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Gynecomastia Correction (Male Breast Reduction)

Gynecomastia is defined as the presence of excessive tissue in the male breast causing it to look more feminine than masculine.  Gynecomastia can be divided into three categories: (1) true gynecomastia where there is overgrowth of breast tissue, (2) pseudogynecomastia which is caused by excessive fat in the breast area, and (3) combination gynecomastia which is the presence of both excessive breast tissue and fat.  In each case the male chest begins to look more like a woman’s breast, thus the name since gyne refers to a female and mastia is a breast.

In all cases of gynecomastia the object of the surgery is to remove the excess tissue and reveal the underlying muscle of a man’s chest.

Most men have experienced gynecomastia of puberty when the teenage body begins to pump out testosterone in relatively huge amounts and the growth spurt begins.  This large volume of male hormone causes a temporary surge in the female hormone estrogen as the testosterone is metabolized into its component parts, part of which is estrogen.  The result is tender nipples and temporary enlargement of the nickel-sized breast tissue immediately under the nipple/areola.  Young teenage boys love to tease their peers unmercifully when gynecomastia of puberty is visible.  Thankfully this condition is self-limited and will resolve in time, usually.   But in some the enlargement becomes permanent and the embarrassment escalates into a lifetime of hiding behind concealing clothing so that no one will know about this life-altering secret.

The chubby child frequently develops feminine-like breasts even before puberty due to excess body fat and in some it just never goes away.  As a man, hiding this condition becomes a lifetime goal and interferes with most athletic involvements and with social interaction.  Many men have told me that they have dieted and hit the gym to reduce this condition but unfortunately it only made the breast enlargement more prominent and so they have packed on the fat in an effort to camouflage the breasts.

In older teens and adults, the use of recreational drugs, particularly marijuana, frequently causes enlargement of breast tissue and even breast tumors.  The same is found in the use of anabolic steroids taken to bulk up the muscles of body builders.  Older men often find that the tissue of the chest area thickens and begins to sag.  Frequently medications that are metabolized in the liver cause estrogen-like derivates to form resulting in gynecomastia of older men.

Whatever the cause, once puberty is past, the only way to correct this condition (at this time) is through surgery.

 

Before Surgery

Gynecomastia is said to affect more than 50% of men by the age of 50.  It is most devastating in the older teen and young adult male.  By the mid-20’s, it will have imposed a pattern of life that is difficult to break even after the surgery for correction is done.  Older men who develop gynecomastia later in life tend to fare better as their lifestyles have been set for many years and the condition is accepted more easily.  Still in any man who has enlarged beasts, it is an embarrassment.

The consultation for gynecomastia correction will review all of the above factors and attempt to isolate the cause.  One condition not mentioned above is an endocrine abnormality such as a tumor which is producing excessive sex hormones.  This is a very unusual condition and while it is certainly to be ruled out during the consult and accompanying physical exam, it is not the likely cause.

Those patients with longstanding gynecomastia and extreme enlargement of the breasts present a more challenging problem, excessive skin due to stretching.  Scars on a man’s chest are always obvious and I will do pretty much anything to avoid making an incision on the skin of a man’s chest.  This may mean removing the excess breast tissue and fat, then waiting to allow the skin to shrink as much as possible, then doing a secondary operation to re-drape the skin into a more satisfactory arrangement.  Most of the time this is not necessary, and most of the time if it is necessary the results are good, but some of the time not even this can correct excess skin stretch and the resulting sagging of the skin.

Before surgery there are lab tests, a preop history and physical examination, and other things that must be done to prepare the patient for the operating room.  All of this will be discussed during the consultation.

The Surgery

The correction of gynecomastia is now made much easier as liposuction has been added to our techniques.

The fat of the chest/breast can be removed with liposuction and should the condition be pure pseudogynecomastia, correction is complete and there are essentially no scars. 

If the enlarged breast is due to combination gynecomastia, liposuction will remove the surrounding fat leaving behind the actual breast tissue as that tissue cannot be suctioned out.  The breast tissue then is removed through a small incision made around the lower ½ of the areola, an area that heals exceptionally well. 

If the problem is true gynecomastia with only breast tissue enlargement, the treatment is removal of the breast tissue through the areola incision.

Your surgery will be done at the IAS Surgery Center.  Anesthesia will be provided by a Board Certified Anesthesiologist.  The time in the operating room will vary depending on the technique outlined above and the amount of tissue to be removed but averages 1.5 to 2.5 hours.  At the end of the procedure, you will be placed into a compression vest which will be worn for 2-6 weeks depending on your specific condition and healing rate.  At the end of the operation, you will be transported to the Recovery Room to awaken.

Post Surgery and Recovery

Most gynecomastia corrections are done as an outpatient, meaning that the patient may go home immediately after awakening in the Recovery Room and making certain that the patient is stable.  At that point a responsible adult may take you home (if you live within a hour of the Surgery Center) where you are to spend the next 24 hours in bed snoozing. 

Sleeping or snoozing for a day is the best way to get off to a good recovery and rapid healing.  Pain is usually not severe.  Prior to surgery you will be given prescriptions for pain med's and antibiotics which you will begin once you are at home.  For a week, no driving the car, usually no work, no partying, no lifting or reaching.  Take a vacation from all that!  You will have been given a 2 page instruction sheet when surgery was scheduled with before and after surgery instructions and you must follow those instructions exactly.  Nobody wants a complication and these instructions have been specifically designed to prevent postop complications.

Your postop visits will usually be at 5 days postop, each week for the next couple of weeks, at 6 weeks, 3 months, at 6 months and 1 year.  The skin incision will heal in about 10 days but the interior area will require 6 weeks to heal.  Warm soaks to cover the chest will help in getting rid of swelling.  All of these things will be covered in your instruction sheets.  Photographs will be taken frequently.

Risks & Complications

This is a surgical procedure and therefore complications may occur.  I can’t imagine how many times I have said this to patients during the consultation.  Frequently about this time, a glaze comes over the eyes and the patient “tunes out”.  Risks of surgery and possible complications are not the most pleasant thoughts when you are concerned about surgery but my advice, pay attention.  The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period.  Simply reaching over your head to get something in the early postop period stretch the pec major muscle and stretching the muscle can cause bleeding or a hematoma that sets off a string of complications.  The list of usual complications and their causes are covered in detail at the consultation so listen attentively.

The Cost

When budgeting for gynecomastia surgery, remember there is the fee for the surgeon,  the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, postop vest, etc.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

 

 

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