An 18 yo student of color with gynecomastia since the age of 10. He is bothered in fitted shirts and with his shirt off. He is shown before and again, 6 weeks after Gynecomastia treatment with external ultrasound assisted, power assisted liposuction using the S.A.F.E. technique ( Suction aspiration fat equalization) with the removal of 325 cc of lipoaapirate and 18 gms of tissue directly excised from the left, and 300 cc of lipoaspirate and 20 gms of tissue excised from his right. He attended school in a distant state and was not able to return for further follow-up visits.
A male student in his late teens who developed female appearing breast tissue in the 3rd-4th grade. He has no history of marijuana or anabolic steroid use, so his case is typically “idiopathic” or of unknown cause. He has tried lifting weights to build up his chest muscles but without improvement. He has not had any significant weight change. He is bothered in fitted shirts and of course with his shirt off. “Shirts vs Skins” in gym class must have been a torment. He is shown just before and again, 5 months after bilateral gynecomastia correction with External Ultrasound assisted/power assisted liposuction combined with direct excision of breast tissue through an incision along the lower areola. 355 cc of lipoaspirate were take from his right side along with the direct excision of 40 gms of breast tissue, and 375 cc of lipoaspirate take from his left side together with 37 gms of breast tissue. A close look will show that the scars are still slightly read but they are not noticeable from a conversational distance and will continue to fade over
the next 18 months. He is thrilled to have a normal chest.
A man in his early 20’s who was troubled by a feminine appearance of his breasts in a bathing suit and in some fitted shirts. He first noted this at the time of puberty but had some additional growth of his breasts and breast tenderness taking over the counter anabolic steroid like supplements. He is shown before and again, 6 weeks after bilateral chest liposuction with a combination of mechanically assisted liposuction combined with a direct excision of a little under an ounce of actual breast tissue from beneath each nipple area. We have just removed his
protective tapes prior to the after photos, and the small incisions at the edge of his areola and in the upper chest are at their reddest and most noticeable at this 6 week mark. They will now continue to fade and improve over the next 18-24 months. He is already thrilled with his improvement and natural appearance after surgery, and is already talking about going to the beach. He will typically also have a little swelling that will diminish and improve over the next 4-6 months.
A professional man in his early 50’s who has been troubled by the feminine appearance of his chest. He has difficulty wearing fitted shirts and sweaters without this being visible and troubling for him. He is shown before and again, 5 weeks after “SAFE” liposuction. After the wetting solution is placed in the operating room, external ultrasound was applied to his chest. Then power assisted separation of the fat with a basket cannula was performed. Then liposuction was performed with cross tunneling from an incision at the areola and an incision in the upper chest. Then fat equalization was performed to smooth the area after aspiration. He is thrilled with his early result. The small
red scars, one on each side of his upper chest, are at their most visible at 6 weeks. They will continue to fade and soften over the next 2 years.
A man in his 60’s who has gynecomastia and significant weight loss. The only way to tighten loose skin is to remove skin, leaving a visible scar on the chest in exchange for a normal contour in clothing. Our patient is shown before and again, 4 years after bilateral gynecomastia excision with free nipple grafting. He is pleased by his contour in fitted shirts and bicycle jerseys, but, as we see with most gynecomastia patients who need skin excision, he does not feel comfortable taking his shirt off at the beach.
A challenging case of a 19 year old man with severe gynecomastia since puberty. Typically with a severe case like this, the recommendation would be for mastectomy/gynecomastia excision with free nipple grafting but this would leave visible scars on the chest that would make it difficult for most patients to feel comfortable with their shirt off, such as at the beach. He has excellent skin elasticity because of his young age and because he has never had significant weight loss. So we decided to try our traditional technique with excision of his breast tissue through a periareolar incision combined with liposuction. He is shown just before and again, nearly 2 years after his procedure. He is thrilled with his new contour and feels comfortable with his shirt off at the beach.
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.
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.
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.
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