Gynecomastia – Male Breast Reduction

Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity 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, glandular tissue and sometimes excess breast skin.

QUICK FACTS

IDEAL CANDIDATE

excess male breast fat, male breast gland, or both

GYNECOMASTIA INCISIONS

Tiny pectoral crease incision (mild gynecomastia),
Beneath areola (moderate gynecomastia), or around areola (more
pronounced gynecomastia)

GYNECOMASTIA TECHNIQUES

Liposuction alone
Liposuction with breast gland removal
Liposuction, gland removal, and skin removal

MALE BREAST REDUCTION STATS

Length: 1.5 to 3 hours
Back to Work: 3 – 5 days
Return to Exercise: 7 days (light cardio), 3 weeks (more strenuous)

Am I a candidate for gynecomastia surgery?

The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen. The best candidates for surgery have firm, elastic skin that will reshape to the body’s new contours. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.

Your personal consultation for gynecomastia surgery

The initial consultation with your surgeon is very important. Your surgeon will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, your surgeon will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you’ll be referred to an appropriate specialist.

Your plastic surgeon may, in extreme cases, also recommend a mammogram, or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast’s composition. Once your surgeon knows how much fat and glandular tissue is contained within the breasts, he or she can choose a surgical approach to best suit your needs.

Don’t hesitate to ask your surgeon any questions you may have during the initial consultation- including your concerns about the recommended treat- ment or the costs involved. Treatment of gynecomastia may be covered by medical insurance–but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by your surgeon.

Before surgery

Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating, drinking, and taking certain vitamins and medications. Smokers should plan to stop smoking for a minimum of one or two weeks before surgery and during recovery. Smoking decreases circulation and interferes with proper healing. Therefore, it is essential to follow all your surgeon’s instructions.

The Day of your gynecomastia surgery

Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself usually takes about an hour and a half to complete. However, more extensive procedures may take longer.

Type of Anesthesia
Correction of enlarged male breasts is usually performed under light general, or in some cases, under local anesthesia plus sedation. Your surgeon will discuss which option is recommended for you, and why this is the option of choice.

The Gynecomastia surgery techniques
In most gynecomastia procedures, an incision is made in an inconspicuous location, usually on the edge of the areola. Working through the incision, the surgeon focuses on treating the 3 main components of gynecomastia:

Excess fat, usually with liposuction which is the main treatment for gynecomastia. Special liposuction techniques are used for gynecomastia and frequently the VASER or ultrasound liposution systems are utilized. A small incision, less than a half-inch in length, is made around the edge of the areola–the dark skin that surrounds the nipple. Or, the incision may be placed in the underarm area. A slim hollow tube called a cannula which is attached to a vacuum pump, is then inserted into the incision. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out. Patients may feel a vibration or some friction during the procedure, but generally no pain.
Prominent glandular tissue. If excess glandular tissue is the primary cause of the breast enlargement, it will be excised or cut out.
Any extra skin, if needed which is usually excised from a circular inconspicuous scar around the areola and more rarely from the sides and/or bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.

Rarely, a small drain is inserted through a separate incision to draw off excess fluids. Once closed, the incisions are usually covered with a dressing. The chest may be wrapped to keep the skin firmly in place.

After your gynecomastia surgery

Whether you’ve had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two if needed. You’ll be swollen and bruised for awhile–in fact, you may wonder if there’s been any improvement at all. To help reduce swelling, you’ll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent.

In the meantime, it is important to begin getting back to normal. You’ll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough–which could be as early as a day or two after surgery. Any stitches will generally be removed about 1 to 2 weeks following the procedure.

Your surgeon may advise you to avoid heavy exercise for about three weeks. You’ll be told to stay away from any sport or job that risks a blow to the chest area for at least four weeks. In general, it will take about a month before you’re back to all of your normal activities.

You should also avoid exposing the resulting scars to the sun for at least six months. Sunlight can permanently affect the skin’s pigmentation, causing the scar to turn dark. If sun exposure is unavoidable, use a strong sunblock.

Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self- confidence. There is little downtime, and you may return to work within one week usually, unless you are involved
in strenuous activities. There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months. Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes.

Risks of gynecomastia surgery

When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.

Combined procedures

Gynecomastia correction is most often performed as an isolated procedure. For men who are considering additional plastic surgery, male breast reduction is combined most often with liposuction, particularly liposuction of the abdomen and flanks.

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