Correction of Gynecomastia by Dr. Ronald Schuster, Board Certified Plastic Surgeon in Baltimore, Maryland

Gynecomastia, male breast enlargement, is a very common condition. Affected males often hide their breast enlargement by not being seen without a shirt, or wearing loose baggy clothing. Unfortunately there is not any medical or non-surgical cure. Fortunately surgery is a safe solution. There are several different procedures that are done depending on how severe the gynecomastia is. The most common form is when the breast enlargement is mild or moderate. In these conditions the breast is firm and the skin relatively tight. The nipple is close to the right place and the breast does not look “saggy”. In these case correction is done using a combination of liposuction, ultrasonic liposuction and direct removal, either through a small incision on the side of the breast (also known as the Pull Through technique), or through a small incision at the lower border of the areola. Recovery is quick. No drains usually needed. The middle type is when the breast enlargement is moderate to large, the nipple looks a little “low”, and the skin is not so tight. In this situation, a small amount of skin must be removed from around the areola in order to “take up the slack” of the skin which can’t shrink enough. Liposuction, ultrasonic liposuction, and direct excision is still performed but all from the peri-areolar approach. This is called a peri-areolar excision or doughnut mastopexy. Recovery is also very quick but usually a drain is used for a week. The most severe type of gynecomastia is when the breast actually resembles a larger woman’s breast, together with the natural or advanced sagging. In these cases all of the excess skin is removed and the nipple complex is first removed and then re-applied in a higher normal position. This “nipple-graft”  technique leaves a longer scar beneath horizontally along the bottom of the breast fold (inframammary crease) and around the areola. All of the breast tissue is removed from beneath the skin in order to make it flat. Recovery is a bit longer, closer to two weeks and a drain is used for a week. Fortunately all of these procedures are done safely as an outpatient procedure.