Gynecomastia refers to enlargement of the male breast. This condition can occur at any age but often becomes apparent in adolescent males with no known cause. Young males are particularly self-conscious and may be subject to ridicule. Older men may be equally self-conscious refusing to take their shirts off at the beach. For those who have particularly large breasts, it can be difficult to camouflage even in loose fitting shirts. Gynecomastia can be related to hormonal changes, the use of certain prescription medications, steroid use, or obesity. Hereditary or genetics may also play a role. The most frequent cause of gynecomastia is idiopathic—of unknown origin.

Gynecomastia may appear as slight enlargement, or in extreme cases, it may be difficult to tell the male chest from a female breast. It usually affects both breasts, but can affect only one side. Breast enlargement is usually a combination of excess fat and glandular tissue but may also involve excess skin. The treatment is surgical, and there are several different approaches. To find out your treatment options schedule a consultation with a board certified plastic surgeon.

During your consultation he/she will discuss your goals and expectations and based on your examination discuss treatment options.

What are my treatment options for gynecomastia?

A liposuction technique using specially designed instruments may be sufficient to obtain a satisfactory result. This can be performed under either local anesthesia or general anesthesia depending on the surgeon and patient discussion. A small incision is made within the hair-bearing underarm area (axilla) or on the chest wall through which liposuction instruments (liposuction cannula) are introduced.

When liposuction alone is insufficient, and there is glandular tissue beneath the areola, 2-3 tiny incisions are made at the border the areola (dark pigmented skin around the nipple) through which dense glandular tissue can be removed. These incisions usually heal well and are minimally perceptible. In some instances, a more extensive incision is necessary. The incision is usually made at the junction of the pigmented areolar skin and the chest skin at the lower border of the areola.

What if my breast tissue sags and it appears I have extra skin?

Excess skin may have to be surgically removed (cut out) which will add additional scars. The amount of excess skin will determine the technique used to remove it and the extent of additional scars. When there is excess skin your surgeon may decide to stage the procedure—first step, remove glandular and fatty tissue; second step, remove excess skin. For patients with relatively good skin elasticity, the skin may “shrink down” and further treatment may not be necessary. In other instances, excess skin will need to be removed. For a modest amount of excess skin, a circular incision around the areola may suffice; with a large amount of skin excess, additional incisions may be necessary, including but not limited to, an incision in the fold beneath the
breast

What type of anesthesia is used and where is the surgery performed?

The surgery is performed in a certified outpatient office facility, a hospital outpatient facility or if patients have underlying medical problems (e.g. Heart problems) the procedure is performed in the hospital once the patient is medically cleared by his medical doctor. The surgery can be conducted under local anesthesia or general anesthesia.

What is the recovery like?

You will leave the facility wearing a surgical vest-like garment which you can remove 1-2 days after surgery to shower, depending on surgeon instruction. Your chest area will be swollen, and you have may have some bruising. Prescription strength medication should keep you comfortable for the first two days. After that, many patients switch to Tylenol. Some patients may have thin plastic tubes (drains) for two to three days that will drain any excess blood or fluid into a receptacle. While most of the swelling will resolve over several weeks, complete resolution of swelling can take several months. Physical exercise can be resumed at two to three weeks based on your plastic surgeon’s recommendations.