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Excess of male breast tissue is also referred to as Gynecomastia. This condition can present itself early in life, around puberty, or in the later phase, between 55 and 60 years of age. Although usually gynecomastia is not associated with any particular disease or condition, specific breast diseases should be ruled out in the evaluation of a patient with this problem.
Gynecomastia in young men is usually isolated, but may also be caused by some prescription and non-prescription drugs, alcohol, and anti-seizure medications.
In general, gynecomastia can be classified in three categories:
The anatomy of the male breast is not significantly different from that of the female breast. Usually the male breast tissue does not respond equally to change in hormones, but in some cases it can grow to sizes that can be signficant. In general, in the male breast anatomy, we can notice:
- Diffuse fat deposits
- Focal retro-areoloar glandular formation: This means that the breast gland is firm and focused to the area just behind the nipple.
- Standard breast anatomy with minor modifications
The problem can be corrected with minimally invasive procedures
The options in the treatment of gynecomastia usually involve some type of surgery, once the possible reasons of the increase in size are identified and more significant diseases are ruled out.
In general we prefer the “periareolar” approach for most cases of gynecomastia, because it allows a significantly smaller scar and equally good outcomes than other procedures.
The example on the left represents a periareolar incision used for male breast reduction procedure.
The incision size is approximately one inch, and it is usually closed with absorbable sutures that do not need to be removed.
Through the same incision, the chest area is also treated with liposuction to reduce the bulk of the tissue around the areola site.
Scars are usually well hidden and rarely present a problem.
The Procedure of Gynecomastia correction:
This procedure can be performed under local anesthesia or asleep, depending on personal patient preference.
First, an incision is made in the lower border of the areola: this incision allows access to treat the fat and breast tissue that constitute the gynecomastia, as well as inject the medication that helps to perform the liposuction and numbing the area. The “tumescent” solution is placed in the breast tissue and fat of the chest, and complete numbing of the area is obtained.
Following this phase of the gynecomastia correction, the entire breast area is treated with liposuction. We use a combination of SmartLipo and standard liposuction to allow for better skin retraction. In some cases, if the skin is more stretchy, Smartlipo may help in firming up the area and decrease bruising. Often, liposuction of the area around the breast toward the back is performed in conjuction with the treatment of gynecomastia to improve the general chest shape.
Following the liposuction, the remaining breast gland is more defined and can be directly reduced via the existing incision.
In general, to preserve skin tone and avoid indentation, a thin layer of tissue is left behind the areola.
With this technique, the breast tissue is removed and the breast mound is reduced completely to a flat surface directly over the pectoralis muscle. This procedure also increases definition of the pectoralis muscle.
Recovery and exercise
Following the procedure, a firm garment is worn for two to four weeks under normal clothes. Exercise should be restricted for one to two weeks, but after that we encourage normal exercise including full range stretching of the tissues of the pecs to improve smoothness of the outcome.
Exercising normally improves the blood flow to the area and decreases lumpiness and irregularities.
We also recommend a scar treatment protocol including vitamines, special lotion and silicone gel sheeting for two months, as we have found that with this approach the incisions heal very well.