Some of the most frequent questions I’m asked about gynecomastia is if weight loss and exercise can make it “go away”. Unfortunately, exercise and weight loss has its limitations when it comes reducing the mass of the male breast. The male breast (like the female breast) is made of breast tissue (glandular), fat, and skin. While weight loss can reduce the fat component of the breast, in true gynecomastia the breast volume will likely change very little. When weight loss is rapid in overweight people, the breast size will be reduced to a certain point resulting in excess skin. Thus, managing male breasts involves looking at the fat, breast, and skin components.
Fat can be liposuctioned. Breast tissue can’t. Skin laxity may return to a more contracted (tight) state over time after weight loss, but often the elastic properties are too poor for adequate contraction over a decompressed breast in men who have lost massive weight rapdily. Thus, skin excision may be needed to contour the chest.
When men come to the office for their breasts, it is almost always because of excessive glandular tissue with or without a skin or fat component. Thus, gynecomastia surgery almost always cannot be managed simply with liposuction. However, glandular excision may be accompanied by liposuction to help contour the chest. Skin excision is generally reserved only for instances of massive rapid weight loss or significant ptosis (droopiness). When gland and fat is removed from the male breast absent of ptosis, the skin often contracts (tightens) obviating the need for additional incisions and scars.
To sum it up: Enlarged male breasts are almost always because there is too much glandular tissue. While there may be excess fat, sucking out fat alone is often insufficient because the gland must be excised. Skin laxity comes in many flavors. Many times the skin will retract with liposuction and glandular excision. When it doesn’t (or can’t due to poor elasticity from massive rapid weight loss), the skin must also be excised along with gland and fat.
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