A man in his early 30’s who is bothered by female breast development. He did not finish growing in height until his sophomore year of college. He noted female breast development starting after college. His endocrinology workup was normal and he does not have a testicular mass on the examination by his physician. He is bothered by the appearance of his chest with his shirt off but also in some shirts. He did not have a history of significant marijuana use or anabolic steroids. The cause of his gynecomastia is “idiopathic” which is a fancy word for unknown.
He is shown before and again, 5 months after power assisted liposuction with external ultrasound assist using the SAFE technique ( Suction Aspiration Fat Equalization) combined with direct excision of breast tissue through a peri-areolar incision.
At 10 months, our patients scars have continued to fade. Hands on head view shows perfect contour of the chest from the S.A.F.E. liposuction combined with the direct excision. It may be tempting to consider only a direct excision without the S.A.F.E. technique- but in my experience it is difficult to perform a direct excision without the liposuction and obtain a smooth surface as we have done here. Even when there is not a large amount of fat, the undermining with the special cannula initially helps to separate the mass of breast tissue so that is technically easier to smoothly excise it without leaving irregularities of the overlying skin. Then after the excision the fat equalization portion of the S.A.F.E. technique further smooths the overlying layer of fat. In this way we have managed to avoid contour irregularities of the subcutaneous layer.