Gynecomastia

As they move into the new millennium, more and more men are considering plastic surgery as a viable way to improve their appearance. Living longer and healthier lives, they now want to look as good as they feel. In 1999, close to 11,000 males underwent surgery in America for gynecomastia, which is the medical term for benign enlargement of the male breast tissue. In practical terms, this means abnormally large breasts on men. Rarely talked about, this condition can cause embarrassment and emotional trauma in boys and men alike who suffer from it. Some estimates reveal 30 to 40 percent of men are affected by this condition. For those males embarrassed or feeling self-conscious about their appearance due to this condition can consult the Dallas office of male breast reduction surgeon Paul Pin.

Featured Cases

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Frontal View - Male Breast Reduction

Male Breast Reduction

This muscular 22-year-old male disliked the mass of tissue beneath his nipple and areola. He was very self-conscious about removing his shirt in public.

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Frontal View - Male Breast Reduction

Male Breast Reduction

This 17 year old was an avid golfer and was self-conscious about wearing tight shirts because his right breast protruded so much.

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Frontal View - Gynecomastia

Male Breast Reduction

This was an 18 year old college athlete with long standing gynecomastia who was tired of being teased in the locker room.

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Who is a Candidate for Male Breast Reduction Surgery?

The best candidates are healthy, emotionally stable men of any age. When the condition is present in teenagers, it is usually advisable to observe the condition for at least a year as it commonly resolves spontaneously.

The well-motivated patient is usually socially inhibited by his breast enlargement and avoids situations where it is most evident. This includes wearing a bathing suit or tight-fitting shirts. Ideally, the patient will have elastic skin that will reshape to the body's new contour.

Obese men are not good candidates and should attempt diet and exercise. Marijuana and anabolic steroid usage must cease completely prior to the surgery.

Gynecomastia Treatment Cosmetic Consultation

Treatment of gynecomastia begins with a visit to a board certified plastic surgeon. After a discussion about how the breast enlargement affects you, the doctor will try to identify potential causes, which can include prescription drugs, marijuana, anabolic steroids and, in rare cases, tumors. In the majority of cases, there is no identifiable cause.

A physical exam will then allow the plastic surgeon to determine what type of surgical procedure is most appropriate for you. The consultation is usually concluded with a discussion of options, expected outcomes, and risks.

Preparing for Male Breast Reduction Surgery

Gynecomastia surgery requires that the patient be in good health. A complete checkup with your doctor is recommended before surgery. When enlargement is significant, a mammogram may be advisable to identify possible tumors.

Generally, patients should stop smoking completely for two weeks prior to surgery, as smoking can interfere with healing.

The Breast Reduction Procedure

 

Surgery for gynecomastia is usually performed as an outpatient, rarely is an overnight stay necessary. Anesthesia for the procedure is normally general, though in mild cases, local anesthesia with sedation may be sufficient

 The surgical technique used is determined by the type of gynecomastia present and the amount of excess skin. Generally, when the gynecomastia is fatty tissue, it can be removed with liposuction.  When the tissue is  glandular breast tissue, it cannot be suctioned and must be excised.  Most gynecomastia surgeries are a combination of the two.  When the excess skin is minimal, scarring is limited as the residual skin will shrink after surgery.  When skin must be removed, excisional treatment is necessary. This means there will be additional scarring, especially when the nipple needs to be moved up on the chest. 

 

SUCTION-ASSISTED LIPECTOMY

 

Liposuction for gynecomastia is similar to other liposuction in that it removes fat. When gynecomastia is due to fatty tissue, this is the perfect procedure.  Through several small incisions placed inconspicuously, (tumescent) fluid is injected to facilitate tissue removal. A thin metal rod (cannula) attached to a vacuum is then inserted to accomplish tissue removal and sculpting of the new breast. When the breast tissue is very dense, an ultrasonic cannula may be needed to effectively remove breast tissue.

GLANDULAR RESECTION

When gynecomastia is due to the development of true breast tissue, it is too dense to be removed by liposuction and must be directly excised. In some cases, this tissue can be removed with an arthroscopy knife, which has the advantage of no incision on the breast. Most commonly, this is done through an incision at the bottom of the areola, at the junction of the pigmented skin and normal skin.  This incision usually results in an inconspicuous scar. 

SUCTION-ASSISTED LIPECTOMY AND GLANDULAR RESECTION

 

Most commonly, gynecomastia consists of a breast with both fatty tissue and glandular tissue. As a result, the surgery consists of liposuction to remove the fatty tissue and direct excision to remove the glandular tissue behind the areola. 

 

GLANDULAR RESECTION WITH SKIN EXCISION

 

When excess skin is present, the glandular tissue is removed and excess skin is removed in the fold beneath the breast.  This looks good as long as the nipple is not too low.  If the nipple is too low, then more complicated surgery is needed.

 

GLANDULAR RESECTION WITH SKIN EXCISION AND NIPPLE TRANSPOSITION

 

This is the most complicated situation where tissue and skin are removed and the nipple is moved up on the  chest, above the fold.  Moving the nipple/areola up on the chest is different in men than in women; the nipple should be much lower in a man. Additionally, when a nipple is moved in a woman, tissue is preserved so the central part of the breast projects outward.  Obviously, in a man this would be terrible, so movement of the nipple has occur while keeping the chest flat.  There are two ways to move the nipple:

 

Free Nipple Grafting

In this procedure, the nipple is completely removed and replaced as a free skin  graft.  The downside of this procedure is that if the graft fails to take, significant  further surgery can be necessary.

 

Pedicled Nipple Transposition

In this case the nipple stays attached to a very thin segment of dermis and is  tunneled under the breast to be brought out in a more desirable position.  This  technique avoids the unpredictability of grafting and still permits the chest  contour to be flat.

Gynecomastia Treatment Recovery

Depending on the extent of surgery, pain can vary from minimal to moderate, and will last from several days to two weeks. Usually, patients are swollen and bruised after the surgery and the breast will have diminished sensation. This will resolve within a few weeks.

To speed recovery and to enhance proper contour, a compression garment is usually worn for several weeks after the surgery. Normally, this would not be noticed under one's clothing.

Walking can be resumed in a few days, and exercise is usually safe within two to three weeks.

Male Breast Reduction Surgery Risks

Male breast reduction is not a simple procedure, but in the hands of an experienced, board certified plastic surgeon it is normally safe. As with any surgery, there can be complications such as: a negative reaction to anesthesia; bleeding and infection following the operation; changes in nipple or breast sensation; and, scarring. Like all body contouring surgery, it is possible that either too much or too little tissue can be removed. In these cases, revisional surgery may be necessary.

Male Breast Reduction Surgery Cost

The total cost of male breast reduction surgery ranges from $3,500 to $8,000 depending on the extent of the surgery required and the region of the country. Most commonly, this is a cosmetic procedure and all of the costs are borne by the patient.

After Surgery - What Results Can you Expect?

This procedure can enhance your appearance and boost your self-confidence. If you have been feeling uncomfortable with the appearance of your breasts and found that diet and exercise did not reduce their size, and you have realistic expectations about the changes surgery can bring, then you will most likely be happy with your new look. The results of the procedure are significant and permanent. Most males undergoing surgery for gynecomastia have been very satisfied with the results.

Dallas Male Breast Reduction Consults

Contact our Dallas office to schedule your male breast reduction consultation.

Surgery for gynecomastia is real surgery and involves risks such as bleeding, infection, and scarring. Results vary. Dr. Pin will be happy to discuss these and other risks of surgery for gynecomastia.