Treating Gynecomastia with Male Breast Reduction Surgery

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 breast, 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 gynecomastia poses no physical health risk by itself, make no mistake – enlarged breasts can dramatically affect self-esteem and that’s why many men seek to have this corrected through male breast reduction surgery.

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 having gynecomastia, 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, men with enlarged breasts is not uncommon and the feeling of embarrassment 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.

The good news is that correcting gynecomastia is possible!  And, male breast reduction is a procedure that Dr. Neavin performs regularly. At Artisan of Beauty, the technique and care that you receive are unparalleled. Dr. Neavin specializes in treating gynecomastia through plastic surgery. And, he has a great deal of experience to guarantee you the best gynecomastia surgery Los Angeles has to offer.

Gynecomastia Components


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 signs. 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, it may be isolated behind the areola, or nipples may swell. In severe cases, the male chest can look very much like woman’s breasts.

How Do Men Develop Gynecomastia?


Many causes of enlarged breasts in men are unknown. This is 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.  It may even 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.

Conditions That Can Cause Development of Male Breast Tissue in Adults Include:

  • Tumors: Located in the brain, testicles, or adrenal glands. Specifically, Sertoli cell tumors, Leydig cell tumors, and cCG-secreting choriocarcinoma.
  • Steroids Induced Gynecomastia (and testosterone therapy)
  • Smoking marijuana (controversial etiology)
  • Excessive alcohol consumption can also cause gynecomastia
  • Renal Failure and Hyperthyroidism
  • Prescription Drugs
  • Liver Disease
  • Certain Herbs

Types of Gynecomastia


In simplest terms, gynecomstia is measured in 4 grades. Grade 1 is mild and Grade 4 is severe. Male breasts can be composed of fat, glandular, and skin elements. Pseudo-gynecomastia 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. When we discuss gynecomastia surgery, the enlargement of the breasts is just one reason to seek treatment from a plastic surgeon. 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 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:

Grade 1

A localized breast tissue growth behind the areola. This Grade is commonly seen in the athletic body. Anabolic steroids may contribute to this condition, which will require surgery to correct.

Grade 2

Moderate breast enlargement that exceed the areola boundaries.

Grade 3

Moderate breast enlargement that exceed the areola boundaries with skin redundancy.

Grade 4

Marked breast enlargement with skin redundancy and feminization of the breast.

Gynecomastia Surgery Details


The key to successful gynecomastia surgery is customizing the procedure specifically to one’s chest. As mentioned, male breast enlargement 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.

Liposuction alone will correct the deformity. However, in truth this is rarely the scenario. Most of the time when excess fat on the breast is present, there is also glandular overgrowth. A common mistake inexperienced surgeons make is assuming that that liposuction alone 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. Below are markings for a mild case of gynecomastia.  As you can see, the surgery must extend beyond the gland to achieve the best possible results.

gynecomastia surgery markings

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.  Often, the incision around the areola is extended from approximately three o’clock to nine o’clock to perform gland excision under direct vision.  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.

Recovery


Gynecomastia surgery is outpatient surgery meaning patients can go home the same day after surgery. Following your gyno procedure, 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 post surgery. Vitally important is the use of a compression vest. A vest should be worn for a minimum of 4 weeks post gynecomastia surgery 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.

Schedule Your Gynecomastia Surgery Consultation

Watch below as Dr. Neavin takes you inside his Los Angeles practice and showcases one of his gynecomastia surgery procedures:

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If you have questions on gynecomastia please visit the the FAQ page. If you would like to find out whether male breast reduction surgery is right for you, contact Artisan of Beauty© by calling 310‑858‑8811 or texting 323‑975‑1287 and schedule a complimentary consultation with board certified surgeon Dr. Neavin at his Los Angeles location.

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