Gynecomastia is excess breast development in males. It is extremely common and may affect up to a third of all boys as they go through puberty. In most it will resolve on its own but for many it will persist throughout the rest of their lives. There are some uncommon hormonal or genetic causes for gynecomastia but for most it simply occurs naturally. Most patients do not have any symptoms although mild discomfort and lumpiness is sometimes described, especially early on. The biggest issue is the emotional and psychological impact gynecomastia has. Most patients will avoid any activity which could result in being seen bare chested. Going to the beach, pool and playing sports, things that most kids take for granted, create enormous anxiety for those with gynecomastia.
There is not any known medical treatment for gynecomastia. Fortunately surgery is curative and fairly easy to go through. I use three basic procedures for gynecomastia treatment. They are chosen based on the amount of excess breast tissue and the amount of excess, or looseness of the skin. In the majority of patients, the gynecomastia can be treated with a combination of liposuction (good for contouring the shape surrounding the breast), ultrasonic assisted liposuction, and direct excision of the breast tissue, all of which can be done through a small incision on the side of the chest. This is called a Lateral Pull Through technique. Ultrasonic liposuction (UAL) is used because breast tissue is too thick to be removed with regular liposuction alone. Also, UAL can help to tighten the skin by heating the undersurface.
The second technique, and next most common, adds the removal of skin surrounding the areola. This is call a peri-areolar reduction. It is used when there is just a little too much looseness of the skin, or if the areola is too puffy.. In this procedure a band of skin is removed surrounding the areola, together with all of the steps in the basic reduction. The result is a flat chest and a circular scar around the entire areola.
The third and final technique I use is reserved for the most severe type of gynecomastia. These patients have a great deal of excess breast tissue and sagging of the entire breast. Usually the nipple rest at or below the lower breast crease. In these cases I will remove all of the lower breast skin in addition to the breast tissue. The scar is placed horizontally along the lower breast crease. The nipple is first removed and the replaced onto the flattened breast in the correct position. This is called a nipple graft technique. Although the scar is longer the procedure is excellent in flattening out the breast and will allow the patients to wear tight tee shirts with feeling embarrassed.
All of the above treatments are performed as an outpatient procedure. There is actually very little discomfort and most can return to work or school within a few days, and certainly after a week. Exercise can resume after 2-3 weeks.
Results can be seen immediately but it takes about three months for all of the swelling to resolve and the final results to appear.
Hope this helps to answer a lot of questions I get. Please feel free to contact the office at 410-902-9800 or email at info@cosmeticsurgerybaltimore.com with any questions you may have.
