What is Gynecomastia?
Gynecomastia, or the development of enlarged breasts in males, can be a major source of self-consciousness in men and teenagers alike. This condition is often caused by a hormonal imbalance, and can affect one or both breasts. Gynecomastia is not a serious condition, and can easily be corrected with gynecomastia surgery, or male breast reduction.
Am I a good candidate for Male Breast Reduction surgery?
Candidates for gynecomastia surgery include males whose excess breast tissue cannot be corrected through alternative treatments, and whose breasts are done growing. It is important that patients are healthy, non-smokers who have realistic expectations of the surgery. Men who consume great amounts of alcohol or marijuana may not be ideal candidates for this procedure, due to these drugs being thought to contribute to gynecomastia.
Gynecomastia – Patient 148
A man in his early 30’s who had gynecomastia surgery 10 years somewhere else before but is still bothered by prominence of his nipple papules in clothing. He works in the travel industry and is lucky to be able to spend a lot of time at the beach and in summer clothes. His left nipple bothers him more than the right nipple. The left nipple papule is 6 mm in diameter and 7 mm high. His right nipple papule is 5 mm in diameter and 5 mm high. After discussions we decided to proceed with bilateral nipple papule reduction utilizing the nipple amputation technique under local anesthesia in the office. He is shown before and again, 6 weeks after correction.
Discussion: He appears that he may still have mild gynecomastia but this is not present with the “hands on the head” view and may be due to mild skin laxity but not additional tissue thickness which means that further surgery of the chest would not be helpful. His nipples do appear prominent. “Normal” measurements for the nipple papule have not been reported but in a female are generally considered to be 8 by 8 mm. My experience in males is that they prefer a flatter nipple to prevent prominence in clothing. Our patient is thrilled with the normal appearance of his nipples and no longer has prominence of the nipples visible in a thin shirt.
Gynecomastia – Patient 147
A college student in his early 20’s who first noticed female breast development at the age of 18. He was heavier, and reduced his weight by 50 lbs by stopping drinking soda, but the gynecomastia did not resolve. He wears compression shirts to hide the appearance of his chest in clothing and is uncomfortable with his shirt off. He is shown before and again, 4 ½ months after gynecomastia correction with power assisted/external ultrasound assisted liposuction using the S.A.F.E. technique ( Suction Aspiration Fat Equalization) combined with a direct excision of breast tissue from an incision around the lower border of his areola. He is thrilled to have a normal appearance.
Gynecomastia – Patient 146
A man with recurrent gynecomastia. He first presented at age 38 when he was 5’7 1/4 and 169 lbs. and had gynecomastia treatment by myself with external ultrasound assisted, power assisted liposuction combined with the direct excision of breast tissue through a periareolar (around the lower areola) incision with the specimen of breast tissue weighing 63 gms on the left and 70 gms on the right. He did well after surgery, with a good result at 5 months.
He returned to see me two years later.
He continued to smoke Marijuana (which can lead to gynecomastia) and also gained 15 lbs. and developed recurrence of gynecomastia, with new development of some firm breast tissue in the lateral lower breasts. This was a little surprising and not common in my experience, especially with direct excision of the breast tissue under the areola at the initial surgery. We returned to the operating room and performed liposuction again, along with the direct excision of 49 gms of breast tissue from the right and 40 gms of breast tissue from the left. The new breast tissue was located more laterally and inferiorly in the breast this time.
He again did well. He is seen again, 5 years after this second procedure. He reports having one treatment of cool sculpting to his upper chest for a little more refinement. He has lost one pound since his second surgery, but has been spending more time at the gym. His case illustrates a few points. Recurrence of gynecomastia is uncommon, but can happen, and may be impacted by gaining weight and significant marijuana usage. I have other patients who have continued to use marijuana without recurrence of their gynecomastia, so a recurrence like this has been uncommon in my experience. Weight gain after surgery can certainly contribute as well.
Gynecomastia – Patient 145
A man in his mid 30’s who has had gynecomastia since middle school. He describes developing breasts at 11-212. He was smoking marijuana at that time, and continues to smoke marijuana on a regular basis. Marijuana use has been associated with gynecomastia development in some studies.
He is bothered by the appearance of his chest with his shirt off and also in fitted shirts. He has worn compression garments to hide the appearance of his chest.
He is shown before and again, just 6 weeks after bilateral gynecomastia treatment with A modified S.A.F.E. technique combined with a direct excision of breast tissue through an incision around the areola. External ultrasound is used to soften the fat before the finned cannula is used to mechanically disrupt the fat. Then liposuction is performed through an incision behind the pectoralis muscle and beneath the areolar. Remaining breast tissue is excised through the periareolar incision and then the fatty layer is mechanically smoothed with the finned cannula.
Scars are at their thickest and reddest at 6 weeks and will now begin to fade and improve over the next 1-2 years. He is already thrilled with his improvement and is looking forward to going the beach this summer and wearing fitted shirts
Update: Our patient is now seen 8 months after surgery. His scars have continued to fade, and his swelling has resolved
Gynecomastia – Patient 144
A man in his early 30’s with gynecomastia. He first noted breast development at the age of 15-16. This bothers him with his shirt off and in fitted shirts. He wears additional shirts to camouflage the appearance of his chest. He does not have a history of marijuana or anabolic steroid usage. He has had endocrinology screening which is normal.
He is shown before and again, just 6 weeks after a modified S.A.F.E. technique using power assisted liposuction and external ultrasound assist, combined with a direct excision of breast tissue through an incision around his areola. The S.A.F.E. technique (Suction Aspiration Fat Equalization) uses a cannula with fins to mechanically loosen up the fat followed by power assisted liposuction to remove fat and then the finned cannula again to smooth or “Equalize” the remaining fat. In my hands this allows the most aggressive removal of fat with less chance of dimples and irregularities. I modify this technique by starting with external ultrasound to soften the fat. After the liposuction is performed I check the chest and if there is a distinct mass of breast tissue (as in his case) I excise this through an incision around the lower aspect of the areola. A gynecomastia vest is worn continuously for 6 weeks along with micro-pore tape. We have just removed his tape in the office. Although scars are typically the reddest and thickest at 6 weeks, he already has an excellent contour. He is thrilled to have a normal appearance of his chest again.
How is gynecomastia surgery performed?
Male breast reduction surgery in Boston and Worcester, Massachusetts is performed under general anesthesia while using a selection of techniques. The first technique is the liposuction technique, where a cannula or thin hollow tube is inserted through small incisions. Dr. Hall moves the cannula back and forth, removing excess fatty tissue through vacuum suction. The second technique is the excision technique, in which an incision is made to remove excess tissue and skin, resulting in a breast reduction. Both the liposuction technique and excision technique can be combined to perform this procedure as well. The technique that is most appropriate in your specific case will be defined during your consultation with Dr. Hall.
What should I expect during recovery?
After surgery, dressings will be applied to any incisions, and a support garment may be worn to aid in support and reduce swelling. A small tube may also be placed to drain any excess fluid or blood that collects. Dr. Hall will give you specific instructions for breast surgery recovery, and it is imperative that you follow them for a rapid and safe recovery.
“Dr. Hall and all of his staff are very welcoming and supportive. In addition, I am extremely pleased with the results of my procedure. I have already referred a friend to Dr. Hall!”
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