Gynecomastia
Overview
Almost 65% of men will develop excess breast tissue during their adolescence, a condition known as gynecomastia that results in an appearance similar to a female breasts. Often caused by a hormonal imbalance, steroids or medications with estrogen, gynecomastia can affect a man’s confidence and make them embarrassed when they remove their shirts.
Male breast reduction surgery for gynecomastia at Contour Plastic Surgery, performed by plastic surgeon Dr. Paresi, uses liposuction and other techniques to remove the excess breast tissue and restore the chest to a more masculine contour. It is important for men to be at a healthy, stable weight before having breast reduction surgery since the procedure removes excess breast tissue and not excess fat.
Gynecomastia Results
What is gynecomastia?
Gynecomastia is the presence of breast tissue in a male. For the majority of patients with gynecomastia, this started around the time of puberty (12-14). The breast tissue forms as a result of an imbalance of sex hormones, specifically, estrogen.
For most males in puberty, this breast tissue will involute once the estrogen levels decrease and testosterone levels increase as the primary sex hormone. Other possible causative factors that may contribute to gynecomastia formation after puberty include; use of anabolic steroids, obesity, marijuana use, and certain medications.
How do I know if I have gynecomastia?
A simple examination of the chest can confirm the presence of gynecomastia. Since breast tissue forms behind the nipple-areola complex (the areola is the pigmented area around the nipple), this is the site where the breast tissue can be found. The breast tissue can be felt by grabbing the tissue behind the areola and rolling in between the fingers. The breast tissue is often firmer than the surrounding fatty tissue and is attached to the nipple areola. (watch the video of how to examine yourself for gynecomastia)
I have puffy nipples. Does this mean I have gynecomastia?
Patients with gynecomastia often have larger, round areolas The normal male areola is typically oval in shape. Patients with gynecomastia often describe it as puffy nipples. The puffiness is due to the formation of the breast tissue right behind the nipple areolar complex. This puffiness is often worse in warmer conditions due to the relaxation of the areola muscular layer and herniation of the breast tissue into the nipple areola complex. Patients with gynecomastia are often afraid to go outside without a shirt on because of the prominence of the nipple areola complex. They avoid going to the beach, hanging out at the pool, or any activities that involve visibility of the chest.
How severe is my gynecomastia?
Gynecomastia is graded on the size of the breast tissue. The grading system is from a Grade 1 to a Grade 3 with 1 being the lease severe and 3 being the most severe. The simplest way to assess your grade is to use the concept of a measuring cup (8 ounces). Gynecomastia tissue that is a measuring cup or less in size would be considered a Grade 1 gynecomastia. Tissue that measures between one and two measuring cups in size would be considered a Grade 2. Tissue that measures over two measusing cups in size would be considered a Grade 3. It is important that the Grade is dependent on the size of the breast tissue not the fatty tissue. Gynecomastia is often present with significant amounts of fatty tissue of the chest called lipomastia. The Grade of the gynecomastia has implications for the treatment options available.
Lipomastia vs. Gynecomastia
Lipomastia is the presence of fatty tissue of the chest area. This may be with or without the presence of gynecomastia. This can be determined on examination for the presence of breast tissue. If lipomastia is present without the presence of breast tissue, the patient can be treated with liposuction of the chest alone. Lipomastia with gynecomastia requires liposuction of the chest as well as excision of the breast tissue. The majority of patients with gynecomastia have some degree of lipomastia. This is why most patients with gynecomastia also require some degree of liposuction with their treatment.
Minimally invasive treatment of gynecomastia
At Contour Plastic Surgery and MedSpa, we offer a minimally invasive approach to patients with Grade 1 and Grade 2 gynecomastia. This involves the entire treatment being done through a 5 mm incision on the lateral aspect of the chest at the anterior axillary line. The procedure can often be done under local anesthesia in about one hour. The procedure is done using tumescent anesthesia which is a local anesthetic solution that is injected into the chest area. This is followed by liposuction of the chest using a MicroAire power-assisted liposuction device to remove any fatty tissue around the gynecomastia. The breast tissue is then excised with special instrumentation followed by additional liposuction and closure of the incision.
What is the treatment for Grade 3 gynecomastia?
Given the significant amount of excess skin and breast tissue, the minimally invasive approach is not an option for patients with Grade 3 gynecomastia. These patients often require some version of a breast reduction which involves incisions on the chest. The exact type of incision and treatment plan will vary by patient.
How do I know if I am a candidate for the minimally invasive approach?
Patients with Grade 1 and 2 gynecomastia are candidates for the minimally invasive approach provided that the overlying chest skin laxity is not compromised. Patients that have undergone massive weight loss or have extensive stretch marks and excess skin may require additional incisions for skin removal.
Are contour irregularities common after gynecomastia excision?
One of the issues that was common after gynecomastia excision in the past was contour deformities of the nipple areola complex, specifically, a depressed nipple areola complex. With the minimally invasive technique, we are using liposuction to treat the lipomastia around the gynecomastia which results in a smoother, more contoured result.
What is the recovery for gynecomastia excision?
The recovery for the gynecomastia excision is 6 weeks. The postoperative restrictions are no lifting greater than 10 lbs and no heart rate above 140.
Patients are allowed to resume mild to moderate aerobic activity after one week. A compression garment is placed on the patient right after the surgery. It is recommended the patient wear the compression garment 24/7 for the first week and then at least 12 hours a day for the 5 weeks after that.
Surgical Technique
Breast reduction surgery for men is done through a special liposuction technique. Some men with milder cases of gynecomastia may only require liposuction to attain good results. This is performed to remove the fatty tissue residing under the skin.
During this approach, a small incision is made around the areola (intra-areolar). This allows access for a suction device to move through the chest and remove fat and tissue. In severe gynecomastia cases, an en bloc resection of excessive breast tissue and tightening of loose skin may be necessary. This includes nipple grafting and may require a staged surgery.
During/After Surgery
Gynecomastia surgeries are performed under local or general anesthesia depending on the severity of the case. We perform all of our surgeries in our accredited surgical facility. The surgery can take 1-3 hours. Following the surgery, there will swelling and bruising in the chest area. The patient will be placed in a compression garment immediately after surgery. The compression garment should be worn as much as possible for the first week after surgery, and then be worn at least 12 hours a day. The patient can do every day activities a few days after the procedure but no heavy lifting or strenuous activity for six week after surgery. The surgery allows men to feel more confident when exposing their chest due to a firmer,flatter chest. Scarring is minimal.
Gynecomastia FAQs
Will This Help My Pecs?
Is Liposuction Always Needed?
In most cases, yes. The soft tissue and fat that collects in excess will need to be removed using liposuction. There are many liposuction techniques to consider. Some are less invasive and can help the skin become tighter on the chest wall. These methods can be discussed during your consultation.
What About Scarring?
Still have a question?
At Contour Plastic Surgery & Med Spa, our expert team is here to guide you every step of the way. We’re happy to answer your questions and help you feel confident in your choices. Contact us today to schedule your consultation — your journey to looking and feeling your best starts here!