Male Breast Reduction
Plastic surgery for men has always been popular, and each year, the number of men who undergo surgery to enhance their appearance rises. Plenty of men feel self-conscious about their bodies and desire surgery to increase confidence in their image.
Gynecomastia, or enlarged male breasts, is a common condition that may impair one’s ability to feel masculine. Gynecomastia literally translates into “feminine breasts”. It may make a man feel terribly self-conscious about their appearance. It may interfere with intimacy or even manifest as avoidance behavior among peers.
When one has gynecomastia, the excess fat and tissue present detract from a sculpted chest and make the chest appear breast-like. While this condition poses no physical health risk by itself, make no mistake – enlarged breasts can dramatically affect self-esteem. Men seldom discuss their insecurities of their breasts with wives, family, or friends, and are more hesitant to see a doctor for such insecurities.
If you suffer from this condition, you may recognize such insecurities. You may be hesitant to be shirtless in public or fear to wear certain t-shirts that can expose your underlying breasts. You also may not feel entirely comfortable discussing your embarrassment with friends or family members. However, this condition occurs very frequently in the adult population. You are not alone. In fact, studies have demonstrated that 30-60% of all men have enlarged breast size to some degree.
However, there is very good news. Correcting gynecomastia is possible, and it’s a procedure that Dr. Neavin performs regularly. At Artisan of Beauty, the technique and care that you receive are unparalleled, particularly because Dr. Neavin understands the unique requirements and characteristics of the male form and the tissue properties of the male chest. And, he has a great deal of experience performing gynecomastia surgery from Los Angeles to Dubai.
The ideal male chest is typically flat and firm with very little projection from the nipple. Ideally, the pectoralis major muscle lateral and inferior border can be seen. Although weight may determine the size of the breasts, it doesn’t always contribute to excess fat and skin on the chest specifically. Thin men may have large breasts. And heavy men may possess no true gynecomastia. Male breasts may consist of any combination of excess fat, skin, or glandular tissue.
With gynecomastia, the chest will appear overly abundant ranging from puffiness behind the nipple to total loss of muscle definition. One or both breasts will contain fat, glandular tissue or excess skin that make the breasts protrude from or sag away from the chest wall. In milder cases, gynecomastia may be isolated behind the areola, or nipples may swell. In severe cases, the male chest can look very much like woman’s breasts.
If you have gynecomastia, your breasts may feel soft or firm, depending on the tissues. Only a qualified physician should make the diagnosis. Because the male breast can be composed of excess fat, skin, or glandular components, the gynecomastia breast can take on a number of different forms in men of different ages and weights.
Psychological effects of enlarged male breasts
More often than not, your breasts are concealed with clothing, but on the occasion when you do need to show off your chest — during physical activity, bathing or intimacy — the thought of exposing gynecomastia may be embarrassing. During adolescence, at a time when most young men are coming to terms with their identity, gynecomastia can create severe insecurity. A fear of engaging in physical education at school or bonding with fellow athletes is a common occurrence with the condition.
As gynecomastia develops into adulthood, men feel less masculine and isolate themselves to protect their appearance. Sexual engagement may also suffer as a result of the shame they feel for their bodies.
What causes men to have enlarged breasts?
Many causes of enlarged breasts in men are unknown, termed idiopathic gynecomastia. It may also be caused by imbalances of testosterone to estrogen marked by an increase in estrogen production, a decrease in androgen production, or a combination of this imbalance. Over representation of estrogen can result in fat deposition or gland development in greater than usual quantity in the breasts. When this happens in puberty, there can be an increase in the development of glandular breast tissue in the teenager that may or may not spontaneously regress after puberty ends. In fact, up to two thirds of pubertal gynecomastia cases resolve within a couple of years of onset without medical treatment.
In the large majority of cases, enlarged breasts exist since puberty. However, there are other conditions that can cause development of male breast tissue in adults. These include:
- Tumors located in the brain, testicles, or adrenal glands. Specifically, Sertoli cell tumors, Leydig cell tumors, and cCG-secreting choriocarcinoma.
- Gym steroids (and testosterone therapy)
- Smoking marijuana (controversial etiology)
- Excessive alcohol consumption. Ethanol may directly disrupt production of testosterone while the phytoestrogens in alcohol may alter the estrogen to testosterone ratio
- Chronic diseases like renal failure and hyperthyroidism
- Many prescribed drugs can affect a male’s hormone balance (including medicines for ulcers, gastroesophageal reflux, high blood pressure, and seizures; methadone, calcium channel blockers, antifungal medications, antidepressants such as HIV medication, cancer chemotherapy, and drugs to treat prostate enlargement)
- Liver disease. Cirrhotics in particular will develop an increase in various types of estrogens and a decrease in testosterone.
- Lavender, tree oil, and dong quai
- Grave’s disease hyperthyroidsim
Thus, most men should be seen by their primary care doctor before considering their surgery for a complete history and physical.
Types of gynecomastia
It should be stated that all men possess breast tissue. What determines whether or not on has gynecomastia really relies on the history, the presentation, and where the breasts sit on the bell curve for men. There are no reliable blood tests to determine if one has gynecomastia or to what extent their breast development is abnormal.
In an attempt to apply order to gynecomastia diagnoses, a classification system has been developed by the American Society of Plastic Surgeons to help diagnosis and develop consistent treatment algorithms. This system employs 4 grades:
1: A localized tissue growth behind the areola. This Grade is commonly seen in the athletic body. Anabolic steroids may contribute to this condition.
2: Moderate breast enlargement that exceed the areola boundaries (1)
3: Moderate breast enlargement that exceed the areola boundaries with skin redundancy.
4: Marked breast enlargement with skin redundancy and feminization of the breast.
In simplest terms, 1 is mild and 4 is severe. Male breasts can be composed of fat, glandular, and skin elements. Pseudogynecomastia refers to a condition where the male breast is enlarged due to fat, not gland. This distinction is important only because it may guide the treatment. If the breast is truly just fat, liposuction alone can reduce it adequately. Once there is glandular elements present, glandular resection must be performed to reshape the chest. Liposuction will not remove glandular tissue.
However, when we discuss male breast reduction, gynecomastia is just one, albeit common, reason to seek treatment from a plastic surgeon. For example, depending on the patient, the appearance of male breasts may have more to do with sagging skin than fat, and could be the result of natural aging or significant weight loss. It’s also common for the areolar complex to widen and the nipples to extend from gynecomastia or breast enlargement due to weight gain and massive with loss.
Details of the surgery
The key to successful male breast reduction is customizing the procedure specifically to one’s chest. Male breast enlargement and gynecomastia can range from mild to severe, and may include any number of tissue abnormalities such as gland, skin, and fat. The tissues playing a role in the misshaped breast must be addressed appropriately for optimal correction.
In conditions where the breast is enlarged due to exclusively fat, liposuction alone will correct the deformity. However, in truth this is rarely the scenario. Most of the time when excess fat is present in the male breast, there is also glandular overgrowth. A common mistake inexperienced surgeons make is assuming that that liposuction alone in a male breast composed of many fat will reduce the breast adequately. What often occurs is a rather good volume decompression with residual firmness or swelling behind the areola. A subsequent glandular excision is required to create a flat chest.
Male breast reduction surgery can be performed under local or general anesthesia. In either case, the procedure starts with the injection of local anesthesia and large volumes of tumescence, which is a combination of salt water, lidocaine, and epinephrine. Sodium bicarbonate may also be added to reduce some of the discomfort with injection when performed under local anesthesia. If liposuction alone is performed, two access sites will be incised, each approximately one centimeter in length. The location of these incisions will be placed on the border of the areola to help camouflage the scar, and the lateral chest wall. With two access points for liposuction, a more uniform result can be achieved. Liposuction will performed from deeper to more superficial using both access sites for crosshatching. The breast, as well as the lateral, superior,and inferior chest walls will be contoured to blend the tissue reduction and aid in skin tightening.
At the completion of liposuction, the incisions are closed with a single stitch, or, the incision around the areola is extended from approximately three o’clock to nine o’clock to perform gland excision under direct vision if necessary. Glandular tissue will be excised carefully, as too much reduction of tissue can lead to deformities which are very difficult to correct. It is far more preferred to leave too much than to remove too much. Small, secondary gland reductions can be performed quite easily in the office under local anesthesia if necessary down the road. Adding volume to a deformity is much more complex with less predictable outcomes.
In many cases with glandular excision, drains will be placed temporarily. Drains can be easily concealed under clothes. They generally remain for a few days and are painlessly removed in the office. The purpose of drains is to reduce fluid accumulation within the dead space from tissue excision. Fluid that is not drained can prolong swelling and lead to the formation of a seroma, a fluid collection that may need to be drained in the office. Undrained seromas may become infected or harden resulting in an irregularity of the chest wall.
A note about skin excision
Men with large breasts may present with skin redundancy. One thing to keep in mind is that when the male breast is reduced of volume, there inherently exists a skin to volume discrepancy. Thus, large reductions of fat and glandular tissue must rely on the contractile properties of skin to tighten post-surgically, or, they should be addressed with a skin excision during surgery. However, the resection of skin should only be performed with very loose skin that is for certain not going to tighten adequately. When in doubt, it is best to not perform the skin resection because the incision (and scar) from the excision is irreversible and quite large.
In men who have lost massive weight, the tissues may not be elastic enough to tighten. The decision to remove skin in this population is often an easy one. However, most men who have some loose skin have not lost massive weight. In this subset of patients, Dr. Neavin prefers to avoid skin resection and give the patient up to six months of healing which can often result in significant tightening with prolonged garment wear. If at six months excess skin exists, it can more easily be resected and often with a smaller incision and scar. Or, the patient may not want to accept the trade-off of a scar for less loose skin. They may be more happy with the result, albeit imperfect, because, placing a scar along the chest wall can be obvious. If the goal often in male breast reduction surgery is to become comfortable topless and large scars across the chest defeat that purpose, then what was really gained? Thus, this potentially staged approach is often the safest method and yields the best results and most happy outcomes.
Male breast reduction surgery is outpatient surgery meaning patients can go home the same day after surgery. The downtime will be proportional to the extent of surgery, with cases involving skin excision being the longest course. Generally speaking, one can return to a desk job within three to five days. Strenuous exercise should be avoided for three weeks.
Vitally important is the use of a compression vest. A vest should be worn for a minimum of 4 weeks to allow the tissues to tighten and reduce potential space for fluid collection. Vests can be worn under normal clothes. Patients may remove the vests for showering, but should wear the vests all other times.
If you would like more information about gynecomastia, or to find out whether male breast reduction is right for you, contact Artisan of Beauty by calling 310‑858‑8811 or texting 323‑975‑1287 and schedule a complimentary consultation with Dr. Neavin.