The ABCs of gynecomastia surgery – three components your plastic surgeon considers

Gynecomastia is the growth of breast tissue in men. There are several different causes of gynecomastia, and it is important to understand the probable cause and the extent of tissue growth in order to receive the most effective treatment. For patients struggling with this condition, gynecomastia surgery may be a treatment option.

Understanding your diagnosis

Gynecomastia involves the growth of glandular breast tissue, similar to breast tissue in females, and may be caused by an imbalance of hormones. Sometimes there is also increased fat or adipose tissue in the chest area, further contributing to the appearance of male breasts.

This condition can be normal in infants, adolescents undergoing puberty and in the elderly. In some men, gynecomastia of adolescence can persist into adulthood. Other known causes of gynecomastia include medications, steroids, marijuana, androgen (hormone imbalance) deficiency, testicular tumors, excess weight, liver disease and kidney disease.

Treatment options

Treatment options for gynecomastia include waiting for spontaneous resolution, discontinuing drugs or offending agents, medications, weight loss and surgery. Your doctor can help you decide which option is best for you.

Which patients are good candidates for surgery?

Patients who have completed puberty and have had persistent gynecomastia for more than a year are unlikely to have a full reversal of gynecomastia with medical treatment alone due to permanent fibrosis, and therefore are good candidates for surgery. Other characteristics that make someone a better candidate for surgery include:

• Overall good health
• Ability to stop agents contributing to gynecomastia
• Willingness to comply with post-operative care
• Realistic expectations
• Being able to complete a trial of medication treatment for gynecomastia

Patients who have breast tenderness, are unable to discontinue offending agents, and who have a medical condition that makes surgery unsafe should not undergo surgery for gynecomastia.

ABCs of gynecomastia surgery

Gynecomastia surgery involves the removal of excess tissue and possibly skin, and a plastic surgeon may remove three different types of tissue depending on the nature and extent of the gynecomastia.

• A: Adipose tissue (fat tissue) is removed in patients who have gynecomastia with excess fat tissue. This is accomplished with liposuction. The liposuction technique used in the chest area is the same as in other parts of the body. The plastic surgeon injects tumescent, which is a combination of saline, to stiffen the fat tissue, epinephrine, to decrease bleeding and lidocaine, to control pain. After tumescent is injected and the fat tissue is stiffened, the surgeon then inserts a small thin suction tube into one or more small incisions to remove the excess fat tissue. Liposuction is used in combination with breast tissue removal (described below) for patients with gynecomastia.
• B: Breast tissue (glandular breast tissue) is the main component of gynecomastia, and therefore its removal is the mainstay of gynecomastia reduction surgery. The surgical procedure usually involves a U-shaped incision at the edge of the areola. The surgeon removes excess glandular breast tissue through the small opening. Cases with larger amounts of glandular breast tissue may necessitate a larger incision.
• C: Cutaneous tissue (skin tissue) may be removed in patients who have excess loose skin after breast tissue and/or adipose tissue removal. Patients who have lost a lot of weight or patients who have large quantities of tissue removed are often left with sagging skin. To achieve a flat chest, excess skin is removed and the nipple-areolar complex is re-centered. This involves a larger incision beneath the nipple in an inverted "T" shape, which will leave a larger scar, but can create significant results.

Postoperative care

After your gynecomastia reduction surgery is complete, your surgeon will wrap your chest with dressings to facilitate optimal healing. Small tubes may be placed in your chest to drain excess fluid and minimize swelling. Your surgeon will discuss proper dressing care with you before you go home.

You will need to limit physical activity for at least two weeks after surgery, and limit upper body exercise for at least four weeks after surgery. It may take six months or longer for the swelling to go down completely and reveal your final result. You will have some scarring where incisions were made for the surgeon to get under your skin, which will heal to become less noticeable throughout the first year.