A man in his mid 30’s who has had breast development since the age of 15. He has not had a history of marijuana or anabolic steroid usage, (both of which can contribute to gynecomastia) His chest was worse when he was in college and 50 lbs heavier. He still requires extra shirts to camouflage the area. He is shown before and again, just 6 weeks after External Ultrasound -assisted/ Power-assisted liposuction combined with direct excision of breast tissue through a periareolar incision under general anesthesia as an outpatient. Swelling will typically continue to improve over the next 5 months and scars for the next 2 years. Although scars are typically at their peak at 6 weeks, the incision around his areolar is difficult to notice and the small incisions behind the border of the chest muscle are off to the side and difficult to notice. At 6 weeks he is ready for the beach, as long as he protects his incisions with sunblock. The “hands on the head” view demonstrates the female breast tissue more easily.
A man in his late 20’s who has had gynecomastia since the age of 10. He is bothered by the appearance of his chest with his shirt off but also with fitted shirts. He has tried to camouflage this with undershirts and loose fitting shirts. No history of anabolic steroid or marijuana use. He is over his ideal weight at 216 lbs and 5’10” (BMI of 30.99) and also requests liposuction of his abdomen. He is shown before and again, just 6 weeks after Power assisted /External ultrasound assisted liposuction with the removal of 4950 cc of lipoaspirate under general anesthesia as an outpatient. Swelling will continue to diminish over the next 4-5 months.
A man in his late 20’s who is bothered by female breast development which started at the time of puberty. He does not have a history of marijuana or anabolic steroid usage (both of which can contribute to gynecomastia). Onset at the time of puberty is typical for “idiopathic” gynecomastia- a common presentation but with the cause being unknown.He is shown just before and again, 6 weeks after power assisted liposuction/external ultrasound assisted liposuction of his chest. Access incisions in the upper lateral chest were placed at the site of prior stretch marks so they will be even less noticeable as they fade with time. He is 6 feet tall and 232 lbs, giving him a BMI of 31.46.
When patients are overweight, we do not expect the skin to be as “tight” after surgery.
But he is already thrilled with his appearance, and was able to go to the beach with his shirt off for the first time in many years.
Our patient is now seen 7 months after surgery. Swelling has resolved and has a normal appearing chest.
A man in his early 30’s with breast development at the time of puberty. He has never been heavy and has no history of marijuana or anabolic steroid usage. He is bothered by his appearance in some shirts and also with his shirt off. He wears an additional T shirt under his shirts to camouflage his chest. His chest bothers him a little less when he is cold and his nipples contract.
He is shown before and 6 months after external ultrasound-assisted/power-assisted liposuction combined with a direct excision of breast tissue through an incision around the lower ½ of his areola. Upper chest access incisions were placed in old stretch marks. An “arms up” view demonstrates the breast tissue and is helpful in determining whether a man has true gynecomastia as opposed to loose skin or prominent chest muscles.
He is thrilled with his improvement and just returned from a vacation where he was able to take his shirt off at the beach for the first time in many years.
A man in his early 60’s who has been bothered with gynecomastia since puberty. He does not like the appearance in some shirts and also wants to be able to take his shirt off at the beach. At his age his skin is not as elastic as someone in their 20‘s so his skin will not shrink as well after the excess tissue is removed. The skin could be tightened further but would require a noticeable scar that would prevent most patients from being comfortable with their shirt off at the beach. So having some looseness of the skin and looking like someone who has lost weight but doesn’t have visible scars on the chest is preferable for most patients.
He is shown before and again, 8 months after external ultrasound assisted/power assisted liposuction . An open excision of breast tissue was not required, but a Rosenberg gynecomastia rasp cannula was used to remove a small amount of tissue from under each areola. He is thrilled with his result and now looks forward to spending time at the beach.
An “arms up” view before helps to demonstrate the excess breast tissue.
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 body builder in his early 20’s who is troubled by female breast development. While not extreme, this bothers him in some fitted shirts, as well as with his shirt off. He is shown before and again, 6 weeks following direct excision of the breast tissue combined with SAFE liposuction (suction aspiration/ fat equalization) using power assisted liposuction. The small scars on his chest from the liposuction are at their peak at 6 weeks and will now fade and soften over the next 2 years. He is thrilled with his early result.
A man in his late 30’s who is troubled by gynecomastia for many years. He was bothered in a bathing suit but also in close fitting shirts. He is shown before and again, 6 weeks after bilateral chest liposuction with a combination of external ultrasound assist and power-assisted liposuction, as well as direct excision of a walnut size area of actual breast tissue( 2 ounces from each side, about the size of a large walnut). He is thrilled with his improvement, and no longer has a feminine appearance to his breasts in a bathing suit or in fitted shirts. He will typically continue to have some additional shrinkage as swelling diminishes over the next 3-4 months.
A man in his late 50’s with breast development since his early teens. He is troubled by the appearance of his chest at the beach, but also in some shirts. He has not used marijuana or anabolic steroids, two common caused of male breast development, and his cause is considered “idiopathic” – which means that doctors don’t know the cause. This is probably the most common scenario. Some medical studies suggest that 30% or more of males may have some female appearing breast development around the time of puberty but in most cases it goes away. If it is not gone by 18 months, then it is probably not going to resolve. He is shown before and again, 6 weeks after gynecomastia treatment with a SAFElipo. His small incisions are still red at this point but will fade as he heals over the next 6-12 months. He is already pleased with the improvement in his contour. Typically skin is felt to continue to shrink and contract over the next 6 months. The “S.A.F.E.” method described by Dr. Simeon Wall gives more effectiveness with fewer irregularities than thermal-based technologies such as laser-assisted liposuction or internal ultrasound-assisted liposuction. These thermal technologies can damage the fat cell and coagulate the tissues surrounding the fat, and can lead to more irregularities in the skin. With SAFElipo, a three step process is followed: S eparation, fat A spiration and F at E qualization. In the first step a special probe is used to mechanically separate the fat cells. This is often done with a power assisted device that vibrates back and forth. Then fat aspiration is performed but can be less aggressive than standard techniques because the fat cells have already been separated. After suctioning, the area may feel smooth, but can still have some irregular areas of fat that are thicker and thinner. The mechanical probe is then used for Fat Equalization, to help reposition the fat deposits and smooth them out. Using this technique can give a smoother result, and helps to preserve the fat cells that are left behind.