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Male Breast Reduction - Gynecomastia

Male Breast Reduction Surgery in New Jersey

If we thought about it long enough, nearly every single person in the world could think of some part of their body that embarrasses them.

But for some, embarrassing parts are more noticeable than others and this can lead to a 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.

Gyno surgery

To view our GYNECOMASTIA VIDEO, please click here.

Regardless of what it is called, it can cause many men social and psychological discomfort.

Men who suffer from Gynecomastia can opt to have male breast reduction surgery where  the gland or excess fatty tissue is removed, giving their chest a flatter, more masculine appearance. A male breast reduction is a much simpler version of 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.  As we gain more experience in gynecomastia surgery, the understanding of a good result changes from just reducing the volume to the shaping of the chest wall.  We have to look beyond just a volume issue, we need to consider the other anatomic structures for the best results.

When I assess a gynecomastia patient, I consider 5 main things:

    1.    Amount of excessive breast tissue
    2.    Location of breast tissue an amount of fatty tissue under 
           the breast tissue.
    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.

So, what causes gynecomastia?  Here are my thoughts about 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 the TV without seeing some form of ED or testosterone remedy.  With a significant increase in testosterone supplementation in this country, I expect the gynecomastia rates to increase accordingly.  In a sense, we are at the beginning of a 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, 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 for the gyncomastia procedure:

When I evaluate my gynecomastia patient, I choose my surgical procedure to better address the patients individual goals.

If there is a high volume of fatty tissue:  To remove an excessive volume of fatty tissue in a 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 important 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 may occur.

Power liposuction: Power liposuction for gynecomastia is similar to traditional liposuction, however 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 liposuction and it allows more precise removal of fatty tisssue.

MicroLiposuction: Microliposuction is similar to liposuction. The surgeon uses a cannula that is a size or two smaller than the usual cannula.  The idea is that  the smaller cannula requires more passes but creates more even appearance.  I am not sure how significant this would be in larger gynecomastia cases but for smaller cases, this is important.

Laser Assisted Liposuction.  The option I prefer is SMARTLIPO. The 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 compared to other methods. The downside with laser technologies is the swelling may stay a bit longer.

VASER Assisted Liposelection.  First of all, it is different from liposuction. The Vaser literally liquifies fat cells. The 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.

If there is breast or glandular tissues:  The breast or glandular tissue in gynecomastia patients is too tough to be removed with liposuction or laser or VaserThere are only two techniques to address this; 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 in gynecomastia surgery. A small oscillating loop blade, that is usually used to shave excessive cartilage in the knee, is used to shave off the excessive glandular tissues which achieves the same result as the traditional method without an incision underneath the areola.

If there is excessive skin in gynecomastia surgery.  There are three ways to decrease or tighten the stretched out skin: 

  • Let it shrink on its own,
  • Tighten it with laser, Vaser, ultrasound or Fadiofrequency
  • 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.

Shape and size of the 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 reduction surgery the nipple of larger side needs to be brought to symmetry with the 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, this is enough. 

If the desired size cannot be achieved with skin relaxation alone, then the following two techniques can be used:

  • Closed purse string
  • Formal incision around areola

The incision around areola is known as mastopexy and depending on shape of removed skin, the incision can be called crescent or doughnut.

Shape and size of the nipple: This is, perhaps, one of the most under-appreciated areas of gynecomastia or male breast reduction surgery.  As the result of a male breast reduction, the tissue volume and sometimes the nipple muscle is 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 surgery, I commonly preserve the muscle and then restore the youthful appearance of the nipple itself by rebuilding its volume.  If the patient is concerned with the final nipple shape and volume, the open approach, or open excision of glandular tissue is needed to achieve excellent results and restore the volume and projection of the nipple.

VASER chest wall sculpting is the next step in gynecomastia surgical techniques.  The final shape and definition of the chest can be further improved with Vaser Liposelection.  If you have read about Vaser Hi Def procedure on the web, I perform a 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 define the chest wall.  With liposuction most surgeons just remove the excessive volume of fatty tissues.  In most cases, the surgeon 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. 

There is a significant difference in Vaser chest wall sculpting versus traditional liposuction or even traditional Vaser assisted liposuction.

Potential 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.

However, in most cases a combination of liposuction and excision are used, especially if there is excess of both fatty and glandular tissue. Dr. Volshteyn also uses a special reconstruction technique to preserve the shape and elevation of the nipple.

If you would like more information on our gynecomastia procedures or to schedule a consultation, please call our office today at 732-641-3350.  We look forward to speaking with you.
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Dr. Volshteyn is a board certified Plastic Surgeon, who is specialized in reconstructive and plastic surgery.

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