A man in his early 30’s who was bothered by a feminine appearance of his breasts in fitted shirts and with his shirt off. His breast development started after he graduated from college. He does not have a history of anabolic steroid or marijuana use. Because of the unusual presentation ( most cases of idiopathic gynecomastia present at puberty) he had a full workup and testicular exam by an endocrinologist which was negative.
He is show before and again, 7 weeks after bilateral chest liposuction using power assisted liposuction combined with external ultrasound assist and direct excision of breast tissue through a peri-areolar incision. Fluid is first placed under the skin, then ultrasound is applied externally to soften the tissues. Fat is then broken up mechanically with a finned liposuction cannula, and then liposuction is performed. The firm breast tissue is exised through a “half moon” incision at the lower border of the areola and then the fat is equalized and smoothed with the finned cannula again.
He is left handed, and his left pectoralis chest muscles are larger. But he has an excellent early contour after his surgery. Swelling typically will continue to diminish for 6 months and scars continue to improve for up to 2 years. The small lateral incisions that are used for cross tunneling are placed behind the lateral border of the pectoralis muscle to camouflage them better. His areola diameter has decreased after removal of the breast tissue.