A man in his early 30’s who developed gynecomastia at puberty. He does not have a history of significant marijuana use or anabolic steroid use, both of which can cause gynecomastia. Studies report that as many as 30% of young boys will develop some growth of the breasts at puberty. In most cases this goes away on its own by 18 months. If it has not resolved by that time it typically is not going to go away on its own.
He is bothered by the appearance of his chest in fitted shirts and with his shirt off.
He is shown before and again, 6 weeks after Power-Assisted liposuction using a modified S.A.F.E. technique combined with direct excision of breast tissue though an incision around the lower part of the areola. In the S.A.F.E. technique ( the letters stand for S uction A spiration and F at E qualization) the procedure is typically performed under general anesthesia. Wetting solution, sometimes called “tumescent” solution is injected under the skin. This is a dilute solution containing some local anesthetic and epinephrine. Then I perform external ultrasound to soften the fat. Then a cannula with fins called a “Becker” cannula is used without suction to mechanically disrupt the fat. I prefer the Microaire power system that vibrates this cannula rapidly back and forth. This loosens up the fat cells that remain viable however. Then the “aspiration” or liposuction is performed using an incision under the arm as well as the incision around the areola. After excising any remaining breast tissue under the areola, the fat is “equalized” or smoothed by using the finned cannula again to smooth the remaining fat layer around. In this manner the most aggressive liposuction can be performed without as much of a risk of leaving dimples or irregularities. A compression vest is worn for 6 weeks.
Scars are at the pinkest and reddest at 6 weeks and then begin to fade and improve over the next 2 years. The peri-areolar scars are nearly imperceptible even at this time. The lateral access scars are typically the most visible early on, and I try and place these behind the border of the pectoralis muscle so they are not as noticeable. He will now wear topical silicone on the small access scars for the next 3-6 months. He is ready to go to the beach now at 6 weeks. Sunblock is recommended for the first 12 months because any scar that is exposed to the sun while it is still pink can turn brown. He is thrilled to finally have a normal chest.