at Our Baltimore, Maryland Area Center
Have you had enough of your man boobs?
Are you a healthy man with abnormally large, womanly breasts? Do you envy men with chiseled and defined pecs that confidently wear tight shirts or even go shirtless at the gym or pool? You may have a medical condition known as gynecomastia (excessive male breast tissue). Unfortunately, no matter how much you diet or exercise like those men you envy at the gym, you won’t be able to eliminate the pesky, excess breast tissue and loose skin on your chest. The only solution for a flatter, firmer chest is male breast reduction surgery. At our Baltimore, Maryland center, cosmetic surgeon Ronald Schuster, MD, can help determine whether gynecomastia surgery will help you achieve your goals.
- To treat gynecomastia, a condition that causes enlarged male breasts
- To reduce breast size and decrease sagging or excess skin
- To create a flatter, firmer chest
- To reduce psychological distress or embarrassment
Video: Male Breast Reduction Surgery
Gynecomastia Surgery Techniques:
- There are three basic steps to the successful treatment of gynecomastia. First is the elimination of fat within and surrounding the breast gland. This can usually be done easily with standard liposuction techniques. Liposuction is used to create a smooth contour. Removing the breast gland without using liposuction can increase the risks of irregularities, over resection and crater deformities. Standard liposuction, however, does not work well for the thicker fibrous tissue that is also mixed in with the fat and breast tissue. For this second step, Dr. Schuster uses Ultrasonic-Assisted Liposuction (UAL). UAL produces a sound wave energy that helps to break down the thicker tissue. In reality, the UAL is performed first during the operation, followed by traditional liposuction. Finally, the third step involves the removal of the most dense, true glandular tissue. This tissue lies directly beneath the nipple area and needs to be directly cut out, or excised.
- Direct excision has traditionally been performed through an incision placed at the lower border of the areola. While there is nothing “wrong” with this approach, there is always the risk of being left with a noticeable scar. Having matching scars on the areola can sometimes be conspicuous and leave the patient feeling a bit self-conscious. For many years, Dr. Schuster has been able to perform all three essential steps through a small incision (1/2”) on the side of the chest. The incision is needed anyway for the liposuction and UAL, so by making it just a little larger, Dr. Schuster is able to successfully perform all three steps without the additional areolar scar. The scar generally heals very well and is “off” the breast. This has been called the Pull Through, or Lateral Pull Through technique.
- Finally, after performing the removal of the breast tissue the final result depends on the ability of the skin to shrink. In most cases, the skin will be able to shrink on its own. Dr. Schuster believes that using a compression vest helps to encourage the skin to shrink and reduce early swelling. In more advanced cases, there is too much skin, or the skin does not have the elasticity to shrink well enough on its own. In these cases, skin has to be removed. In the moderately advanced patients, the extra skin can be removed in a donut pattern around the areola, leaving a thin scar that goes around the border of the areola. This is called the Peri Areolar excision. In the most severe cases the excess skin is removed at the bottom of the breast, leaving a scar that extends along the inframammary crease. The nipple is actually removed and placed back onto the breast in the right position as a Nipple Graft. A thorough examination is needed to determine which type of correction is right for the individual patient.
- Surgery is performed as a short outpatient procedure under a twilight type of anesthesia. It is not at all painful since a great deal of numbing medicine is used. Patients are very comfortable for the entire day and night after surgery. The following day the discomfort is mild, generally feeling similar to the soreness that one feels the day after a hard workout.
- Other possible causes of gynecomastia are excess alcohol or marijuana use, obesity, and anabolic steroids. Correction of these factors should be completed prior to undergoing gynecomastia surgery at our Baltimore, Maryland area center.
Recuperation After Gynecomastia Surgery:
- Recovery is easy and discomfort is mild.
- Dr. Schuster typically recommends a week off work / school. However if you do not have a physically demanding job, most patients are able to have their surgery performed on a Friday, and return to work on Monday.
- You will wear a compression vest beneath your clothes for three weeks. The vest helps to control the swelling and helps to shrink the skin quickly.
- You may resume exercise in two weeks.
- You will see results within the first two weeks but they will continue to improve for about three months.
Gynecomastia Surgery Alternatives:
- No treatment
- Compression undergarments
- Weight reduction with diet and exercise — effective in cases of pseudo-gynecomastia, where breast enlargement is surplus fat
General Gynecomastia Information:
- Gynecomastia is the abnormal enlargement of the male breast. There are many theories as to what causes gynecomastia. Abnormal levels of estrogen and testosterone, abnormal hormone receptor activity and/or quantity have all been postulated. In the majority of cases (called idiopathic gynecomastia), there is not any identifiable cause. Idiopathic gynecomastia develops during puberty. It has been written in the pediatric literature that up to one third of all boys develop some degree of gynecomastia, and that 80-90 percent of cases will resolve on their own. Even if true, at face value, this still leaves many men with gynecomastia.
- There are other known causes of gynecomastia which can result from medications,
marijuana, anabolic steroids, medical conditions such as hyperthyroidism, pituitary tumors (prolactin secreting and growth hormone adenomas), chronic kidney disease, liver failure, steroid secreting tumors (involving the testicles, adrenal glands and lung), inherited genetic disorders resulting in hypogonadism.
- Patients who develop either pre-pubertal or delayed gynecomastia (after age 30) should have a complete medical work up to rule out any other cause for their gynecomastia. Laboratory tests that can be useful during this work-up include:
- Blood work — serum levels of LH, FSH, testosterone, estradiol, and human chorionic gonadotropin (hCG), prolactin, thyroid panel (recommended)
- Ultrasound of testicles, if there is any suspicion of a mass
- CT scan – brain/skull to rule out pituitary adenoma
- Gynecomastia is not associated with an increased risk of breast cancer. It primarily causes psychological distress, embarrassment, and other emotional side effects. This can be very severe at times and results in the avoidance of activities which require a boy or man to be seen without his shirt on. If not addressed as a youth, uneasy feelings often linger and can become an issue for men as they marry and have children. They will often have difficulty spending time with their children at the pool or beach. It is unfortunate that this problem is not spoken about more often, because gynecomastia treatment is actually very easy.
- Insurance companies rarely cover gynecomastia surgery. During your consultation, Dr. Schuster will be able to better determine if your insurance company will reimburse your procedure. Whenever possible, our staff will write to your insurance company before your gynecomastia surgery is performed so that you will know in advance what kind of coverage to expect.
To learn more about gynecomastia treatment options, please contact our Baltimore, Maryland plastic surgeon for a private consultation.