Gynecomastia: Effective Male Breast Reduction

Male breast reduction surgery: what is it?

Male breast reduction surgery, also known as gynecomastia surgery, is a procedure to reduce breast size in men by removing excess fat, tissue, and skin from the breasts. Typically performed to correct overdeveloped or enlarged breasts in men, a condition known as gynecomastia. This surgery aims to flatten and enhance the chest contours, and in severe cases, may also involve improving the position and size of the areola and reducing excess breast skin. Hormonal changes, heredity, obesity, or specific drugs can all contribute to gynecomastia. The surgery is considered an effective treatment for gynecomastia and can help men feel more confident and alleviate discomfort or pain associated with excess breast tissue, especially during physical activities. The procedure can be safely performed on both teenagers and adult men. Typically, gynecomastia surgery is performed as an outpatient procedure under general anesthesia or local anesthesia with sedation.

How common is gynecomastia?

Gynecomastia, the abnormal, non-cancerous enlargement of one or both breasts in males, is a relatively common condition. The prevalence of gynecomastia varies across different age groups:

• In neonates, the prevalence of asymptomatic gynecomastia is 60% to 90%
• In adolescents, up to 70% of boys may experience gynecomastia to some degree, with 75% of cases resolving within two years of onset without treatment.
• In men aged 50 to 69 years, the prevalence of gynecomastia can be up to 70%.

Overall, gynecomastia is considered a common benign disorder of the male breast tissue, with a significant prevalence in various age groups

What are the causes of gynecomastia?

1. Hormone imbalance: An imbalance between the sex hormones testosterone and estrogen is a common cause of gynecomastia. An increase in estrogen or a decrease in testosterone can lead to breast tissue growth.
2. Medications: Certain medications can cause gynecomastia as a side effect, such as some antidepressants, antibiotics, chemotherapy drugs, prostate cancer medications, ulcer or cardiovascular medications, anabolic steroids, and antiretroviral medicines. The list (3) includes: Eplerenone (Inspra)

• Spironolactone (Aldactone)
• Chlorpromazine (Thorazine)
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Perphenazine (Trilafon)
• Thioridazine (Mellaril)
• Trifluoperazine (Stelazine)
• Aripiprazole (Abilify; Abilify Discmelt)
• Asenapine sublingual tablets (Saphris)
• Clozapine (Clozaril; Fazaclo)
• Finasteride (Propecia; Proscar)
• Iloperidone (Fanapt)
• Olanzapine (Zyprexa; Zydis, Zyprexa Relprevv)
• Paliperidone (Invega; Invega Sustenna)
• Quetiapine (Seroquel; Seroquel XR)
• Ziprasidone (Geodon)
• Cimetidine (Tagamet)
• Digoxin (Lanoxin)
• Efavirenz (Sustiva)
• Estrogen use
• Ethanol (Alcohol)
• Ketoconazole (Nizoral)
• Methadone
• Saw Palmetto (Serenoa repens)

3. Health Conditions: Gynecomastia can be associated with various health conditions, including liver diseases, kidney disease, lung cancer, testicular cancer, tumors of the adrenal glands or pituitary gland, tumors, and some congenital disorders. Additionally, obesity and aging can also contribute to the development of gynecomastia.
4. Substance Abuse: The use of illegal drugs such as marijuana, anabolic steroids and heroin can also cause gynecomastia.
5. Newborn and Puberty: Gynecomastia can affect newborns due to exposure to estrogen from the mother. Gynecomastia is also common during puberty due to hormonal fluctuations. In most cases, gynecomastia in newborns and during puberty resolves on its own.

It's important to consult a healthcare provider for an accurate diagnosis and appropriate management of gynecomastia, especially if it causes discomfort or is associated with underlying health conditions or medication use.

Pros and cons of male breast reduction surgery

Pros:

Increased confidence and the ability to feel more comfortable revealing the chest.

- Alleviation of physical discomfort, such as pain, tenderness, and chafing associated with enlarged male breasts.

- Permanent results, provided that a stable weight is maintained.

- Safe outpatient procedure, typically performed under general or local anesthesia with sedation.

However, it's important to consider the potential drawbacks and risks, which include:

Cons:

- Scarring, although efforts are made to create small and well-concealed incisions.

- The surgery does not provide toned pectoral muscles, and maintaining results may be impacted by future weight gain.

- Possible complications include bleeding, infection, changes in sensation, and the need for further surgery in some cases.

It's essential to discuss the risks and benefits with a board-certified plastic surgeon and carefully consider whether the procedure is the right choice, as nonsurgical methods may also be effective depending on the underlying cause of gynecomastia.

What are the different types of male breast reduction surgery?

There are two main types of male breast reduction surgery:

1. Liposuction: This technique removes excess fat and glandular tissue from the breasts. It involves using a narrow cannula to suction the excess tissue through small incisions. Liposuction is ideal for treating male breast enlargement due to excess fatty tissue, especially when there is no significant skin laxity. (3)
2. Surgical Excision: This method involves the direct surgical removal of excess breast tissue and skin. It is suitable for moderate to severe gynecomastia and when there is excess skin laxity requiring skin excision and repositioning of the nipple-areolar complex. The incisional scar varies and will be clarified by your plastic surgeon before the operation.

In some cases, a combination of liposuction and surgical excision may be used to address the specific characteristics of gynecomastia. The choice of technique depends on the individual's condition and is determined during a consultation with a board-certified plastic surgeon.

What are the risks and benefits of surgical excision for male breast reduction?

The surgical excision for male breast reduction, also known as gynecomastia surgery, offers several benefits and carries certain risks. Some of the benefits include:

-Improved Confidence: The surgery can help men feel more confident about their chest, allowing them to be more comfortable revealing it.

-Alleviation of Physical Discomfort: Gynecomastia surgery can address pain, tenderness, and chafing associated with enlarged male breasts, improving overall physical comfort./p>

-Permanent Results: Gynecomastia surgery provides permanent results if a stable weight is maintained, eliminating the need for follow-up procedures.

However, there are also risks and potential drawbacks to consider, including:

-Noticeable Scars: The surgery will result in scars, although efforts are made to create small, well-concealed incisions.

-Impact of Future Weight Gain: While the removed breast tissue and fat do not typically return, future weight gain can affect the results.

-Possible Complications: These can include noticeable scars, permanent pigment changes, infection, skin injury, and mismatched nipples.

Recovery time for gynecomastia surgery

The recovery time for scars after male breast reduction surgery can vary, but the general timeline for scar maturation and recovery is as follows:

• 2 Weeks: The incisions will heal in about two weeks, but the scars will continue to mature for up to 1 year.
• 2 Weeks: The incisions will heal in about two weeks, but the scars will continue to mature for up to 1 year.
• 2 Weeks: Most men will be back to their usual selves and be able to engage in light exercise in moderation. At the end of the second week, you should be able to sleep on your side if your plastic surgeon approves.
• 3-4 Weeks: Any swelling and bruising will almost disappear, and the garment worn during this time will have reduced the chances of long-lasting scars.
• 6 Weeks: The area will not be exposed throughout this time this minimizes scarring because a compression garment is typically worn for six weeks.
• 3-6 Months: Results are permanent, but it may take about three to six months for the breast tissue to heal and for swelling to decrease. It can take a few months for scars to fade to a natural color, but by this time, they will be lighter, flatter, and softer until they are significantly unnoticeable.

Following your plastic surgeon's post-operative instructions carefully is important to promote proper healing and scar maturation. Factors such as the surgical technique used, genetic makeup, and aftercare can also impact the extent of scarring.

What are the psychological effects of male breast reduction surgery?

Gynecomastia can cause psychosocial issues such as anxiety, depression, and low self-esteem. Studies have shown that even mild cases of gynecomastia can lead to a downturn in psychological health, impacting how males perceive themselves and their self-esteem. The condition can also lead to feelings of embarrassment and a desire for restored confidence, which can result from bullying or negative comments. Gynecomastia surgery can improve body image, increase self-esteem, and improve quality of life and psychological health. Often patients report feeling more confident, comfortable, and masculine following the procedure. The surgery can also help alleviate physical discomfort associated with enlarged male breasts, such as pain, tenderness, and chafing, which can further contribute to improved psychological well-being.

Choosing the best plastic surgeon for gynecomastia surgery

To find a qualified plastic surgeon to complete your gynecomastia surgery, choose a board-certified plastic surgeon who is a member of reputable organizations such as the American Society of Plastic Surgeons (ASPS). These plastic surgeons have met rigorous standards and are highly trained in performing gynecomastia surgery. The ASPS website provides a search tool to find board-certified plastic surgeons in your area.

Dr. J. Timothy Katzen has performed hundreds of male breast and reduction surgeries, specializing in reconstructive surgery after massive weight loss. Schedule your consultation with an experienced board-certified plastic surgeon here. Dr. Katzen is making appointments for initial consultations with prospective patients interested in gynecomastia surgery. During the individualized consultation you have scheduled with Dr. Katzen, he will address any concerns you have and go through what to anticipate during the treatment. If indicated, Dr. Katzen will try to seek authorization from your insurance company for coverage.

Appointments with Dr. Katzen may be made in person at his locations in Beverly Hills, Nevada, Las Vegas, Nevada, and Dubai, United Arab Emirates. In addition, patients can visit with Dr. Katzen virtually using the video conferencing applications FaceTime, Skype, Zoom, or WhatsApp.

Call at (310) 859-7770 or email [email protected] to take your first step towards male breast reduction surgery.

Citations

1. Danker, Sara, and Lauren M. Yarholar. “Gynecomastia treatment through open resection and pectoral high-definition Liposculpture.” Plastic & Reconstructive Surgery, vol. 150, no. 5, 2022, https://doi.org/10.1097/prs.0000000000009580.
2. Rasko, Yvonne M., et al. “Surgical Management of Gynecomastia: A review of the current insurance coverage criteria.” Plastic & Reconstructive Surgery, vol. 143, no. 5, 2019, pp. 1361–1368, https://doi.org/10.1097/prs.0000000000005526.

“What Are the Most Common Medications That Can Cause Gynecomastia (Breast Enlargement and Tenderness) in Males?” EBM Consult, www.ebmconsult.com/articles/what-are-the-most-common-medications-that-can-cause-gynecomastia-breast-enlargement-and-tenderness-in-males. Accessed 20 Dec. 2023.

Before and After Photos: Gynecomastia