Many young men who develop Gynecomastia are understandably anxious to correct it without a long waiting period. The timing, however, depends on a number of factors that must be discussed thoroughly with your internist and plastic surgeon. One indicator is breast enlargement that has been present for more than two years. Another factor is whether the breasts are still growing.
Sometimes, treatment should proceed early if there is very large breast development that shows no sign of halting, or if it is causing much psychological suffering for the boy. Otherwise, teens with Gynecomastia should wait until they are 18 years or older in order to have completed their growth phase, before seeking surgical treatment.
Pubertal Gynecomastia that has remained into adulthood can be treated by an experienced plastic surgeon by Breast Reduction and/or Liposuction as detailed below.
“I just want to be able to hug my girlfriend without feeling self conscious.”
— Larry, age 23
Adult onset Gynecomastia must be first evaluated by an endocrinologist in order to first address the underlying cause. Once the origin of Gynecomastia has been determined, then an experienced plastic surgeon can correct the cosmetic abnormality.
Various drug trials have been conducted, with varying degrees of success. These include the use of Tamoxifen and Clomiphene, which are anti-estrogens routinely used in cancer treatment. However, there have not yet been any controlled studies to establish the clinical effectiveness of these regimes.
“For years, I didn’t even know that I had a condition with a name. I always felt that my breasts would look more like a man’s if I exercised and lost weight. But, after losing a lot of weight with much effort, there was no change in the size of my breasts. Thankfully, I finally learned that I could have surgery to correct the problem. Today, I go shirtless without feeling ashamed.”
— James, age 40
The general goal of all methods of surgical treatment for Gynecomastia including, Breast Reduction, Liposuction, and Mastectomy, are to reduce the male breast to a normal size by removing excess fat and/ or glandular tissue from the breast and chest.
In extreme cases of Gynecomastia where there is excessive hanging breast skin it is also necessary to remove breast skin via different techniques. The final outcome is a male chest that is flatter, firmer, and does not look like a woman’s breast.
Surgical approaches to Gynecomastia were classified in 1970′s according to the size of the breasts. Group One involves small, but visible breast enlargement, without excess skin. Group 2A shows moderate breast enlargement without excess skin. Group 2B shows moderate breast enlargement with some excess skin. Group Three involves gross breast enlargement with enough “skin redundancy” such that the breast appears like a pendulous female breast. While all groups require removal of breast fatty and glandular tissues, group Three also requires removal of the excess skin.
Generally, Gynecomastia surgery takes between one and three hours. The procedure is usually performed under general anesthesia on an outpatient basis. The surgical approach depends on whether overgrown breast tissue primarily consists of excess adipose, glandular tissue, or a combination of both.
Surgery may not be the best first line of treatment for obese men who have not yet stabilized their weight and have not altered their lifestyle for a healthier one. Also, individuals who drink alcohol excessively or smoke marijuana are not the best candidates for surgery, barring a change in their lifestyle. A cosmetic surgeon will encourage them to first try these lifestyle changes before undergoing surgery.
If Gynecomastia is caused primarily by excess adipose tissue, your cosmetic plastic surgeon will probably use only Liposuction to remove the fat. Liposuction involves the insertion of small wand-like instruments (cannula) into small incisions. The wands are attached to plastic tube, through which the fat is vacuumed. Prior to the suctioning, the fatty tissue is infiltrated with “tumescent” fluid which facilitates the removal of fat.
The incisions utilized for Liposuction are very small, usually less than the width of a pencil. These incisions are placed in areas that are not very noticeable, such as the arm pit, the breast under-fold, and the edge of the areola – the dark skin that surrounds the nipple.
The most popular method for Liposuction of the chest/ breasts is Tumescent Liposuction. A minority of plastic surgeons favor using Ultrasonic or Power-Assisted Liposuction for their ability to breakup thicker or “fibrous” fatty tissue rapidly. While these modalities make for a faster and less physically demanding procedure for the plastic surgeon, they carry an increased risk of complications which, on balance, are not optimal for the patient.
Following Liposuction, the chest skin, as well as the size of the areola, shrinks over a period of six to eight weeks resulting in a well-formed and flat male chest.
If Gynecomastia is caused largely by hypertrophied fibrous glandular tissue, your cosmetic surgeon may not be able to suction out this tissue, and instead will have to surgically remove it. This “excision” of the tissue may be performed simultaneously with Liposuction. Here, the incision will be made in an area where the scars won’t show– on the edge of the areola. If larger amounts of breast tissue and/or skin require removal, the peri-areolar incision is extended outwards, or a separate incision is made in the breast under-fold.
Extensive and near total excision of the entire breast tissue is termed Mastectomy. Depending on how much excess skin remains, different amounts of skin can also be removed. The combined removal of breast tissue and skin is termed Breast Reduction. There are different techniques of male breast reduction depending on the approach and the resulting final scar. In some cases the final scar is limited to the outer edge of the areola thus termed Peri-Areolar Breast Reduction. On the other hand, the Inverted-T (or Anchor) Breast Reduction uses an anchor-like incision that extends from the areola down to the breast under-fold, and continues outwards. This method enables a much larger amount of skin excision. There are also other modifications of this technique with varying locations and extends of incisions. Your plastic surgeon can utilize any of these techniques to fit your needs.
In some cases, a small drain will be inserted through a separate incision to draw out excess fluids.
Generally, Gynecomastia surgery is performed under general anesthesia. In few cases when only very minimal tissue needs to be excised, this procedure can be performed under local anesthesia plus sedation, where the patient is awake, but very relaxed and relatively insensitive to pain.
In my experience, the best results with the least scarring can be achieved through a combination of Liposuction and Glandular Excision. First, I perform a thorough Liposuction of the breast tissue and the adjacent chest areas to reduce the size of the breasts, as much as possible. This usually enables me to remove at least 90 percent of the breast volume. Although theoretically Liposuction is not supposed to remove breast glandular tissue, in practice I have noted that Liposuction does significantly reduce the size of the breast gland. It leaves a very small amount of fibrous tissue to be removed at the end. Finally, through a less than one inch incision over the areola, I can tease out the remaining fibrous glandular tissue. This small incision always ends up being far smaller and ultimately less noticeable than the standard peri-areolar incision used with the Glandular Excision Technique.
“Now, when I hug or pat my son, he doesn’t pull away or act uncomfortable. He plays team sports and stands taller. He is starting to have friendships with girls. He is finally at ease with himself.”
— Mother of a 14-year-old Gynecomastia patient
For those that have moderately large breasts (cups B to C), I have been able to first remove the entire breast volume via the combination technique and then at a later second stage remove the excess skin. The advantage of the two stage technique is that, after the first surgery, breast skin and areolas shrink significantly, thus lessening the amount of skin that has to be removed during the second stage. This results in much smaller scars, and enables some patients who would have had to undergo Inverted-T Breast Reduction, to have their excess skin excised only with a Peri-Areolar incision instead.
Dr. Younai is a Board Certified Cosmetic Plastic Surgeon who is experienced in all treatments for Gynecomastia- Male Breast Reduction and Liposuction. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, and recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients who might be similar to you with Gynecomastia and have had Male Breast Reduction.
Our center also includes the Regency Surgery Center which is a state-of-the-art outpatient surgery facility certified by Medicare and accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc., (AAAASF).
Thank you for taking the time to visit our Web site. Our staff is always available to help answer your questions regarding any plastic surgery procedures and financing options, as well as with your travel to our center. Plastic surgery has truly become a way to better ourselves. It allows us to take control of our lives, and to give ourselves the body and look we always wanted, and truly deserve. Why not! We deserve the best.