable portion of the penis is hidden under the abdominal fat pad and the bone. The penis is suspended from the overlying bone via a ligament known as the suspensory ligament of the penis. If this ligament is cut then the hidden portion of the penis would come out thereby increasing the apparent length of the penis. However, it needs to be noted that there is NO real gain in the erect penis length by this surgery.

Q: How can permanent penis length gain be achieved?

A: Following ligament surgery of the penis, if a penis stretcher is used for a couple of hours per day, then it has been shown that permanent length gain of the penis can occur over a period of 1-2 years. However, it needs mention that one needs to use the stretcher on a daily basis without fail in order to gain length permanently.

Q: Can penis stretcher use work on its own in increasing penis length?

A: As a considerable part of the penis is hidden under the bone fixed to it by the ligament, patients would get limited result if the penis stretcher is used only without surgery. However, patients can still use the same to see if they are getting benefit from it.

Q: What are the types of penis stretchers?

A: Basically, there are 2 types of penis stretchers: spring based and weight based. As the penis accustoms to the effect of weight or tension of the spring the weight or spring tension needs to be increased intermittently so as to stimulate length increase.

Q: When should penis stretcher be used after ligament surgery?

A: As early as possible! Erections and penis stretcher use should be started as early after surgery as possible so that the cut ligament does not get the opportunity to attach back to its original site.

Q: I feel that my penis is small. What should I do?

A: Do not be motivated by pornographic images of humongous penises. Most of the times the images are manipulated. If you have a doubt regarding your penis length, consult a doctor. Do not come to a decision by yourself.

Q: What are the major risks associated with ligament surgery?

A: Apart from the standard risks associated with any surgery, there can be major risks associated with penis length increase surgery. The nerves and blood vessels run very close to the ligament and can be injured if the ligament is cut in inexperienced hands. Although there are supplementary blood supplies to the penis, in case the arteries of both sides are injured then the front of the penis or the glans might undergo necrosis. Damage to the nerves may result in loss of sensation to the glans and thereby affect erection.

Q: Can the cut ligament attach back? How can it be prevented?

A: Yes, the ligament always has a tendency to attach back to its previous location. In fact, it can attach at a higher position thereby decreasing the length of the penis from its preoperative state. The surgeon may use a fat flap taken from adjacent spermatic cord and fill in the defect created by cutting the ligament or put in a silicone block to prevent this. However, if patients resort to erections immediately after surgery and penis stretcher use then also the ligament can be prevented from reattaching back.

Q: What is the type of anesthesia used in ligament surgery?

A: Ligament surgery can be safely done using local anesthesia. In patients who are apprehensive, spinal or general anesthesia can be used but most patients are operated under local anesthesia. This helps them achieve erections quickly in the postoperative period.

Q: What type of incision is used for penis length increase surgery?

A: Previously, many surgeons performed V-Y advancement flaps at the root of the penis to create an apparent increase in penis length. However, these flaps created a lot of problems and also lack proper blood supply. Therefore, ligament surgery can be safely performed using a single transverse incision over the lower abdomen.

Q: How long should a penis stretcher be used after ligament surgery?

A: For permanent length gain, the penis stretcher should be used for a couple of hours per day on a daily basis for at least 1-2 years after surgery. If you cannot comply with this, please understand that you may not gain any length increase in your penis size after ligament surgery.

Q: When should erections be started after ligament surgery?

A: As early as possible after surgery! Performing early erections might be a bit painful but at the same time ensures that the ligament does not get attached back to its normal position.

Q: Would I be able to see any length gain in my penis immediately after surgery?

A: Yes, following ligament surgery there would be an increase in FLACCID length of the penis but the erectile length would not increase. Permanent increase in erectile length can only be achieved with regular penis stretcher use after surgery.

Q: How much length gain can I expect after penis length increase surgery?

A: As mentioned, there would be an immediate increase in flaccid length of the penis which might range from 1-2 inches. Erect length increase is seen only with penis stretcher use following surgery. If penis stretcher is used daily for a period of 1-2 years then one can expect an erect length increase of 1-2 inches or even more at the end of stretcher use.

Q: What are the procedures used for increasing girth of the penis as I feel that my penis is too thin?

A: There are a couple of procedures employed for increasing girth of the penis. The simplest one is injection of fat into the penis. Other procedures employed are dermofat grafting and use of flaps, typically the SEPA flap or the SCIP flap.

Q: Please let me know about fat injections to the penis.

A: Fat injections to the penis are the simplest form of girth augmentation surgery. In this, liposuction is done from one area and the fat is processed and then injected into the penis. However, much of the fat may be absorbed by the body so these injections might need to be repeated. Also, injections of fat usually leads to a spongy texture of the penis which might not be acceptable to many patients. Despite this, it is a procedure of increasing penile girth which has the least number of complications.

Q: What is dermofat grafting to the penis?

A: In dermofat grafting, an area of the body is selected (usually the lower abdomen, groin, buttocks) from where skin and the underlying fat are taken. The outer layer of the skin is peeled off which is the epidermis. The underlying layer or the dermis coupled with the fat beneath is known as dermofat. This combined structure is then inserted into the penis to augment girth.

Q: How is dermofat grafting done?

A: Dermofat grafting can be done under local anesthesia or under spinal anesthesia. If you are getting it done under spinal anesthesia then you would need to spend the night in the hospital.

Q: What is SEPA Flap augmentation?

A: In SEPA flap augmentation of the penis, the flap is outlined in the lower abdomen and the same process employed as in dermofat grafting. The main difference with dermofat grafting is that in SEPA flap the blood supply to the tissues is preserved so that the chances of thinning of the flap in the long run is much less compared to a dermofat graft.

Q: How is SEPA Flap augmentation done?

A: Both under local and spinal anesthesia.

Q: What are the complications of dermofat grafting and SEPA Flap?

A: Complications are FREQUENT in girth augmentation procedures, therefore, if you cannot accept the risk of complications, do not go in for this form of surgery. Complications include (but are not restricted to) necrosis and skin loss of the penis, obliteration of the urethral meatus from foreskin swelling after surgery which might lead to urinary leak from somewhere else, long-standing ulcers, seroma formation and abscess formation, theoretical risk of injury to nerves of the penis, decrease in augmented size over time and so on. Some amount of the fat component in the flap may undergo denaturation which might lead to persistent exudation of oil like fluid.

Q: What happens if there is penile skin loss after girth augmentation?

A: Usually, the area of skin loss is small and should heal with regular dressings. In rare cases, a skin graft might be required.

Q: How is the foreskin swelling managed?

A: If a concomitant circumcision is performed along with girth augmentation, then the issue of foreskin swelling does not arise. If you do not agree to circumcision then please note that you might have to wear a catheter for a couple of days after girth augmentation surgery to ensure that urine passes through its normal tract. The catheter would be removed after a few days when the foreskin swelling subsides. You may have to visit your doctor in case the foreskin swelling does not subside. Alternatively, a small cut may be made in the foreskin of your penis to accommodate for the swelling and this cut may be repaired later on to reconstruct the foreskin.

 Q: What happens if I get an abscess or a seroma after girth augmentation?                                      

A: These would need drainage and intake of antibiotics.

Q: Can penis length and girth increase surgery be done at the same time?

A: No, these 2 surgeries should not be combined together. It will be difficult to use a penis stretcher if both of these are done at the same time and the results would therefore not go along expected lines. Any surgery can be done first, usually the ligament surgery followed by penis stretcher use and finally a girth increase surgery.

Q: Can a patient perform sex while using penis stretcher?

A: Yes, there are no issues with sex.

Q: What is a SCIP flap for penile augmentation?

A: A SCIP flap is different from a SEPA flap by its orientation. While a SEPA flap leads to a vertical scar below the umbilicus, a SCIP flap leads to a scar in the groin which can thereby be concealed by underwear, therefore many patients would choose this flap to hide the scar.

Q: How long after penis girth augmentation can I have sex?

A: Usually a period of 3-4 weeks is given for the flap to settle down and the swelling to subside, following which sex may be initiated.

Q: What is the cost of Penis Length Surgery in Kolkata?

A: Compared to other clinics, the cost of penis length surgery is kept at a minimal so that most patients can avail of this surgery, please contact with Prof. Adhikari regarding the cost in your case.

Q: What is the cost of Penis Girth Increase Surgery in Kolkata?

A: Penis girth increase surgery cost is quite reasonable and depends on the technique incorporated, please contact Prof. Adhikari for an examination first and then an estimate.

Q: What is breast reduction?

A: Breast reduction is a procedure where the size of the breasts is reduced by a surgical procedure in patients who have large sized breasts.

Q: Who should undergo breast reduction surgery?

A: Breast reduction surgery is advocated for patients who are troubled by the excessive weight of their breasts. Symptoms which warrant surgery include too heavy breasts resulting in injury to shoulder area from bra straps, neck pain, alteration in posture and recurrent infections in the undersurface of the breasts and so on.

Q: What is breast amputation?

A: Breast amputation is another type of breast reduction performed in huge breasts also known as gigantomastia. This procedure results in drastic size reduction of the breasts and the nipple-areolar complex is taken out and applied as a free graft. Therefore, patients undergoing this procedure will have no nipple sensation (some protective sensation may develop in the long run) and will lose the ability to breast feed. Portions of the free nipple graft may also be lost.

Q: Is there any other way of reducing the size of the breasts?

A: In moderately oversized breasts, liposuction may be employed for limited size reduction of the breasts though this is much less effective as compared to surgery.

Q: How are the scars positioned in the breast during breast reduction?

A: There are a variety of techniques for breast reduction. In small reductions, a circumareolar scar technique can be done where the final scar sits around the areola only. In moderate sized reductions, a vertical scar technique is often employed where, apart from the scar around the areola, a vertical straight-line scar forms. In huge reductions, in addition to the above scars, there might be a horizontal scar in the undersurface of the breasts (Wise pattern).

Q: Would I be able to breast feed after the procedure?

A: Adequate breast tissue is kept in the pedicle for breastfeeding although this might not be possible in all cases.

Q: Is there any other advantage of breast reduction surgery?

A: Yes, in addition to reduction in size of the breasts, the nipple areola complex is lifted up and secured to its normal position which is an advantage to patients having breast ptosis or excessive drooping of the breasts because of the large size.

Q: Would I be able to wear a bra after the procedure?

A: For the first few weeks after the procedure a sports bra would be helpful for supporting the breasts. Later on, normal bra can be used.

Q: Will nipple sensation be altered following breast reduction surgery?

A: Usually not, although, in large reductions and in breast amputations it might be altered.

Q: Will I be requiring further surgery in future?

A: Sometimes, because of hormonal issues, the increase in size of the breasts may happen even years after a breast reduction. In those cases, secondary breast reduction may be contemplated.

Q: What is the cost of Breast Reduction Surgery in Kolkata?

A: Depending on the extent of reduction required, the cost of Breast Reduction Surgery in Kolkata varies from patient to patient but is kept affordable so that patients in need of this surgery can avail this.

Q: Am I a candidate for breast augmentation?

A: You are a proper candidate for breast augmentation if you are more than 18 years old, your breasts have fully developed, your physical health is excellent, you are not pregnant or breastfeeding, you are realistic regarding the outcome of breast augmentation and if you are willing to accept the risks of surgery.

Q: Why would I require breast augmentation?

A: You may require breast augmentation if you are dissatisfied with your breasts even after complete development because they may be small in size, asymmetrical, underdeveloped or poorly shaped as in tubular breast deformity.

Q: Can I opt for silicone implants?

A: Yes, but silicone implants are usually advocated in candidates more than 22 years old.

Q: I am 18 years old, what are my options?

A: You can opt for repeated fat injections to the breasts or saline implants.

Q: What are the complications of silicone implants?

A: The complications associated with silicone implants may be infection leading to their removal, capsular contracture, displacement, silicone leak, rupture and so on. Please contact your surgeon for a detailed list of possible complications.

Q: Can I opt for fat transfer to my breasts?

A: Yes, autologous fat grafting is a good way to increase your breast size, however, it must be kept in mind that around 70-80% of the injected fat will be absorbed in the long run, therefore, you would need to undergo repeated injections at intervals to get the final desired size and shape of your breasts. Touch ups will always be needed because the absorption of fat may not be equal in all areas.

Q: Do I require any special tests prior to surgery?

A: Apart from the routine investigations, you would be advised either a mammogram or a breast ultrasound which is important for documentation of baseline breast characteristics because changes will occur especially after fat transfer.

Q: Is there any possibility of breast cancer following breast augmentation surgery?

A: There is a very small risk of BIA-ALCL, a form of cancer when textured implants are used for breast augmentation. Prof. Adhikari performs augmentation with smooth implants which do not have the risk associated with textured implants. If a mammogram is done few months after a fat injection to breasts, then the picture might show macrocalcifications and microcalcifications but these are different from microcalcifications seen with breast cancer. Therefore, fat transfer may lead to false positive results on mammogram.

Q: I have saggy breasts, am I a candidate for breast augmentation?

A: Saggy breasts are managed by a procedure known as breast lift, however, if the volume of breasts is small, then additional implants may be added to make the appearance of breasts more beautiful.

Q: How long does breast augmentation surgery take?

A: Between 1-2 hours if implants are used and more if fat transfer is done as liposuction and fat processing takes additional time. Surgical time is increased if additional procedures like a breast lift is contemplated.

Q: Would I be able to breastfeed following a breast augmentation?

A: Yes, there should be no problems with breastfeeding if an incision is used below the breasts.

Q: What is the cost of Breast Augmentation Surgery in Kolkata?

A: The cost of Breast Augmentation Surgery in Kolkata varies according to the type of implants used or whether fat injections are used and whether any associated procedure like mastopexy is combined along with augmentation, kindly contact Prof. Adhikari regarding an estimate.