As many as 6 out of 10 men are affected
by gynecomastia, or male breasts

• Has massive weight loss left you with loose, sagging chest skin?
• Have your breasts enlarged with age?
• Do you wear a t-shirt, even at the beach?

Gynecomastia is rarely discussed, though it affects 40% to 60% of men, according to the American Society for Aesthetic Plastic Surgery (ASAPS). More and more men are turning to plastic surgery to correct this condition.

ASAPS statistics show a 71.2% increase in the number of men undergoing surgery for gynecomastia between 1997 and 2008. In 2008, 19,124 men had surgery to treat this all-too-common condition.

What is gynecomastia?

Gynecomastia is a condition where the male breast is enlarged by excessive glandular tissue. It may affect one of a man's breasts or both.

Is every case of male breast enlargement
due to gynecomastia?

No. There is also a condition called pseudo-gynecomastia, characterized by excessive fat tissue. Unlike men with gynecomastia, patients with pseudo-gynecomastia have a normal amount of glandular breast tissue. Pseudo-gynecomastia is often found in:

• Older men
• Younger, overweight men
• Men with massive weight loss following bariatric surgery

What causes gynecomastia?

Possible causes of gynecomastia in normal-weight men include:

• Drug side-effects
• Heredity
• Certain medical conditions

In many cases, the cause of gynecomastia is unknown.

How does plastic surgery treat gynecomastia?

Male breast reduction surgery removes fat and/or glandular tissue from the breasts, resulting in a chest that is flatter, firmer and better-contoured. In extreme cases, the surgery involves removing excess skin to achieve a more masculine chest.

Who is a candidate for gynecomastia surgery?

Surgery to correct gynecomastia should be performed on healthy, emotionally stable men. Age is not necessarily a consideration; however, the best candidates have firm, elastic skin that will reshape to the body's new contours.

Surgery is not recommended for overweight men, as the problem may correct itself through diet and exercise. Men who drink alcoholic beverages in excess, or regularly smoke marijuana are not good candidates, nor are those who take anabolic steroids. These drugs can contribute to gynecomastia.

Smokers are never good candidates for any surgery, as smoking decreases circulation and interferes with proper healing.

What if only one breast is enlarged?

In rare cases, a single enlarged breast could be caused by breast cancer. If you have one enlarged breast, Dr. Rappaport will recommend that you have a mammogram to rule out breast cancer before you proceed with gynecomastia surgery.

How is gynecomastia surgery performed?

Surgery for gynecomastia is most often performed as an outpatient procedure. It is usually done under general anesthesia and takes about an hour and a half to two hours.

Glandular tissue may first be removed with a scalpel, either alone or in conjunction with liposuction. The incision is usually made along the edge of the areola, the darker skin surrounding the nipple. Usually the scars are inconspicuous, but their size depends on the amount of tissue and skin removed. The same incision is used for both tissue removal and liposuction.

In cases of pseudo-gynecomastia, you will likely have liposuction to remove the fat. As in the case of glandular tissue, the incision will be under the arm or around the perimeter of the areola, but is nearly imperceptible.

In the case of extreme amounts of fat or glandular tissue, some skin may have to be removed for the remaining skin to properly drape over the new chest contour.

What does recuperation after gynecomastia
surgery involve?

Most patients have some discomfort after surgery, but this is easily controlled with pain medication. Swelling and bruising are common. The swelling can be reduced by wearing an elastic pressure garment for several weeks after surgery.

It may take six months to a year to see the final results. Stitches are removed one to two weeks after surgery. Most patients can return to work two days after surgery if their job does not involve physical activity. Heavy exercise is discouraged for at least three weeks.

Are there other ways to treat gynecomastia?

In some cases, liposuction in surrounding areas or a
breast lift is appropriate.

Dr. Rappaport answers questions
about gynecomastia

What is involved in the initial consultation?

“You will be asked to bring your medical history to your personal consultation so we can review it together. Because underlying conditions such as liver disease, use of estrogen medications or steroids have been linked to gynecomastia, I will examine both your history and your chest to rule out these obvious causes. If I detect a medical problem, I will refer you to an appropriate specialist.

“Depending on the degree of fat and glandular tissue involved, we will discuss the best surgical approach for you. I will also take the time to answer your questions.”

What kind of scars will I have after
gynecomastia surgery?

“You can expect a two- to five-millimeter scar at the bottom of the areola or lateral chest wall when the procedure involves only liposuction of the fatty tissue. An extended scar along the areola might be necessary if additional breast tissue must be removed.”

When can I go out in the sun?

“This is a very important question. Sun can permanently affect the skin's pigmentation, causing the scars to turn dark. In any case, it is advisable to use a strong sunblock (SPF 30 or greater) and be cautious.”

Can I develop gynecomastia again?

“Male breast reduction is permanent. However, significant weight gain or exposure to drugs and steroids can affect the size of your breasts.”

How do I know if I need a breast lift
along with a reduction?

“A breast lift may be appropriate, depending on the amount of breast tissue and loose chest skin you have. In some cases, it is necessary to remove not only fat and breast tissue, but excess skin as well. When I examine you during your consultation, I will advise you on the procedures I recommend for you to achieve your desired result.”

What are the risks and complications
of gynecomastia surgery?

“Every surgical procedure carries a certain amount of risk. Complications associated with gynecomastia are infrequent and usually minor. These risks include infection, skin injury, excessive bleeding, an adverse reaction to anesthesia and excessive fluid loss or accumulation.

“Gynecomastia surgery can also result in noticeable scars, permanent pigment changes or slightly mismatched breasts or nipples. Some patients experience temporary loss of breast sensation (rarely permanent) or numbness.”