Gynecomastia is a procedure to reduce enlarged male breasts. This condition is quite common and it affects as many as 40% of the male population. Gynecomastia may affect only one or both of the breasts. The majority of the cases have no known cause while the others might be related to the use of drugs or medical conditions. Gynecomastia can be caused by excessive glandular breast tissue, fat, or a combination of the two. For men who feel self-conscious about their over sized breasts, this procedure can help restore self-confidence and appearance.
- Healthy, emotionally stable men of any age
- Men who have firm, elastic skin that will reshape well after surgery
- Obese or overweight men who have not attempted to correct the problem with diet and exercise
- Individuals who consume excessive amounts of alcohol and / or marijuana. These drugs along with anabolic steroids may cause Gynecomastia.
The treatment of gynecomastia will obviously depend upon each individual’s desires as well as the extent of this disorder. It is vital that all pathological specimens be sent to pathology for investigative purposes to rule out any form of atypia or cancer. In the majority of patients a direct incision under the periareolar can be performed in a similar fashion to placing a periareolar implant. Dissection can then be made leaving a cuff of glandular tissue behind the nipple areolar complex to prevent concavity or depression deformity. Subsequently, this wedge of tissue can be meticulously and carefully resected with electrocautery. Once this has been completed, tumescent lipectomy of the chest can be performed using a Klein needle to infiltrate the tumescent fluid, including Lidocaine, epinephrine and sodium chloride or Lactated Ringer’s solution. At this time I prefer a 2.6 mm blunt tip triple lumen Mercedes cannula to sculpt the entire chest wall extending to the anterior axilla along the lateral pectoral border up to the infraclavicular and along the parasternum. Very meticulous and even distribution suctioning should be performed to prevent any contour deformities.
Patients who present with all different Tanner IV stages can be candidates for liposuction alone or liposuction with combined direct partial subcutaneous mastectomy and in severe Tanner IV cases, patients may undergo breast lifts in order to remove skin using a formal mastopexy similar to women who require breast lifts for severe skin laxity.
Treatments for adolescent gynecomastia can once again include inferior pedicle reduction mammoplasty and can be unilateral or bilateral subcutaneous mastectomies when severe. Patients must be aware and considerate of the scarring when performing any form of mastopexy skin excision in a male chest. The milder cases can undergo direct lipectomy and liposuction with the moderate cases requiring partial subcutaneous direct excision of tissue using a periareolar approach.
Gynecomastias should be performed under general anesthesia with a Board Certified Anesthesiologist.
All anesthesia is performed by Board Certified anesthesiologist, Dr. Hoffman.
Laryngeal mask airways can be used in the majority of the patients. However, those who have a history of reflux or gastroesophageal disease are usually better candidates for endotracheal tube intubation. This should be discussed with your Board Certified Anesthesiologist.
Surgery Time Table
- Patient is started on an intravenous antibiotic.
- Gynecomastia surgery takes between one - two hours.
- Recovery Room
- At least one hour. This is a requirement of federal law in Medicare.
- After Surgery
- Oral antibiotic, ice pack, chest wrap and pain medication
- Postoperative Visit
- All dressings are removed and replaced. A chest compression garment is worn.
- Day 7 Follow Up
- Evaluate incision and change out dressings
- Days 8 - 14
- Sutures are removed. Dressings are changed twice a day.
- Days 14 - 21
- Light activies can resume - no heavy lifting.