Surgical Options
All About Gynecomastia:
There are two methods for treating male chest enlargement: liposuction and excision. In the pre-liposuction era, the only thing to do was to cut out the tissue (“excision”), usually using a small incision around about half the diameter of the areola. This worked great when there was a small and well-demarcated and circumscribed gynecomastia mass under the areola. But it didn’t work well when there was fat spread throughout the chest. Liposuction is ideal for the reduction of fat, because fat is soft and is easily removed through the liposuction instrument (much like a straw.) However, firm and glandular gynecomastia tissue cannot be removed by liposuction; it needs to be excised. (If you are interested in seeing what this looks like, refer to the section of the Photo Gallery titled, “What Gynecomastia Looks Like.”
How do we know what we will do? The preoperative physical exam is often very helpful in revealing what will need to be done to reduce a man’s chest so that it looks the way that he wishes it to look. On one extreme, imagine a very thin man, who has just a little puffiness deep to his nipple; other than that the chest is flat. When feeling the chest, a very firm and well-delineated mass can be felt beneath the nipple. So with no excess fat distributed throughout the chest, and a firm, well-circumscribed mass that is too firm to be removed by suction, excision through an incision around the areola would be the method for reducing his chest.
On the other extreme would be an overweight man who has diffuse fat throughout his whole body, but with disproportionately more in the chest area. His whole chest feels evenly smooth and spongy, with no discernable discrete mass beneath his areola. Since fat is best removed with liposuction and he has no firm tissue that needs to be excised, he would best be treated with liposuction alone.
Most men are somewhere in the middle: they have some fat, but they also have some firm glandular tissue that can only be removed with excision. Oftentimes in the operating room, once the fat is removed, the mass of glandular tissue can be more easily felt. It is kind of like a chocolate bar with almonds in it; once the chocolate is melted away, the almonds become more visible.
So we usually have a discussion before surgery. Some men want to be “as flat as possible,” and so we go into surgery knowing that we will do both suction and excision. Others want to have the excision only if I determine during surgery that it will make a noticeable difference. In these cases, we start with the suction, and if I can feel or see a bulge after I am done with the suction, then I proceed to do the excision.
Gynecomastia Surgery - Male Breast Reduction
It is undesirable because it makes men reluctant to take their shirt off. Some wear two shirts everyday just to conceal it. Even thin men who work out regularly at the gym and otherwise have put the effort into developing bodies that would look good in tight shirts and sweaters cannot do so. Gynecomastia can make men who are just a few pounds overweight look much heavier than they really are.
In the past, gynecomastia surgery was mostly done on teenage boys sent to plastic surgeons by their pediatrician. Weightlifters that developed gynecomastia from steroid or supplement use learned about surgical options from reading muscle magazines or from trainers at the gym.
But in the past few years, the treatment of gynecomastia has finally become mainstream. It is not just the weightlifters and teenagers with the really bad cases seeking male chest reduction; it is the men in their 20s and 30s with just enough extra tissue in their chest for them not to look as good as they should.
Unlike women who talk to one another about their breast augmentation or liposuction, men do not talk to one another about gynecomastia. They hide it under their clothes, and so even their best friends are often totally unaware. Once fixed with surgery, they go forward with their lives as if they never had it. But thanks to the Internet, men can now privately research words such as, "gynecomastia," "male breast reduction," "males breasts," "man boobs," "male chest reduction," etc., and learn that there is a very effective solution.
There are two methods for treating male chest enlargement: liposuction and excision. In the pre-liposuction era, the only thing to do was to cut out the tissue ("excision"), usually using a small incision around about half the diameter of the areola. This worked great when there was a small and well-demarcated and circumscribed gynecomastia mass under the areola. But it didn't work well when there was fat spread throughout the chest. Liposuction is ideal for the reduction of fat, because fat is soft and is easily removed through the liposuction instrument (much like a straw.) However, firm and glandular gynecomastia tissue cannot be removed by liposuction; it needs to be excised. If you are interested in seeing what this looks like, refer to the section of the Photo Gallery titled, "What Gynecomastia Looks Like."