breast reduction (male) surgery

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Gynecomastia (male breast enlargement) is a very common condition. It occurs in up to 60% of adolescent boys and young men. It may also develop later in life. In most cases, there is no apparent cause for the development of the male breast tissue, although it can occur as a side-effect of some medications, significant weight gain, or from some medical conditions. Gynecomastia is a medical term that comes from the Greek words for "woman-like breasts". While the condition is quite common, it is rarely talked about. Men often feel self-conscious about the condition, and it can lead to teasing, embarrassment, and social trauma, causing men to avoid situations that may require that they remove their shirt, such as beaches and athletic activities.

Causes of Gynecomastia

Abnormal breast development may occur in as much as 60% of adolescent boys, due to natural fluctuations in hormone levels. In these cases it often resolves spontaneously, so no treatment is recommended in this age group unless the gynecomastia is quite severe. An evaluation by your primary physician is recommended prior to considering treatment for gynecomastia, to evaluate your general health, as well as to be certain there are no underlying testicular hormone disorders or liver abnormalities causing the gynecomastia. Excessive alcohol consumption or marijuana use can cause male breast development. Other drugs, such as anabolic steroids, herbal hormonal supplements, and cimetidine (Tagamet) have been known to cause gynecomastia.

Treatment of Gynecomastia

If a specific cause for gynecomastia can be determined, then this should be addressed by your primary physician or an endocrinologist. In most cases, no specific cause can be determined, and often, even treatment for an underlying cause does not produce full resolution of the gynecomastia. Surgical treatment is then the only way to address the gynecomastia. The best candidates are healthy, emotionally stable men. Surgery is often deferred in adolescents unless the gynecomastia is very severe, as it may resolve spontaneously.

Two types of surgery are utilized for the treatment of gynecomastia – liposuction (often utilizing ultrasonic liposuction) and direct excision. Frequently both treatment modalities are used together to obtain the best results.

The Plastic Surgeons at Edina Plastic Surgery are experienced and skilled in the treatment of gynecomastia. Your surgeon will evaluate you at the initial consultation, including history and risk factors, and work with you to develop the best treatment option for your individual case. If the excess tissue is mostly soft, fatty tissue, liposuction alone may be a good option. This can be performed through small incisions along the lower edge of the areola, and/or the lateral or lower chest. If the excess tissue is dense and glandular, then excision will be required (often performed along with liposuction). This is done through an incision along the lower half of the areola. The scars from these incisions typically fade very well, and often become nearly imperceptible.

Potential incision sites using liposuction

Periareolar incisions used for excision of gynecomastia

If the overlying skin is loose, it may not adequately tighten after the excess tissue is removed. In these cases, excision of some of the overlying skin may be recommended, although this does produce more significant, visible scars.

Excision of excess skin is occasionally required

Resulting scars

Drain tubes are sometimes placed, to be removed within several days of the procedure.
These surgeries are most often done under a light, general anesthesia, in which you sleep through the entire procedure and feel no pain. Small cases may be done under local anesthesia, although there is some discomfort associated with the local anesthetic injections. At Edina Plastic Surgery, we have a fully certified ambulatory surgery center on site, where these procedures are performed with your safety, comfort and privacy as our priorities.

Risks

All surgeries have some associated risk. Scars are inevitable, although the scars from gynecomastia treatment usually fade to the point of being nearly imperceptible. Suboptimal scarring can, however, occur. Bleeding or infections are also risks of all surgical procedures. Occasionally a fluid collection develops where the tissue was removed, and this can require drainage. Contour irregularities or asymmetry can also occur. Revision of the surgery could be required for optimal results. Swelling after surgery is normal, and it takes at least 6 months to obtain the full result from surgery, although much of the improvement is apparent by 4-6 weeks.

After your surgery

You will likely be wrapped with a compressive dressing after surgery. You will be able to go home a short time after your procedure and will need someone to drive you. Generally, rest is recommended the first several days after surgery, although we encourage some walking. You may return to work within several days if the work does not involve physical labor. We recommend no heavy lifting, pushing, or strenuous activity for approximately 3 weeks after the procedure. You may then gradually return to full activities. A light compressive garment may be recommended for you to wear for several weeks after the procedure to minimize swelling. Some swelling is normal, and while a very good improvement is usually apparent by 4-6 weeks, full improvements are not seen for up to 6 months.

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