Gynecomastia is a condition of enlarged breasts that affects men of all body types. There is typically some increased breast gland but most men also have associated fatty tissue surrounding this as well. The amount of fat and breast tissue can resemble female breasts in heavier or obese men so there are degrees of severity of the condition. It is caused by an unusual sensitivity of the breast tissue to circulating hormones. Environmental effects may also contribute to this. Anabolic steroids and marijuana have been associated with gynecomastia as well.
The American Society of Plastic Surgeons, of which I am a member, has seen an increase of male breast reduction procedures of 36 percent since 2000. In the past five years, our office has also seen a significant increase in the number of men requesting surgery for this. Many millennial men are seeking treatment. Men are affected psychologically. Their self-esteem can be controlled by this issue. The embarrassing term, “man boobs” can cause men to hide their chest in a “T” shirt. There is the idea that it can be exercised away but it doesn’t really change that much when you work out, even with a muscular chest. You may see some loss of fatty tissue but not in proportion to this in other parts of the body and the breast gland is not going away. In obese or heavier men, the fatty tissue of the breast will go down with weight loss but this can leave loose skin with partially deflated breasts.
Gynecomastia is typically treated with liposuction and in most cases, breast gland removal as well. The fat is removed through small hidden incisions, usually along the side of the chest. I typically remove the breast tissue gland through a small incision within the areola, (the brown skin around the nipple) that hides the scar nicely.
I use the SmartLipo Triplex, laser assisted system to produce skin tightening and assist in fat removal. The breast tissue is sent to the pathologist for evaluation to rule out the rare possibility of cancer. Four percent of breast cancers are found in men.
Severe forms of breast enlargement may require a full excision of a ring of skin or “donut” around the areola or even a breast lift in cases of massive weight loss. All attempts are used to minimize scars though. Most patients will have minimal discomfort following the procedure which is done under general anesthesia in our AAAASF Accredited, State Licensed, office based ambulatory surgical center, (ASC) on an outpatient basis. A compression vest is used for two weeks but the downtime is minimal and most men can be back in the gym in a month following surgery.
If the male enlarged breasts primarily consists of fatty tissue, then liposuction is generally used. If enlarged glandular tissue is the main cause, then it may be cut out by the plastic surgeon. This ablation may be performed by itself or in conjunction with liposuction.
During a gynecomastia procedure, an incision is made on either edge of the nipple areola. Sometimes the underarms are used instead. The surgeon will cut away the glandular tissue, additional fat and sometimes the skin from around the nipple areola. Some reductions involve the removal of a large amount of breast tissue and skin which may leave a more prominent scar. However, generally, scars are usually minimized in this procedure.
When liposuction is to used, a small cannula is inserted into the incision and fat is sucked out with a vacuum pump.
Where liposuction is only used in treating gynecomastia, the plastic surgeon will usually make a very small incision on the edge of the nipple areola or sometimes under the underarm area as well. In cases like this the surgeon may opt to use local anesthesia instead. Most patients report that there is very little discomfort and pain while under a local anesthesia.
Male breast reduction surgery for gynecomastia is generally performed on an outpatient basis. Rarely is an overnight hospital stay recommended. Surgery for this procedure is typically an hour and a half, however, more extensive male breast reduction surgery may take longer in some cases.
Male breast reduction may be performed under general anesthesia or local anesthesia with sedation. Dr. Stephens will discuss anesthesia options with the patient once they have decided upon surgery.