Gynecomastia (Male Breast Reduction)
The goal of male breast reduction is to reduce breast size in men who are embarrassed by larger than normal breasts. Reduction methods include liposuction, excising excess glandular tissue or using a combination of liposuction and excision.
When to Consider Male Breast Reduction
- If you are reluctant to go without your shirt in public.
- If you want to improve your overall body contours.
- If you experience psychological pain associated with large breasts.
- If you want to increase your confidence.
Things to consider
- You can feel comfortable with your shirt off in public.
- You can gain more confidence.
- You can enjoy permanent results.
- Scarring around the nipple may make you feel self-conscious.
- You may be disappointed with your results.
- Weight gain following this surgery will compromise results.
These are the top three pros and cons to weigh when considering male breast reduction. If you want to focus on what is unique to you, please consult with Dr. Jensen.
Am I a good candidate for gynecomastia treatment?
Gynecomastia is usually not caused by any significant medical problems; in fact, its cause is rarely known. However, because there are some medical problems that may cause gynecomastia, your first step is to consult with your family doctor.
The following are some common reasons why men will consider gynecomastia treatment:
- You are unhappy with the size and appearance of your breasts.
- Your Breasts are uncomfortable when you exercise.
- You have good skin elasticity. Successful surgery involves adequate skin contraction after your breast tissue is surgically removed. Those at risk for poor skin contraction include; age fifty or older, have significant sun damage, have breasts with stretch marks or have undergone gastric bypass surgery.
- Diet and exercise has been unsuccessful in reducing breast size.
- You are not overweight. Although surgery can help this patient population, the results tend not be as good. You should try to get within thirty to forty pounds of your ideal body weight before surgery.
- You do not use marijuana, steroids or drink alcoholic beverages excessively (all of which contribute to gynecomastia).
If you are in good general health, have a positive attitude and realistic expectations, you are a good candidate for this procedure.
How is a gynecomastia treatment procedure performed?
The goal of surgery is to restore a masculine breast contour and to correct deformities of the breast, nipple or areola. Surgical treatments include liposuction, excision or a combination of both. Glandular breast tissue is denser than fatty tissue and is not removed by liposuction.
- The choice of surgical technique will also depend on the elasticity of your skin and likelihood of skin redundancy after surgery. Skin contraction is greater in younger than older people.
- Minimally invasive surgical procedures are the most popular form of treatment for gynecomastia. Dr. Jensen specializes in the “pull-through technique,” a very small incision (approximately 5 mm) is made at the base of the breast. Following liposuction, the glandular tissue from beneath the areola is pulled out through the incision. The major advantage of this procedure is the smaller incision. This technique is used in well-selected patients with good skin elasticity.
- Surgical approaches include the intra-areolar incision, or Webster incision, which extends along the circumference of the bottom of the areola in the pigmented portion.
- The length of the incision will be based on your anatomy.
- In severe gynecomastia, or where significant loose skin is present, skin resection and moving the nipple may be necessary.
- Dr. Jensen’s use of Ultrasonic liposuction has improved the results of gynecomastia correction. In liposuction-assisted breast reduction, there is less compromise of blood supply, nipple distortion and loss of nipple sensation. In addition, postoperative complications are fewer with this technique than with open surgical resection. The fatty and glandular components of your breast must be assessed before surgery. Most patients can be sufficiently treated with liposuction combined with the pull through technique.
What are your options?
Enlarged breasts may be due to excess fatty tissue only, rather than breast tissue and, in this case, can occasionally be improved with diet and exercise alone. To treat the puffy nipples associated with gynecomastia, you will most likely need liposuction combined with the pull-through technique. If you’re considering gynecomastia surgery, Dr. Jensen will help determine the best course of treatment based on your physical presentation, i.e., your options will be determined by your physical findings.
What will my surgical scars be like?
Scars resulting from male breast reduction surgery vary, depending on the amount of breast tissue you have and the elasticity of your skin. Even those who have larger breasts and end up with longer scars are usually quite satisfied with the results.
- If you have breasts that are mostly fat, then your scars will be tiny, large enough for a liposuction cannula.
- If you have large breasts, then the scars may extend across each side of your chest, but Dr. Jensen will attempt to hide them in a crease.
- With firm breast tissue, this can usually be removed with the pull-through technique.
- If the areolas are large and need reduction, then the scar will extend around the circumference of the areola.
How do I prepare for surgery?
Dr. Jensen and his staff will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for surgery.
If you are older than 45 years, or have heart disease, you should have a preoperative EKG. Get medical clearance from primary care physician, especially if you have heart disease, low blood count, or any other serious medical condition. You cannot have liposuction if you are anemic. If Dr. Jensen recommends weight loss or lifestyle changes, do your best to achieve them to ensure the best results. Regardless of the type of surgery performed, hydration is very important before and after surgery for safe recovery.
Prior to surgery, Dr. Jensen will ask you to:
- Avoid sunbathing for two weeks before surgery. Tanning your chest skin can potentially increase the risk of hyperpigmentation.
- Quit smoking and nicotine use at least four weeks before surgery since nicotine can impair wound healing and contribute to infection. This includes any nicotine patch or nicotine-containing product.
- Two weeks before surgery, stop all aspirin-containing products, anti-inflammatories (Ibuprofen Motrin, Advil etc.), vitamin E and herbal supplements, including St. John’s Wort, green tea, Gingko and garlic supplements. You may take one multivitamin a day.
- Hydration is very important before and after surgery for safe recovery.
- Let us know if you develop an illness, cold or any skin infection in the chest area prior to surgery.
- Make sure all requested lab results and doctors’ clearances are submitted.
- Schedule time off work, approximately five to seven days; two weeks if your job is labor intensive.
- Gynecomastia is performed on an outpatient basis. Make sure a responsible adult is available to drive you to and from surgery and that someone is available to stay with you around-the-clock for the first 24 hours after surgery. If you don’t have such a person, let Dr. Jensen know in advance so arrangements can be made for an after-care facility or hospital.
- Dr. Jensen will advise you to purchase surgical chest compression garments ahead of time (such as an Under Armor compression shirt), which you should bring to your surgery. You will wear these under a tee shirt, following surgery, for three weeks after surgery.
- Have some comfortable shirts available to wear during the first four weeks after surgery. These need not be larger in size, just comfortable and preferable with opening in the front.
- Tend to all of your chores before your surgery, so you don’t have to worry about taking care of things during your recovery. You are not allowed to engage in heavy lifting for three weeks after surgery.
- If you routinely have your chest hair removed, avoid doing this for two weeks prior and six weeks after surgery.
- Prepare plenty of reading and movie-watching material to keep you entertained while you recover.
- Place toiletries and easily prepared foods and snacks in areas where you will not have to reach.
- Place plenty of fluids and all medications, including over-the-counter antacids, at your bedside.
What can I expect on the day of surgery?
Your surgery will be performed in one of our accredited office-based surgical suites. Most procedures take at least one to two hours to complete but may take longer.
- Medications are administered for your comfort during and after the surgical procedure.
- Intravenous Sedation with local anesthesia is commonly used during your procedure, although general anesthesia may be desirable in some instances.
- For your safety, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- After surgery, you will be taken to our recovery room where you will continue to be closely monitored by the recovery room nurse.
- Wear comfortable and loose clothing the day of surgery. It is helpful to wear tops that open in front and loose sweat pants.
- Check the fit of your compression garment in advance and bring it with you the day of surgery.
You will be permitted to go home after a short observation period unless you and Dr. Jensen have made other plans for your immediate postoperative recovery.
Dr. Jensen and his staff will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postoperative care, including information about:
- Drains, if they have been placed
- Normal symptoms that you should expect
- Signs of complications
Immediately after your surgery
- You can expect to be bandaged, wearing a compression garment, and you may have surgical drains.
- The first three postoperative days are the most important in your recovery. You must take it easy at home, but not necessarily in bed; sitting and watching TV or having meals in the kitchen or living room is permissible.
- Movements of the waist and elbow are acceptable, but you should avoid vigorous shoulder/chest movements for the first few days. Lateral arm movements are generally permitted, but do not lift your arms above your head. There are many variables; Dr. Jensen will provide you with more details.
When the anesthesia wears off, you may have some discomfort. If the pain is extreme or long lasting, contact our office. You will also have some bruising and swelling after the surgery. Contact our office to find out if your pain, bruising and swelling is normal or a sign of a problem.
Your recovery time after surgery depends on how severe your condition is and what surgery you had. The average patient, treated with a combination of liposuction and breast gland tissue excision, will likely be back to work after a week. Gynecomastia surgery usually has a relatively short recovery period.
It is vitally important that you follow all patient care instructions provided by our staff. This will include information about wearing the compression garment, care of your drains, taking an antibiotic and the level and type of activity that is safe. Dr. Jensen will also provide detailed instructions about the normal symptoms you will experience and any signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
- Your first follow-up visit will probably be the first day after surgery. Your sutures will be removed after a week, as well as your drain if the drainage is low enough or has disappeared.
- You should wear your compression shirt for at least three weeks after surgery.
- In terms of exercise, you may resume low impact activities at one to three weeks; you may begin gentle upper extremity progressive resistance exercises at three to six weeks.
- You will probably return to work within five to seven days after surgery.
- Avoid strenuous activities for the first two to three weeks to ensure optimal healing.
- Pain tolerance varies from person to person. For many, the pain is minimal at best. When extensive liposuction is done, you may experience tenderness equivalent to a day of exercise. You will be provided with a prescription painkiller, but most patients do not need more than extra strength Tylenol.
- You will be asked to apply Neosporin or other antibiotic ointments to the wound.
- Avoid direct sun exposure and tanning for about six weeks, until bruising and most of the swelling has disappeared.
- Sun exposure will prolong swelling and may cause permanent discoloration. Sun exposure in the early stages can cause scars to become darker later.
- Swelling and bruising are normal after surgery. Bruising can appear in various degrees, ranging from minimal to extensive. It can be confined to the breast area or extend to the abdomen. Bruising can appear as yellow, black, blue, purple or a combination of colors. It may increase in intensity over the first three to four days and then will diminish and become yellowish for another week or two. The discoloration will usually disappear in two to three weeks.
- You will notice a decrease in sensation in the area around the operated wound. This is usually more frequent in patients that require significant liposuction. Most men find the temporary loss of sensation to be inconsequential. Sensation returns after a year at most.
- In some patients with poor skin tone (most commonly older patients) there may be excess skin or skin creases that are more noticeable after surgery. Most of these creases will persist for six to twelve months and then diminish significantly, and the loose skin usually tightens up.
- After surgery, there is a phenomenon of spontaneous shrinking of the entire areola. The diameter of the areola will decrease ten to fifty percent from its original size. This usually occurs when significant amounts of glandular tissue are excised.
- Be patient. It may be three to six months or more before the swelling abates and you can see the final results.
Fortunately, significant complications are infrequent. Your specific risks for gynecomastia will be discussed with Dr. Jensen.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma and seroma
- Infection and bleeding
- Loss of sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may require additional procedures
- Blood clots in the legs or lungs.
You can help minimize certain risks by following the advice and instructions of Dr. Jensen and his staff, both before and after your surgery.