You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit, which takes at least an hour, your final questions will be answered and you will confirm that you understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Preoperative photos will be taken. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogramat your doctor’s office or any state licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

It will be necessary to scrub the chest for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery.

Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Laguna Hills Surgery Center, prior to your procedure. You must make arrangements to have someone drive you to and from the Surgery Center and stay with you at home for the first two or three days afterwards.

The operation will be performed in an outpatient facility under deep sedation or a light general anesthetic to supplement the local anesthetics injected by your surgeon.

A small incision may be made beneath the areola (the dark skin surrounding the nipples). Occasionally, if liposuction alone will be utilized to remove the excess tissue, more distant incisions will be made in the fold by the arm pit or under the breast tissue. Excess fat and glandular tissue can be removed, depending on the firmness of the tissue, either with direct surgical excision or with liposuction.

Adequate pain medication will also be prescribed.

Wounds are generally closed with buried sutures. The incisions are covered with surgical glue and a dry dressings, which are to stay in place for the first few days. This glue will generally peel off as you shower over the first few weeks. Thereafter, use of a scar cream such as ScarGuard® will enhance healing.

Your first post-operative visit will generally be scheduled four to five days after surgery at which time the wound will be examined and dressing changed if needed.

Serious complications after treatment for gynecomastia are relatively uncommon. There will be small incisions which have to heal. The scars may remain itchy, painful, thick, or otherwise unsightly, but this is very rare. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for some time.

Every patient undergoing tissue removal for gynecomastia will experience some degree of surface irregularities or visible indented folds, due to the skin healing down to the underlying muscle after breast tissue removal! One of the possible problems after surgical treatment for gynecomastia is a persistent collection of serous fluid or blood under your skin. Should this occur, this fluid will be aspirated by your surgeon with a needle during your post-operative visits. Such drainage always stops eventually (but may persist for more than a month) and usually does not affect the final results.

It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.

This procedure is rarely covered by insurance; the office staff will help you determine if your insurance can be helpful. They can also assist you with financing if desired.

In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in his motivation and can afford the surgery, thus creating a better patient/ physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but never later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.

WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!

Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.

I, ______________________________________________certify that I have read and understand the “Gynecomastia” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Witness _______________________________ Date __________________

I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.

Surgeon’s Signature_____________________ Date_________________

Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________

Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.