Also known as male breast reduction
The goal of gynecomastia treatment is to reduce breast size in men who are embarrassed by overly large breasts. Reduction methods include liposuction, cutting out excess glandular tissue or using a combination of liposuction and excision. If you are treated by a board-certified plastic surgeon, gynecomastia can be effectively and safely improved or corrected completely. Most teenage boys experience some degree of breast enlargement affecting one or both breasts. However, by early adulthood less than 10% have a residual problem. This incidence rises with age, reaching approximately 30% (1 in 3) in older men. Rarely, the breast enlargement can be caused by medicines (for high blood pressure, heart disease and prostate cancer), drugs (such as marijuana and anabolic steroids), some diseases (such as liver failure and some cancers) and some very rare congenital abnormalities (errors of development that one is born with). These causes should be excluded by the surgeon during an initial consultation. Additional information will be needed at this consultation regarding overall health, chest size and body shape, previous chest surgery, any bleeding tendencies and healing capabilities, some of which will be affected by smoking, alcohol and various medications.
When to Consider Gynecomastia Treatment
- If you are reluctant to remove your shirt in public, to swim, to participate in sports or to exercise at a gym.
- If you want to improve your overall body proportions.
- If you experience psychological discomfort associated with large breasts.
- If you want to increase your social confidence.
- You can feel comfortable revealing your chest contours, clothed or unclothed.
- You can gain more social confidence.
- You can enjoy permanent results.
- Scarring may make you feel self-conscious.
- You may be disappointed with your final results.
- Weight gain following this surgery will compromise results.
These are the top three pros and cons to weigh when considering gynecomastia treatment. If you want to focus on what is unique to you, please consult with your aesthetic plastic surgeon.
Gynecomastia is usually not caused by any serious medical problems; in fact, its cause is rarely identified. However, because there are some medical problems that do cause gynecomastia, your first step is to see your family doctor to rule this out.
A. Diet and exercise-resistant fat in the chest area can cause both physical and social discomfort.
B. Maintaining a stable weight will ensure that your improved body contour will be long lasting.
The following are some common reasons why you may want to consider gynecomastia treatment:
- You are unhappy with the size or appearance of your breasts.
- You experience physical discomfort because of your breasts.
- You have good skin elasticity. Successful gynecomastia surgery involves adequate skin contraction after your excess skin is surgically removed. Your skin may lack the necessary elasticity for good contraction if you are age fifty or older, have significant sun damage, have breasts with a lot of stretch marks or have undergone gastric bypass surgery.
- You have first tried diet and exercise to reduce your breast size.
- You are not significantly overweight. Although surgery will help this patient population, the results will not be as good. For this reason, you should try to get within thirty to forty pounds of your ideal body weight before surgery.
- You do not use marijuana, steroids or drink alcoholic beverages excessively (it is theorized that these substances may cause gynecomastia).
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
How is a gynecomastia procedure performed?
The goal of gynecomastia surgery is to restore a normal male breast contour and to correct deformities of the breast, nipple or areola. Surgical options include liposuction, excision (surgical removal of tissue) or a combination of both approaches. Glandular breast tissue is denser than fatty tissue and is not appropriate for liposuction.
- The choice of surgical technique depends on the likelihood of skin redundancy after surgery. Skin shrinkage is greater in younger than older patients.
- The most common approach is the intra-areolar incision, or Webster incision, which extends along the circumference of the bottom half of the areola in the pigmented portion.
- The length of your incision will be based on your anatomy.
- In severe gynecomastia, skin resection (surgical removal of part of an organ or structure) and moving the nipple (nipple transposition) may be necessary.
- Minimally invasive gynecomastia surgical procedures have gained popularity. In the “pull-through technique,” a very small incision (approximately 5 mm) is made at the areolar edge. Following liposuction, the glandular tissue from the overlying areola is pulled through the incision. The major advantage of this procedure is the smaller incision. This technique is used in well-selected patients.
- Ultrasonic liposuction has improved the results of gynecomastia correction. In liposuction-assisted breast reduction, there is less compromise of blood supply, nipple distortion and areola slough. In addition, postoperative complications are fewer with this technique than with open surgical resection; however, liposuction-assisted breast reduction is not effective for correcting glandular gynecomastia. The fatty and glandular components of your breast must be assessed before surgery. Few patients can be sufficiently treated with liposuction only.
What are my options?
Enlarged breasts may be excess fatty tissue (pseudogynecomastia) rather than breast tissue and, in this case, can often be improved with diet and exercise alone. To treat the puffy nipples associated with gynecomastia, you will probably need liposuction combined with chest reduction using glandular excision. If you’re considering gynecomastia surgery, a board-certified plastic surgeon will determine the best course of treatment based on your physical presentation, i.e., your options will be determined by your condition .
What will my gynecomastia incisions and scars be like?
Scars resulting from gynecomastia surgery vary, depending on the amount of breast tissue you have and the elasticity of your skin. Even those who have larger breasts and tend to get larger scars are usually quite satisfied with the results.
- If you have small breasts that are only fat, then your scars will be tiny (just large enough to admit a liposuction cannula).
- If you have large female-like breasts, then the scars may extend across each side of your chest, but your surgeon will attempt to hide them in a crease.
- With firm breast tissue, there is usually a scar under the areola.
- If the areolas are large and need reduction also, then the scar goes all the way around the areola.
A. Small incisions for liposuction treatment are placed in hard to see areas on and around the chest.
B. If surgical excision is required, the incision is commonly made under the areola.
Select a surgeon you can trust
It’s important to choose your surgeon based on:
- Education, training and certification
- Experience with gynecomastia surgery
- Your comfort level with him or her
Members of the Iranian Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure.
After finding a board-certified plastic surgeon in your area who is experienced in performing gynecomastia surgery, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
Your initial consultation appointment
During your initial consultation, you will have the opportunity to discuss cosmetic goals. Your surgeon will evaluate you as a candidate for gynecomastia surgery and clarify what a gynecomastia procedure can do for you. Understanding your goals and medical condition, both alternative and additional treatment may be considered .s
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions?
- Past and present medical conditions.
- Have you had any previous surgeries?
- What are your current medications and vitamin and herbal supplements?
- What is your current use of alcohol, tobacco and recreational drugs?
- What is your history with any noninvasive cosmetic procedures?
- What outcome do you expect from the surgery? What is your chief motivation in undergoing gynecomastia surgery?
Your surgeon may also:
- Ask you to look in a mirror and point out exactly what you would like to see improved.
- Take photos for your medical record, using computer imaging to show improvements you can expect.
- Evaluate your health status, including pre-existing health conditions or risk factors.
- Evaluate the elasticity of your skin.
- Discuss your options and recommend a course of treatment.
- Discuss likely outcomes, including risks or potential complications.
- Discuss the type of anesthesia that will be used.
Your treatment plan
Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:
- An approach to your surgery, including the type of procedure or combination of procedures.
- The outcomes that you can anticipate.
- Your financial investment in the procedure.
- Associated risks and complications.
- Options for anesthesia and surgery location.
- What is needed to prepare for the surgery.
- What you can expect to experience after surgery.
- Show before-and-after photos of cases similar to yours and answer any questions.
Questions to ask your aesthetic plastic surgeon
For a general list of questions to ask your surgeon about his or her background, to find out about plastic surgery safety and to plan your procedure.
We developed these questions to help you:
- Make the most informed and intelligent decision about your procedure.
- Confirm that you have the right surgeon for your procedure.
- Make your initial consultation as rewarding as possible.
- Understand your options, potential outcomes and risks.
It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation:
- Am I a good candidate for gynecomastia surgery?
- Are the results I am seeking reasonable and realistic?
- Do you have before-and-after photos I can look at for the procedure I am undergoing?
- Will my scars be visible? Where will my scars be located?
- What kind of anesthesia do you recommend for me?
- What will be the costs associated with my surgery?
- What will you expect of me to get the best results?
- What kind of recovery period can I expect and when can I resume normal activities?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?
How do I prepare for a gynecomastia procedure?
Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.
If you are older than 45 years, or have heart disease, you should have a preoperative EKG. Get medical clearance from your internist or specialist, especially if you have heart disease, low blood count, or any other medical condition. You cannot have liposuction if you are anemic. If your surgeon recommends weight benchmarks or lifestyle changes, do your best to achieve them to ensure the best results. Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and critical outcomes.
In advance of your surgery, your surgeon will probably ask you to:
- Avoid sunbathing for two weeks before surgery. Tanning your chest skin can potentially increase the risk of permanent scarring.
- Quit smoking and nicotine use at least four weeks before surgery since nicotine can impair and delay healing. This includes any nicotine patch or nicotine-containing product.
- Two weeks before surgery, stop all aspirin-containing products, medications that contain blood thinners (Ibuprofen Motrin, Advil etc.), vitamin E and herbal supplements, including St. John’s Wort, green tea, Gingko and garlic supplements. You may take one multivitamin a day.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
- Let the doctor know if you develop an illness, cold or any skin infection in the chest area within a week of surgery.
- Make sure all requested lab results and doctors’ clearances are submitted.
- Schedule time off work, approximately one week; two weeks if your job is labor intensive.
- Gynecomastia is usually performed on an outpatient basis. Make sure a responsible adult is available to drive you to and from surgery and that someone is available to stay with you around-the-clock for 24 hours after surgery. If you don’t have such a person, let your surgeon know in advance so arrangements can be made for an after-care facility or hospital.
- Your doctor will advise you to purchase surgical chest compression garments ahead of time, which you should bring to your surgery. You will wear these over a tee shirt, following surgery, for a time specified by your doctor.
- Have some comfortable shirts available to wear during the first four weeks after surgery. These need not be larger in size, just comfortable.
- Tend to all of your chores before your surgery, so you don’t have to worry about taking care of things during your recuperation. You are not allowed to engage in heavy lifting for several weeks after surgery.
- If you routinely have your chest hair removed, avoid doing this for two weeks before and six weeks after surgery.
- Prepare plenty of reading and movie-watching material to keep you occupied while you recover.
- Place toiletries and easily prepared foods and snacks in areas where you will not have to lift or reach.
- Place plenty of fluids and all medications, including over-the-counter antacids, at your bedside.
What can I expect on the day of gynecomastia surgery?
Your gynecomastia surgery may be performed in an accredited hospital, free-standing ambulatory facility or office-based surgical suite. Most gynecomastia procedures take at least one to two hours to complete but may take longer.
- Medications are administered for your comfort during the surgical procedure.
- General anesthesia is commonly used during your gynecomastia procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
- For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- After surgery, you will be taken into a recovery area where you will continue to be closely monitored.
- Wear comfortable and loose clothing the day of surgery. It is helpful to wear tops that open in front and loose sweat pants.
- Check the fit of your compression garment in advance and bring it with you the day of surgery.
You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postoperative care, including information about:
- Drains, if they have been placed
- Normal symptoms you will experience
- Any potential signs of complications
Immediately after your gynecomastia surgery
- Generally, you can expect to be bandaged, wearing a compression garment, and you may have a surgical drain.
- The first three postoperative days are critical in your recovery. You must be at full rest at home, but not necessarily in bed; sitting and watching TV or having meals in the kitchen or living room is permissible.
- Movements of the waist and elbow are acceptable, but you should curtail vigorous shoulder movement for the first few days. Lateral arm movements are generally permitted, but do not lift your arms up vertically. There are many variables; consult your plastic surgeon for more details.
When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. Contact your surgeon to find out if your pain, redness and swelling is normal or a sign of a problem.
Recovery time frame
Your recovery time after surgery for gynecomastia depends on how severe your condition is and what was performed for you. The average patient, treated with a combination of liposuction and breast gland tissue excision, will likely be back to work after a week. Gynecomastia surgery usually has a relatively gentle recovery period.
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
- Your first follow-up visit will probably be five to seven days after surgery. Your sutures will be removed at this time, as well as your drain if the discharge is diminished or has disappeared.
- How long you wear your compression dressing will be based on your surgeon’s assessment.
- In terms of exercise, be guided by your plastic surgeon. Generally, you may resume low impact activities at two to three weeks; you may begin gentle upper extremity progressive resistance exercises at three to six weeks.
- You will probably return to work within seven to ten days after surgery.
- Avoid strenuous activities for the first two to three weeks to ensure optimal healing.
- Pain tolerance varies from person to person. For many, the pain is moderate at best. When extensive liposuction is done, you may experience soreness equivalent to a day of exercise. You may be provided with a prescription for a painkiller, but most patients do not need more than extra strength Tylenol.
- You may be asked to apply Neosporin or other antibiotic ointments to the wound.
- Avoid exposure to direct sun or tanning for about six weeks, until bruising and most of the swelling subside.
- Sun rays will prolong swelling and may cause permanent discoloration. Sun exposure in the early stages can cause scars to become more noticeable later.
- Swelling and bruising are normal after surgery. Bruising can appear in various degrees, ranging from minimal to massive. It can be confined to the breast area or expand to the chest and abdomen. Bruising can appear as bright red, black, blue, purple or a combination of colors. It will increase in intensity over the first three to four days and then will diminish and become yellowish for another week or so. The discoloration will usually disappear in two to three weeks.
- As with most surgeries, you may notice a decrease in sensation in the area around the operated wound. This is usually more frequent in patients with enlarged male breasts that require significant liposuction. Most men find the temporary loss of sensation to be insignificant. Sensation returns after a year for most.
- In some patients with diminished elasticity (most commonly older patients) there may be excess skin or skin creases that are more noticeable postoperatively. Most of these creases will persist for six to twelve months and then diminish significantly, and the loose skin usually tightens.
- After male breast reduction surgery, there is a phenomenon of spontaneous shrinking of the entire areola. The diameter of the areola will decrease ten to fifty percent from the original size. This usually occurs when significant amounts of glandular tissue are removed.
- Be patient. It may be three months or more before the swelling abates and you can see the final results.
Gynecomastia surgical results are permanent, assuming your weight is stable. If your condition arose from the use of medication or anabolic steroids, further use could lead to recurrence.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes. Do not hesitate to contact your surgeon when you have any questions or concerns.
The cost of gynecomastia surgery varies from doctor to doctor and from one geographic area to another.
These numbers only reflect the physician/surgeon fees and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to surgery.
The biggest factors influencing surgical cost are the severity of your condition and the techniques your surgeon uses. In some instances insurance covers this surgery. When it is covered, requirements to get coverage are stringent. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training and experience—not cost.
Fortunately, significant complications from gynecomastia are infrequent. Your specific risks for gynecomastia will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in skin sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
Other risks specific to gynecomastia surgery are outlined below:
- Blood clots in the legs or lungs.
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your gynecomastia surgery.