Gynecomastia

Male Breast Reduction

Gynecomastia, a condition of over-developed or enlarged breasts in men, is common in men of any age. It can be the result of hormonal changes, heredity conditions, disease or the use of certain drugs.

Gynecomastia can cause emotional discomfort and impair your self confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.

Gynecomastia is characterized by:

• Excess localized fat
• Excess glandular tissue development, typically located just beneath the areolae
• A combination of both excess fat and glandular tissue, most common
• Gynecomastia may be present unilaterally (one breast) or bilaterally (both breasts)

Gynecomastia surgery is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

This procedure is a good option for you if:

• You are physically healthy and of relatively normal weight
• You have realistic expectations
• Your breast development has stabilized
• You are bothered by the feeling that your breasts are too large

Adolescents may benefit from surgery, although secondary procedures may be needed in the future should breast development continue.

The success and safety of your gynecomastia procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Plastic surgery to correct gynecomastia is technically called reduction mammaplasty, and reduces breast size, flattening and enhancing the chest contours.

Liposuction

In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used.

This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.

There are various liposuction techniques that may be used; the technique most commonly used is ultrasonic liposuction because of the tougher fat located in a man’s chest. Ultrasonic liposuction involves an additional step in comparison to more traditional liposuction techniques. Prior to suctioning the fat from the chest, a probe is placed in the area that “melts” the fat. This allows the fat to then be removed with a liposuction cannula more effectively and with less trauma to the area.

Excision

Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Most patients have some degress of glandular tissue beneath the areola that will require excision through a small incision placed just beneath the areola where it is nicely hidden.

Excision of skin can also be necessary in men who have extreme cases of gynecomastia where the skin is severely stretched. This is more common in older men whose skin does not retract as readily as a younger man’s skin does. This can result in more extensive scarring as shown below.

The majority of the time, patients require a combination of liposuction and limited excision to treat their gynecomastia.

Surgery to correct gynecomastia is usually performed on an outpatient basis, in our office-based surgical facility using local anesthesia with sedation. The procedure usually takes about 2-3 hours to perform.

After surgery, dressings or bandages will be applied to your incisions and a support garment is used to minimize swelling and support your new chest contour as it heals. You are asked to wear this garment, which is easily hidden under clothes, for 6 weeks.

A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. This drain is usually removed 3-5 days after surgery.

Your chest will be bruised and swollen for about 3 weeks. It may take as long as 3-6 months to appreciate the true final contour of your chest. The final results of breast reduction in men are permanent in many cases.

However, if gynecomastia resulted from the use of certain prescription medications, drugs including steroids or weight gain you must be fully free from these substances and remain at a stable weight in order to maintain your results.

The risks include:

• Unfavorable scarring
• Bleeding (hematoma)
• Blood clots
• Infection
• Poor wound healing
• Changes in nipple or breast sensation may be temporary or permanent
• If liposuction is used, additional risks include uneven contours, rippling or loose skin, irregular pigmentation, excessive fluid loss or fluid accumulation
• Anesthesia risks
• Breast contour and shape irregularities
• Skin discoloration, permanent pigmentation changes, swelling and bruising
• Damage to deeper structures – such as nerves, blood vessels, muscles, and lungs – can occur and may be temporary or permanent
• Allergies to tape, suture materials, glues, blood products, topical preparations or injected agents
• Breast asymmetry
• Fatty tissue found deep in the skin might die (fat necrosis)
• Fluid accumulation
• Deep vein thrombosis, cardiac and pulmonary complications
• Pain, which may persist
• Possibility of revisional surgery

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. Another surgery may be necessary:

• To perform additional tightening or repositioning of the breasts
• To treat any complications that may occur

Following our instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. The patient is asked to refrain from any strenuous activity such as exercise or sexual activity for 2-3 weeks.

All scars are permanent, even though some scars may be concealed in the natural contours of the breast. Your improved upper body will likely enhance your self-image and confidence, whether in a shirt and tie, a t-shirt, or baring your chest at the beach.

When choosing a plastic surgeon for gynecomastia surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.