Man showing his muscular bodyWhat is gynecomastia?
Gynecomastia is best defined as excess tissue on the male chest, and is often breast tissue mixed with fatty tissue. The breast size of gynecomastia can range from slightly increased to as large as a D cup female shaped breast.
What causes gynecomastia?
Gynecomastia frequently occurs in two phases of life. It can often appear in puberty and then disappear as a young man. If it doesn’t resolve itself after 12 months it will most likely not resolve on its own. It can also appear later in life due to various diseases, hormonal irregularities, use of bodybuilding steroids, marijuana, or a side effect of various medications. Some supplements can cause disruptions in hormones leading to an increase in breast tissue. Sometimes you see gynecomastia running in families.
Am I more prone to develop gynecomastia if I am overweight?
No. There can be very thin patients with large breasts and overweight men with flat chests. However, overweight men often put extra fat on their chest, for that is one of the places that fat is first deposited. Frequently, obesity and gynecomastia will coincide.
What are the treatments for gynecomastia?
Male breast reduction surgery is the only recognized treatment. Creams, lotions, massage, injections, exercise and “magic pills” all will do nothing for established gynecomastia. Diet and exercise will not help resolved gynecomastia.
Am I a candidate for male breast reduction surgery?
The most important question you should ask yourself is: does the condition bother you both psychologically and physically? Should the answer be positive, you should consider surgery and start to gather information that will help you make an intelligent decision. Consult with a Board Certified Plastic Surgeon who is experienced in this type of surgery, obtaining information from web sites and referrals. In general, it is recommended to wait until the age of 18 years. However, there are some circumstances where a person should consider it earlier. For this you will need to refer to the expertise of your cosmetic surgeon.
What needs to be considered and completed before surgery?
- A consultation with your Cosmetic Surgeon, where you will complete a medical history. This an opportunity to seek possible causes (marijuana, bodybuilding steroids), side effects of medicines, adrenal tumor, pituitary tumor, testicular tumor, cancer, etc. and determine if further investigation is needed. It also provides an opportunity to ensure there is sufficient skin elasticity, or the need for additional incisions during surgery to tighten loose skin.
- Most insurance companies consider gynecomastia surgery a cosmetic procedure and therefore refuse to pay for it. Therefore, payment options need to be considered.
- You will receive detailed instructions from your surgeon’s office. Pre-operative testing is mandatory. Medications such as blood thinners, Advil, Vitamin E, and herbal remedies need to be stopped pre-surgery. Smoking needs to be stopped two weeks before surgery and the two weeks after surgery. On the day of your surgery have a responsible person accompany you.
If surgery is performed, will the results be permanent? What if I gain weight after the surgery?
Surgery will remove much but not all of the breast tissue and it will not re-grow. Should you gain substantial weight after surgery, then some amount of fat will return to the chest but it will also be distributed over other parts of the body so that you will not regain the specific enlargement on the chest that you had prior to surgery. Conversely, if you lose weight after gynecomastia surgery, the results of the surgery will be enhanced.
What are the most common complications after gynecomastia surgery?
Gynecomastia surgery is very safe surgery. However, as in any surgery, complications may arise. Fortunately, the possible complications are treatable and non-life-threatening. There are three common possible complications:
- Bleeding/ Seroma: Rarely after a surgery, a blood vessel may open up and bleed- this is called a hematoma. This may happen within hours, days, or even a week or two afterwards. Sometimes it is associated with a patient being non-compliant with the post-op instructions – and sometimes there is no explanation. Small amounts of bleeding may just be observed. Large collections of blood may require a brief return trip to the operating room to remove the blood. A seroma is a collection of clear, yellowish fluid, which may also occur after surgery. These are usually removed by syringe aspiration.
- Infection: Infections are extremely rare as antibiotics are routinely used for prevention.
- Irregular contours: Irregular contours, including the “crater” deformity (in which too much tissue is removed directly below the areola), are best treated by recognition and prevention. Irregular contours after surgery rarely improve spontaneously and may require revision surgery.
Will I be under anesthesia during surgery?
Local anesthesia is determined based on the type of surgical procedure and the patient’s tolerance. The local anesthesia is delivered via IV while the patient is sedated. Sedation is not a general anesthesia, but the patient is asleep.
Will I have pain that will require medication?
Usually pain is minimal, but a prescription for pain management is given to ensure an optimal level of comfort.
Will I have post-operative numbness of the skin and nipples?
No matter what method is used for surgery, there is always post-operative numbness of the chest skin and the nipples. This is due to the temporary interruption of sensory nerve fiber conduction to the skin and nipples. There is not just one sensory nerve to the nipple – there are hundreds of tiny nerve endings. In essence, the nerves are “in shock” and need time to recover.
Eventually symptoms of the healing such as tingling, itching, and super sensitivity do subside. In the vast majority of men, normal sensation returns to the skin and nipples. It may take anywhere from 6 to 12 months for full sensation to be recovered.
What should I expect immediately after surgery?
There may be some minor bruising after surgery; this will subside in just a couple of days. Swelling will appear over the first few days after your procedure and can continue for several weeks. Compresses and support garments may help reduce some of the swelling. A post-op compression garment, worn 24/7 for one month (minimum) after surgery, is absolutely essential for appropriate healing and for an excellent result.
Will I experience any scarring with a male breast reduction?
Every effort is made to minimize the scars for surgery. Usually a 3 mm (1/8 inch) incision is made on the side of the chest just down from the armpit masking the appearance of scars. With the appropriate post-operative scar management, your male breast reduction scarring will be minimal and virtually undetectable.
When will I see my results?
Prospective gynecomastia patients are always told that the surgery will affect two parts of their body: their chest and their head. For example, most patients rapidly adopt and accept their new chest contours and are totally delighted with their results. There are some others who take many months until their mental self-image adjusts to the new physical image.
Some surgical results will be evident over the first couple weeks, as the swelling begins to subside, but your final results may take up to 6 months. You may continue to notice improvements in the chest contour for up to 12 months after your procedure, as the body finishes healing.
Can liposuction be performed on other areas of the body (for example, abdomen or love handles) at the same time as the gynecomastia surgery?
Can the size of areolas be reduced?
In the majority of cases, the chest skin will spontaneously tighten after the excessive tissue beneath (breast and/or fat) has been removed in the course of surgery. Since the nipple/areola is also a skin structure, it too will tighten and diminish in size. In fact, the average areolar shrinkage is about 15-20%. The areola will also darken somewhat in color after surgery.
In rare cases, when the areola is extremely large, surgery can be performed to reduce it to a more appropriate size.
What can be done for very large, female-type nipples (not the areolas)?
Nipple enlargement (hypertrophy) can consist of abnormal length, abnormal width or both. Surgery can be performed to correct either or both of these conditions at the same time. The scars resulting from this procedure are virtually invisible. These procedures can be performed alone or in conjunction with gynecomastia surgery.
When can I return to work? When can I exercise?
Prior to surgery make arrangements to be off from work or school for healing time. This is usually between 3 and 10 days and depends on the type of work you do and the extent of the surgery. After two weeks, light exercise can begin, and more strenuous activity can be resumed after one month. Healing time will be discussed with your doctor.
How much does gynecomastia surgery cost?
The cost is usually between $4,200 to $5,000 depending on the complexity of the repair.