That’s a very sincere, good question. But a better question really is, “Why not me?” More men will get gynecomastia than will not, so the chances are better that you will ask yourself the question than you will not.
Male breast cancer is rare, but it does occur. Usually, it happens in men in their 60s and 70s, and often it is one-sided, starting as a firm and often painless mass. The content of this site is for information purposes only, and there is nothing that can be said to be sure that you do not have cancer. If you have a mass in your breast, you should seek medical attention.
Treatment of gynecomastia is a standard part of training by the American Board of Plastic Surgery. They are the only board recognized to credential plastic surgeons, and you should look for a member to have your surgery. Surgeons certified by this board are members of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS). Each of these have referral sources on their website: try http://www1.plasticsurgery.org/ebusiness4/PatientConsumers/findasurgeon.aspx and http://www.surgery.org/public/find_a_surgeon. If you would consider traveling to Southern California to see Dr. Teitelbaum, you can call 310 315 1121 to arrange a preliminary consultation over the phone.
Remember, this is elective surgery. Do not feel rushed. If you do not feel enthusiastic about proceeding, or if you are not confident about a doctor, then just wait until everything seems right. Look at photos of their results after male chest reduction surgery. Do they seem to be experienced and knowledgeable about gynecomastia and how to correct it with surgery? Where were they trained? Do you have a choice of anesthesia? Do they have an accredited operating room? Do they seem to understand what bothers you, and do they seem capable of delivering you the result that you want? These are some of the questions that you should be considering.
Unfortunately in most cases they will not cover the treatment of gynecomastia. Insurance companies change their rules daily, with little regard for logic. But if there is any trend, it is for them to pay for this less and less often. It has been a long time since I have had an insurance company pay for this. In one case, it was an adolescent who had it so severe his chest looked like a woman’s breast, and the other was a man with a firm mass in which we were concerned about cancer. The insurer paid for the biopsy, but that was but a small amount of the total cost for the procedure.
There are some men who are on medications known to cause gynecomastia, whether by prescription or illicitly. It is advisable to curtail all illicit substances for many reasons, beyond just the gynecomastia. If you are on prescription medicines that might be related to causing gynecomastia, discuss with your prescribing doctor whether there are alternative drugs for you to take.
There is no absolute age requirement. In general, we wait until puberty has finished and the hormone levels have stabilized, which is usually 18-20 years old. However, there are cases in which the chest enlargement is so severe that it seems cruel to make a child live with it all through high school in the hopes that it will get better. I have operated on boys for gynecomastia as young as 12 – but only with a letter from their pediatrician agreeing that their problem is so severe and emotionally so difficult that he or she feels that they should not wait. Most of the time gynecomastia experienced during puberty will go away, and that is why we wait. But if it is causing enough distress, we will consider treating the gynecomastia earlier. That decision must be individualized to the age of the boy, the extent to which it is bothering him, all discussed in detail with the boy, his parents, and his pediatrician.
There is no age limit per se, only the general health status of the patient. But the older patients get – particularly in their 60s and 70s – but even younger sometimes – the more I worry about male breast cancer. The point of this is to say that even if a man has an enlargement of his chest and he is older and in ill health, he still must see a doctor to make sure that there is not cancer in his chest. But it is very common that men in their 60s and 70s getting facelifts may also ask about having a chest reduction. Whether from medications, obesity in the past or present, or simply gynecomastia left over from puberty that never went away, once aware that something can be done about it, many men ask for treatment of their gynecomastia.
The most common technique involves making an incision around part of the areola to cut away the thick, glandular tissue, and then to perform liposuction to thin out the chest and contour the entire area. In some cases, particularly very thin men with just a little “puffiness” under the areola, and a very firm, well-delineated mass, excision alone is all that is needed. But when the chest is diffusely enlarged and is very soft and spongy – usually in men that are or have been a bit overweight – liposuction alone can give an excellent result. But sometimes a patient feels on initial exam like they just have fat. But during the operation, after the removal of the fat, the glandular tissue can suddenly be felt – just as if you might imagine the chocolate melting in a candy bar, and an almond embedded in the center gradually becomes increasingly obvious. There is no right or wrong approach; the patient and I decide beforehand what the goal is. If it is to make them as flat as possible, then we usually proceed with doing both. If the patient is overweight, there is obviously a lot of fat, the patient does not expect to be totally flat, and doesn’t want the scar around part of the areola, then we may not do an excision. Each case is individualized, but to repeat, most of the time there needs to be both liposuction and excision.
While a single surgery usually corrects gynecomastia for life, there are times in which patients come back for another surgery. The most common situation is when liposuction alone was done, and residual glandular tissue needs to be removed later. These men will often have noticed a big improvement in their male chest enlargement following the first procedure, but with the fat melted away, a firm bulge might be seen and felt beneath the areola, and they simply want to be flatter. In other cases, there can be an asymmetry – more fat was removed on one side than the other, or for some reason the contour is not ideal or symmetrical. Finally, men with very glandular types of gynecomastia, particularly ones that might be related to medications, marijuana, or steroid use, may return after future use of those substances.
I have every major type of liposuction available in my operating room: tumescent, syringe, power, and ultrasonic. Too much is made about comparing these techniques to one another. The differences between the methods is far less important than the skill of the surgeon. Perhaps ultrasonic liposuction achieves a better total yield of fat removal with a bit more skin tightening, but the difference is subtle. However when doing a revision of a previous gynecomastia surgery, ultrasonic liposuction seems to have a definite advantage. The problem with ultrasonic liposuction is that it does require a slightly longer incision. If a man has a place to hide the scar, such as a stretch mark, or if he has hair on his chest to cover it, I am more inclined to use the ultrasonic. I often use more than one technique on each patient, and I will discuss with you before surgery which method(s) would give you the best result in my hands.
No. SmartLipo™ has been entirely debunked as having been just marketing hype. There is no paper ever published that objectively describes any advantage to it. The scars are just as large; it is just as invasive; it is just as painful; and no skin contraction has been documented. And there has been nothing at all published specifically on the treatment of gynecomastia with SmartLipo™.
The scarring depends upon what needs to be done: liposuction, excision, or both. If it is liposuction alone, there is usually a ¼” scar along the border of the areola. Through that, we suck fat out of that breast and from the opposite breast. Usually, however, it is necessary to make one other incision if the surgeon removes glandular tissue. This technique requires that a small peri-areolar incision, or a half-circle incision around the lower half of the areola, be made. In most cases the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However within 6 months to a year most scars fade to the point where you cannot distinguish them from your normal skin.
In almost all situations, it is also treated with removal of the gland through an incision around the areola and with liposuction. Even with fairly extreme cases of gynecomastia, the skin shows a powerful ability to contract. But there are some extraordinary cases in which skin does need to be removed – essentially doing a breast lift. When a patient has a lot of laxity and I am concerned that this is a possibility, I will discuss it ahead of time. But because the extent of skin contraction is so great, I typically do not do a skin excision at the same time as the removal of the gynecomastia. I will do an excision of the gynecomastia with liposuction, place a drain, have the patient wear good compression, and then come back and reassess, only doing the lift later, which is rarely necessary. Breast lift scars on a man can be very unsightly, and are often more cosmetically debilitating than a bit of skin laxity, so we try to avoid breast lift scars on a man at all costs.
The objective in the surgical treatment of gynecomastia is to make the chest proportional to the rest of the torso. If a man is significantly overweight, it would look odd to make the chest totally flat; if a man is very thin, then the chest should be quite flat. With less fat over the pectoralis muscle, treatment of gynecomastia should make it so that the pectoralis muscles are easier seen aftersurgery. Your efforts in the gym will now show through without gynecomastia hiding the shape of your muscles.
While it is better to do plastic surgery when someone is at their ideal weight, true gynecomastia does not fluctuate much with weight. The rubbery, glandular tissue of true gynecomastia is gland tissue. It can be affected by hormones and drugs, but is not affected much by body weight. Body weight just affects fat. So if there is a lot of fat in your chest, then weight fluctuations can affect the chest. The question to ask yourself is this: is your chest out of proportion to the rest of your body? If it is, then you at least should consider speaking to a plastic surgeon.
Every plastic surgeon has a different routine they want patients to follow before gynecomastia surgery. Usually, patients are asked to quit smoking and stop all aspirin containing products. In addition, herbal remedies that can thin the blood or increase anesthetic risks are terminated. Your surgeon will give you a specific list that they want you to follow.
Most patients take 3-4 days off work, but some go back a day or two later. For the first 48 hours after surgery, you will have a tight surgical vest over your chest, with foam padding underneath it. This stays in place for the first 48 hours. After that, the vest is removed and cleaned, and the foam is thrown away. There is no absolute rule on how much and for how long the vest must be worn, but it is clear that men who use the compression more definitely get better faster. The vest is bulky for some men, so a lot of guys get one of those tight lycra/spandex UnderArmour undershirts to wear under their clothing. I ask gynecomastia patients to wear compression for as much as they can tolerate for about the first month after surgery, but this varies according to their particular case. Stitches around the areola are dissolvable, and liposuction sutures are removed about 4-5 days after surgery.
Gynecomastia surgery is done as an outpatient. You need to have someone drive you home and stay with you the first day, but you do not need to stay in the hospital. Out of town patients who do not have anyone in the Los Angeles area to stay with can stay at the aftercare facility across the street, Serenity. But that is not because it is medically necessary; it is just for convenience.
Most patients say that they feel sore after gynecomastia surgery, akin to working out too hard or the day after getting punched hard in the chest. It is very uncommon for a patient to actually say that it was painful. A long acting pain medication is injected during the procedure, and that reduces pain quite substantially for the first 24 hours. You are also given plenty of pain medicine, and it works very quickly at eliminating any pain.
Some surgeons drain all the time; some none of the time. I usually do not put in drains unless there is a substantial amount of tissue removed and the skin is loose. The drain helps empty the fluid out of the space so that it can flatten out and heal. When I do use a drain, it is usually for just for a couple of days.
Although not absolutely essential, it appears that keeping good compression on the chest after male breast reduction surgery helps the swelling and bruising to go away faster. Whether the final result is any different – or you just get there quicker – is not entirely clear, because it is so hard to judge. But I encourage patients to have some form of compression over their chest for about 4-6 weeks after surgery. If you do not want to wear the surgical vest we give you, it can also be helpful to wear a tight, lycra/spandex type of an undershirt, such as the UnderArmour type of shirts that are popular with athletes today.