Gynecomastia Surgery
Enlargement of the male breast is called Gynecomastia and is a fairly frequent finding. Over 50% of adolescents developed some degree of breast enlargement during puberty,but, for the majority of men this resolves. When breast enlargement does not disappear with maturation, enlargement of the male breast can occur and results in feeling self-conscious and embarrassed with breasts that appear somewhat feminine In many cases this can resemble fully formed female breasts. Sometimes, weight gain early in life can result in larger male breasts even after the majority of the weight is lost. Older men also suffer from fatty replacement of normal breast tissue and enlargement. While there are several underlying medical conditions and medications that can cause Gynecomastia, the majority of patients suffer from idiopathic Gynecomastia, which means that there is no definitive underlying cause. Patients who suffer from this condition seek a more masculine appearing chest. Unfortunately, insurance carriers rarely cover the removal of the men’s breast tissue unless it is causing symptoms or a result of an underlying pathology.
The type of surgery for male breast reduction necessary depends on the severity of skin excess that accompanies breast enlargement, the composition of the breast, or whether or not it is primarily fatty or primarily glandular. Liposuction alone is frequently the only necessary surgical means to remove it and this occurs when the tissue is primarily fatty or mixed glandular and fatty. This procedure would involve just a few small incisions and the use of ultrasonic-assisted liposuction to remove the excess fat. Sometimes additional breast tissue has to be removed after completion of the fat removal through an incision or small opening. More complicated procedures are necessary when excess skin is present and removal of excess gland or fat would result in significant excess skin giving the appearance of the very saggy breast envelope. In these cases, a mastectomy-type technique which involves some degree of scarring to remove the excess skin will be necessary. Decisions about incision location and type of removal have to be made during the Gynecomastia surgery consultation with a plastic surgeon.
The Procedure
The procedure is performed in our certified AAAHC surgical suite in most cases; unless, the patient has underlying health problems or their weight exceed our safety limit here at Raleigh Plastic Surgery Center. In these cases, the Gynecomastia surgeries are performed at Rex Hospital as an outpatient surgery. There is generally a compression vest placed after surgery and often a surgical drain to collect excess fluid during the first week after surgery.
The Recovery
Most men require one week off from work after Gynecomastia surgery, depending on their job description. Discomfort is moderate and does usually require pain medication. Swelling and bruising may be expected and resolves in several weeks. Activity is limited for the first four weeks and the use of a compression vest is necessary to maintain the ideal result. Return to vigorous activity in a gym is restricted for the first 4-6 weeks but then encouraged after recovery is complete to build the pectorals muscle back up to the desired athletic-appearing chest. Scars are usually kept to a minimum unless large amounts of excess skin have to be removed. Surgical taping and subsequent scar reducing creams are utilized to improve scar appearance. Major complications are rare.
FAQ
Q: I notice that my nipples only are swollen. Is this Gynecomastia?
A: Gynecomastia may involve just the sub-areolar tissue in which case the nipple area looks quite protuberant despite a normal appearing chest. This type of gynecomastia can be treated frequently with local anesthetic and simple excision through a small incision around the areola which leaves minimal scarring.
Q: Will I have scars?
A: The degree of scarring is dependent upon the degree of skin excess. With patients with female like saggy breasts liposuction alone is not effective in improving appearance. Skin removal is necessary and this cannot be completed without a resulting scar. In women, preservation of volume and lifting of the nipple is a goal and it is worth the surgical scars which are typically hidden to some degree. Men, however, desire a flat appearing chest and there is little option to hide the scars. Sometimes it is better to remove the nipples and replace them as skin grafts to allow for a better skin contouring procedure. The graft nipples will regain their coloration and projection however will not have sensitivity. This procedure is performed with patients with severe Gynecomastia.
