Gynecomastia / Male Body Contouring
Patients present to my Beverly Hills office for gynecomastia symptoms and diagnoses weekly. Gynecomastia is referred to as a benign enlargement of the male breast with increased amounts of glandular tissue behind the nipple areolar complex as well as increased fatty tissue extending along the chest wall. Etiologies of gynecomastia can include the use of alcohol, marijuana, steroids, testosterone use and a multitude of other medications. The majority of patients with gynecomastia will require surgical intervention if they desire to have this corrected completely. The treatment of gynecomastia will obviously depend upon each individual’s desires as well as the extent of this disorder. Only Board Certified Plastic and Reconstructive Surgeons should perform gynecomastic surgery as the specifics and details of this operation requires skill and understanding of the functional anatomy of the male chest.
It is also 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.
The following pictures show patients with variable Tanner levels from mild, moderate and severe gynecomastia requiring either direct liposuction, liposuction with direct partial subcutaneous retroareolar mastectomy and lipo mastectomy subcutaneous partial and breast skin lifting.
Men, similar to women, have weight fluctuations throughout their years. We obviously see more women for lipo contouring and abdominoplasty due to the birthing process and the effects of pregnancy with not only the diastasis of the rectus muscle, but as well as the increased skin laxity after the significant stretch effect of the lower abdominal wall. Men, however, can also have significant weight fluctuations, weight gain and loss, leading to a significant apron of skin. These patients do well with paniculectomies or abdominoplasties. We have taken care of many male patients who have undergone gastric bypass procedures, including laparoscopic banding, Roux En-Y and VBGs and which at this time they are now left with a huge over-draping of skin and the abdominal paniculectomies are performed in a similar fashion to that as their female counterpart. A large incision is made from the suprapubic hairline regions extending bilaterally to the anterior superior iliac spine or hip region. Circumferential incision around the umbilicus is also made and all the redundant tissue is undermined and dissected up to or just below the level of the ribcage subcostal margin. The scarring is significant and it is the tradeoff for a panniculectomy or abdominoplasty in men in a similar fashion to women. Men, however, may have more hair-bearing areas which may actually help to cover some of the lower scarring in a favorable manner. Lipo contouring of men is on the rise. In fact, we see an increased number of men every week in Beverly Hills for lipo contouring. Small localized deposits of fat in the iliac crest rolls, hip or muffin-top areas is very amendable to liposuction and does quite well. A belt lipectomy is the most common procedure men desire. This is simply removing fat below the belly button up to the suprapubic region and extending along the hip. This is a belt liposculpture procedure which we perform under the tumescent liposuction technique. First, the infiltration of tumescent fluid with lidocaine, epinephrine and sodium chloride is infiltrated. This reduces bruising, bleeding, pain control and allows for a more even flow of suctioning and smoothing out through the feathering process.
Our patients present for liposuctioning of the belt lipectomy areas often with a combination of gynecomastic procedures where they have increased lipo fat of the chest area and a gynecomastic partial subcutaneous mastectomy under the chest wall. These men are extraordinarily happy with the results of the total body transformation. The fat in men is often a little bit thicker and a little more rigid, especially in the lower abdominal and the iliac crest or hip area. Therefore, it is quite amenable to lipo and there is less risk, in my thoughts, of contour deformity or irregularity to the skin.
Good skin tone is always the most important variable associated with liposuction. Spot liposuction can be performed on body builders that have specifically localized areas of small amounts of fat that are bothersome. Using small 1.6 and 2 mm cannulas allow for very localized control of suctioning these areas and smoothing them out without contour irregularities or deformities that would be critical.
All-in-all, liposuction of men, body contouring procedures due to an increase in laparoscopic banding and weight loss procedures and gynecomastia in general, is a more common procedure now than ever. Men do extraordinarily well and in fact their healing time seems to be significantly less than their counterpart females in that the men normally have minimal pain postoperatively and get back to work within 72 hours.