If we thought about it long enough, nearly every single person in the world could think of some part of their body that embarrassed them.
But for some people, their embarrassing parts are more noticeable than others and this can lead to great degree of self-consciousness and embarrassment. One such feature that plagues anywhere from 40 to 60 percent of men is Gynecomastia, or female-like breasts.
It is estimated that over 50% of males over 50 and over 70% of males over 70 have some form of gynecomastia.
Gynecomastia is usually created by one of two things: excess breast tissue or excess glandular tissue. Some men can also experience it from excess fatty tissue and this is called pseudoGynecomastia. In most men gynecomastia consists of both - breast tissue and fat.
To view our GYNECOMASTIA VIDEO, please click here.
But regardless of what it is called, it can cause many men social and psychological discomfort.
Men who suffer from Gynecomastia can opt to have a Male Breast Reduction Surgery where excess fatty tissue or gland is removed, giving their chest a flatter, more masculine appearance. Male Breast Reduction is a much simpler version than a female breast reduction and it is less expensive and requires less time to heal.
Some patients and, unfortunately, physicians, might feel that gynecomastia surgery is a very simple procedure. It is not complicated, however, it is not simple either. As we get more experience in gynecomastia surgery, the understanding of a good result changes from just reducing the volume to shaping of the chest wall. We have to look beyond just a volume proble, we need to consider other anatomic structures for best result.
When I look at Gynecomastia patients I look at 5 main things:
1. Amount of excessive breast tissue
2. Amount and location of breast tissue an amount of fatty tissue under
the breast tissue ball.
3. Amount of excess skin
4. Size, shape, position and symmetry of the areola
5. Size, shape and symmetry of the nipple itself
Most surgeons perform liposuction alone. For many patients it may work well but in my mind, it may not be enough for a good result.
If you have more questions about gynecomastia surgery, please contact our practice.
My Thoughts About Gynecomastia
So, what causes Gynecomastia? Common causes include obesity, subtle hormonal or metabolic imbalances, and liver disease (which can cause hormonal imbalance). Some medicines and supplements can cause it as well, especially steroid abuse and street drugs.
These days you cannot turn on a game on TV not to see some form of ED or testosterone remedy. With significant increase in testosterone supplementation in this country, I expect the gynecomastia rates to increase accordingly. In a sence, we are at the beginning of gynecomastia epidemic.
I am a proponent of safe testosterone supplementation, but I feel that currently promoted non-supervised use of it is not appropriate. In many males testosterone will convert to estrogen and create side effects, like gynecomastia, for example.
As mentioned above, Gynecomastia can appear as excess breast or fatty tissue or as excess glandular tissue, or both. The type of Gynecomastia may dictate the appropriate remedy: removal of excess tissue with liposuction, excision, or a combination of both. Depending on nipple and areola size and shape, additional procedures may be needed.
My Guidelines about the Procedure
When I look of what to do for my gynecomastia patient, I choose my surgical procedure to better address the patients individual goals.
Dealing with volume of fatty tissue. To remove excessive volume of fatty tissue in gynecomastia patient we can use a variety of techniques: liposuction, power liposuction, tickle liposuction, laser liposuction (aka Smart Lipo) and Vaser liposelection. Please note, that none of these techniques can remove glandular breast tissues.
Liposuction. If the Gynecomastia is created from excess fatty
tissue, liposuction can be the preferred first method of removal. The
excess tissue is removed through an incision placed in the armpit or
around the nipple, or underneath the fold. The improtant part is to
remove the fat not only from the lower part of the chest wall but also from
the lateral chest and outer aspect of the muscle, otherwise, indentation
Power liposuction. Power liposuction for gynecomastia is similar to
liposuction but the cannula oscillates back and forth during liposuction
process. The principle is the same but the removal process is a bit
more gentle then traditional liposuctionj and it allows more precise removal
of fatty tisssue.
MicroLiposuction. Microliposuction is similar to liposuction but the surgeon
uses the cannula a size or two cmaller then usually. The idea is that smaller
cannula requires more passes but creates more even appearance. I am not
sure how significant that in larger gynecomastia cases but for smaller ones
it is important.
Laser Assisted Liposuction. The option I prefer is SMARTLIPO.
Laser vaporizes fat tissues and removes the excess volume. The benefit
is that it is more gentle in removing fat cells and it also allows
ADDITIONAL SKIN TIGHTENING compatred to other methods. The downside
is that with laser technologies swelling may stay a bit longer.
VASER Assisted Liposelection. First of all, it is different from liposuction is
that Vaser "liquifies fat cells" literally. I would compare it to "shaking a tree
before picking apples up". Vaser loosens up fat cells from surrounding
connective tissues and they turn into "buttremilk type liquid" in front of our
eyes. We still use liposuction to remove this liquid but it is much more gentle
and Vaser also allows ADDITIONAL SKIN TIGHTENING.
Dealing with breast or glandular tissues. The breast or glandular tissue in gynecomastia patients is too tough to be removed with liposuction or laser or Vaser. There are only 2 techniques of dealing with it. Traditional excision and endoscopic excision.
Traditional Excision. If the Gynecomastia is created from excess glandular
tissue, the tissue may need to be excised. An incision is made along the edge
of the areola (the dark part of the nipple). The gland is then removed and the
sutures are placed along the incision.
Endoscopic Excision, aka Scarless Gynecomastia surgery. This is an elegant
way of using orthopedic technology to use in gynecomastia surgery. A small
oscillating loop blase is isually used to shave excessive cartilage in the knee.
By using the same device we can shave off the excessive glandular tissues
and get to the same result as open method avoiding incision inderneath
Dealing with excessive skin in Gynecomastia surgery. There are 3 ways to decrease or tighten the stertched out skin:
let it shrink on its own,
tighten it with laser, Vaser, ultrasound or Fadiofrequency, or
excise it with surgery.
Most of the time we do not have to cut extra skin any more, except in more
extreme cases. My preference is to use a combination of Laser and Vaser
to allow both fatty tissue removal and skin tightening. Occasionally other
non invasive methods can be used to further tighten the skin after surgery.
Dealing with Shape and Size of areola. In many Gynecomastia patients areolas are rarely discussed. Most patients with unilateral Gynecomastia have areola enlargement only on one side. When we perform unilateral Gynecomastia or Male Breast ReductionSurgery the nipple of larger side needs to be brought to symmetry with normal side. Sometimes it can be quite challenging, especially of the patient chooses to have a scarless method. If the patient has Gynecomastia on both sides, then both sides need to be treated. There are several ways to treat stretched out areolas. One is to allow tissues shrink naturally. In many mild cases it is enough.
If the desired size cannot be achieved with skin relaxation alone, then 2 techniques can be used:
closed purse string or
formal incision around areola.
The incision around areola is known as mastopexy and depending on shape of removed skin can be called crescent or doughnut.
Dealing with shape and size of the nipple. This is, perhaps, one of the most under-appreciated areas of Gynecomastia or Male Breast Reductionsurgery. As the result of Male Breast Reduction, or Gynecomastia or Male Breast Reduction Surgery the tissue volume and sometimes the nipple muscle are removed. As the result the nipple loses its shape and ability to function. I call it splayed nipple.
It is important to recognize that for many patients the shape and size of nipple are very important also. As a part of Gynecomastia or Male Breast ReductionSurgery I commonly preserve the muscle and then restore youthful appearance of the nipple itself by rebuilding its volume. If the patient is concerned with final nipple shape and volume, the open approach, or open excision of glandular tissue is needed to achieve excellent results and restore the vilume and projection of the nipple.
VASER Chest Wall Sculpting is the NEXT STEP IN GYNECOMASTIA surgery. The final shape and definition of chest can be further improved with Vaser Liposelection.
If you have read about Vaser Hi Def procedure in the web, I perform similar procedure focused on the chest wall and further improved definition of the chest wall. This is a technique of selective fat sculpting. Traditional liposuction usually removes excessive fatty tissues from the chest wall but it DOES not artfully defines the chest wall. With liposuction most surgeons just remove volume of excessive fatty tissues. The surgeon usually is trying to leave an even thickness layer of skin and fatty tissues on top of the muscle.
Chest wall sculpting is a bit different. With Vaser liposelection, some areas of the chest wall are left a bit fuller or thinned out more on purpose, in order to create or truly sculpt a chest wall that the patient could rarely get on his own.
That is a difference in Vaser chest wall sculpting versus traditional liposuction or even traditional Vaser assisted liposuction.
Risks and Complications
As with all surgical procedures, there is the possibility of some risks. While they don't happen often, some of the risks include excessive bleeding, bruising, hematoma, asymmetry and scarring. Following your physician's pre- and post-op instructions will help you heal and minimize any other complications.