'High-Definition Liposculpture' Offers New Option for Men With Gynecomastia

Summer's coming, and for most guys that means shirts are coming off – at the beach, the pool, or the jogging path. But some men are embarrassed by the way their chest looks due to the common problem of gynecomastia, or male breast enlargement.

For a more attractive, athletic appearance, a growing number of men are consulting plastic surgeons. In 2019, member surgeons of the American Society of Plastic Surgeons (ASPS) performed breast reduction in more than 24,000 men with gynecomastia – a 19 percent increase compared to 2000.

Amid growing interest in surgery for male breast enlargement and new and evolving surgical techniques, gynecomastia treatment has been challenging, with concerns about "aesthetic and unnatural results." Over the past decade, Colombian plastic surgeon Alfredo E. Hoyos, MD, has been developing aesthetic approach to gynecomastia surgery, including targeted liposuction to perform "pectoral etching."

In a new paper, Dr. Hoyos and colleagues present their experience and results with a new approach to treating male breast enlargement – combining high definition liposculpture, pectoral muscle surgery and/or fat grafting, tailored to the individual patient. The report appears in the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the ASPS.

The experience included 436 men, aged 18 to 62 years, treated for gynecomastia (or "pseudo-gynecomastia") between 2005 and 2019. Treatment was targeted to the specific causes of breast tissue enlargement as well as the men's body type. Key steps in Dr. Hoyos' approach include:

• High or "dynamic" definition liposculpture – removing deep fat deposits under and adjacent to the pectoral muscle. Liposuction includes artistic sculpting of the surface fat, emphasizing "negative spaces" that contribute to definition of the pectoral muscles, based on the artistic anatomy of the male chest.
• Gynecomastia resection – surgical removal of excessive glandular tissue. This is carefully done using an "inverted omega-shaped incision" (℧) around the nipple. The use of tiny "stealth" incisions avoids unpleasant scarring, which can occur with more conventional incisions.
• Fat grafting – transferring fat from another part of the body to enhance the chest area. This is done to create a more athletic appearance, particularly on the upper portion of the pectoral muscle.

High-definition liposculpture efficiently removed the breast gland tissue in seventy percent of men, while open resection to remove the gland was required in 30 percent of patients. Fat grafting was performed in 65 percent of patients. (Most of the men underwent torso liposuction, sometimes including abdominal "six-pack" etching, at the same time as gynecomastia surgery.)

"A new athletic and muscular appearance of the male chest was successfully achieved through gynecomastia resection and dynamic definition liposculpture," Dr. Hoyos and coauthors write. In a follow-up survey, the results were rated "excellent" by 76 percent of men and "above expectations" by another 17 percent.

Minor complications (such as persistent swelling and bruising) occurred in 3.2 percent of patients and major complications (such as blood collections or localized infections) occurred in 1.6 percent. There were no medically serious complications.

While the evaluation suggests good aesthetic outcomes and patient satisfaction, the researchers emphasize the need for further studies to assess the long-term results – including the survival of fat grafts. "Gynecomastia resection through inverted omega-shaped incision and dynamic definition liposculpture are safe and reproducible techniques for the management of male patients with chest contour defects," Dr. Hoyos and coauthors conclude. "Multilayer fat grafting and high-definition liposculpture are fundamental to ensure a natural athletic appearance."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture"

Article: "Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture" (doi: 10.1097/PRS.0000000000007901)