Male Breast Reduction (Gynecomastia)
Age 20: Gynecomastia
This is a 20 year old young man who had developed gynecomastia or “puffy nipples” since puberty. He is seen here after removal of breast tissue beneath both of his nipple-areolar complexes.
This is a handwritten note that this patient asked me to share with my patients:
“Once I learned about gynecomastia surgery it took me a little over a year to pull the trigger on it. What seemed to be a radical choice turned out to not be a big deal at all. I would recommend to anyone who suffers from the mental anguish of gynecomastia to have the surgery. I feel the benefits of the surgery every hour of every day. I volunteer at a nursing home and am more active in general simply because I don’t have the burden of wearing tape on a daily basis.”
“To those debating getting the surgery I would just say that the faster you get the surgery the faster/longer you get to enjoy the benefits.”
Lessons to learn from his case:
- It may not look like a big difference in photos, but it is a HUGE difference.
- His hand written note to me says it all.
- He was seen by another doctor who was a nice guy but when he met me he preferred someone with my experience. He was told by the doctor that he was going to treat his condition with liposuction alone. This would NOT have removed the breast tissue, and there would be yet another gynecomastia patient running around telling others that his gynecomastia recurred when, in fact, it was never actually removed.
- Treatment of this condition is basically “not a big deal” in terms of the actual surgery (in experienced hands that is). Don’t delay treatment as this will only delay the benefits of treatment and life is too short.
Age 13: Gynecomastia
This is a 13 year old boy who presented to me with his Dad for evaluation of unilateral fullness in his breast. It developed during puberty over a year earlier and has not gone away. He was told by his pediatrician that it may take 1-3 years for this to resolve. It was causing significant psychological stress on this young man at a critical time in his development and his father was aware of this. He did research on the internet and learned that some people recommend treatment sooner than later.
On exam, he had one sided gynecomastia that was firm and rubbery. The young man clearly was having a difficult time coping with this because he was quite active in school and was often in situations where the other boys were taking off their shirts and he didn’t feel comfortable in this situation.
I removed well localized breast tissue under local anesthesia in my office operating room while listening to his favorite music. These pictures were taken at five months after surgery. The only commend made by his dad was to question the small fold or crease just beneath the breast on the treated side.
Learning points:
- Unilateral gynecomastia can be seen in up to ten percent of patients. It is not different than when it presents on both sides.
- If it is large like it is in his case, rubbery and hasn’t changed in a years’ time and the patient is suffering from it I would suggest it is time to consider the option of treatment.
- The slight depression below his nipple areola complex on the treated side is simply from the removal of a firm mass and now less tissue is there and the shape is slightly different. This is no big deal—both Dad and patient agree. It could be “improved” if they wanted by injecting some fat into that area but they were not interested.
- When I was speaking with his Dad in my exam room on the day of these post-operative photographs it was quite obvious that the patient was very comfortable without his shirt on. In fact, I could see him staring at himself in the mirror! Quite a big change from before surgery when he didn’t want to be without his shirt, and certainly didn’t want to admire himself in the mirror! This SAYS IT ALL TO ME.
- Gynecomastia can cause significant psychological damage and treatment should be considered if it hasn’t gone away/improved after a years’ time after it develops at the time of puberty.
- Personally, I feel that I have served this patient and his Dad well, and that his son will be a much better adjusted individual in the future for having done this.
Age 35: Gynecomastia
This is a 35 year old six foot male who is 215 pounds and presented to me for treatment of gynecomastia. He was a professional athelete who took steroids and developed fullness in his chest area.
He is seen here after gynecomastia treatment with liposuction and tissue removal from a small incision around his areolas. I removed about 1000cc of fat from his chest and underarms and reduced about 10 grams of tissue beneath his nipple-areola complexes. He is seen here about 8 months from his procedure. He has lost about 20 pounds and has been working out three times a week.
What we can learn:
- Steroids can cause gynecomastia.
- Most of the fullness in his chest was fatty tissue and not gland. This varies considerably from patient to patient.
- His scars are almost imperceptible at eight months. Scarring is NOT an issue when using an incision about the areola.
- Reducing the burden of gynecomastia has provided him with the incentive to lose weight and get in shape—BIG TIME in his case!
- I couldn’t have achieved this impressive result without his help. We work together to achieve the best outcomes from my procedures.
Age 23: Gynecomastia
This is a 23 year old young man who is 5’10” and 190 pounds who complained about “puffy nipples”. It bothers him a lot. On a scale of 1 to 10, ten being the worst, he rated it as a nine! He says he thinks about it every day and has to be very careful about what he wears and is very self-conscious.
This guy is buffed for sure and most guys would love to have the physique that he has. Yet this is very traumatic for him. He has some glandular material that I can appreciate on examination immediately beneath his nipple-areola complexes on both sides. He has some fullness to this area that is worse depending on how relaxed the muscle is around his areolas.
Under local anesthesia and in about 30 minutes I removed a small amount of breast tissue on both sides. You can see the specimen in the pictures included. He has healed very well and is very pleased with the results and is appreciative of my services to help him. I don’t suppose you can actually see much of a difference in the photos, but any guy out there who suffers from the same thing he did is well aware of the difference. Simply put, he doesn’t want to appear to have nipples when wearing a shirt. His problem is solved and he is very happy.
Follow-Up
I recently asked this patient to respond to some questions after viewing his final photographs. I was wondering if I would get more information than what I can typically obtain face-to-face. Here are my questions and his responses:
- I told you that you had a very minor amount of tissue that made for your “puffy nipples”. Did this procedure adequately address this problem?
Yes, very happy with the results. - If this procedure has helped you, can you elaborate a bit? Give me some specific examples of how this helped?
I am no longer self concious about the puffy nipples. I now feel comfortable taking my shirt off in public, and I don’t have to worry about what shirts I wear. I felt like certain shirts, especially plain t shirts, made my nipples protrude and visible to others. I dont worry about that anymore. - Would you recommend this procedure to others?
Yes, I should have had it done sooner. - You stated that this really bothered you and that you thought about it every day. Do you still think about it every day? If it bothered you as a 9/10 before surgery, how would you rank it today? (1 is normal and 10 is really bad.)
1, It really doesn’t cross my mind anymore, but after the procedure it felt like a huge weight off my shoulders. - Do you have any suggestions for me to help me help others better?
You had the most informative website and made the situation as easy as possible. I appreciate all your help.
Age 23: Gynecomastia
This is a 23 year old male, 5’6” and 188 pounds interested in treatment alternatives for his chest. He doesn’t like the fullness in his chest. He says it bothers him as an 8 out of 10, ten being the worst and one being the best .
He is seen here after treatment with liposuction and some tissue removal. Most of the gain I was able to obtain was from liposuction on his chest and under his arms. I removed 900cc’s of fat and about 30 grams of tissue from each breast.
He is pleased. He will take his shirt off in public now and feels liberated for sure. He also lost a significant amount of weight since his procedure and plans on losing more in the future.
Age 37: Gynecomastia
This is a 37 year old male who is 6’2” and 250 pounds who was interested in dealing with fullness in his chest. On examination he has excess fat all around as he is overweight. He certainly has fullness in his upper chest, under his arms, and fullness of his breast area as well. This most likely represents pseudogynecomastia or fullness in his chest that is mostly fatty in nature (not as much glandular tissue as it is simply an area where the fat went to). It is seen in overweight men.
Weight loss alone would make a big difference, but in his case I don’t believe it would make a significant enough difference to the point he would not be self-conscious about the appearance of his chest when wearing shirts or when he is bare chested. In his case I recommended that we treat his breast fullness with liposuction primarily and then remove residual breast tissue (if any) as it appears after liposuction.
He is seen six months after his procedure. He has lost 10 pounds (I want him to lose a lot more). He seems satisfied in general, although he still thinks his left side is still a bit full. I told him that his results are very impressive, and that it takes about a year and a half for all the swelling to subside. One observation for the reader of this patient story is that his result is much more impressive in real time than the photographs are able to illustrate. I removed 1200cc of fat from his breast and underarm area (this is a lot of fat). He has less fullness under his arms, his breasts are flatter and less prominent and certainly less “female breast like” than before (mission accomplished from a surgical perspective). He is interested in liposuction of his abdomen and love handles now. I told him to lose twenty pounds and he can come back and we can talk about it. Generally speaking, the treatment of gynecomastia caused by weight gain is weight loss.
Age: 23 Gynecomastia/Breast Reduction
This is a case of a young man who presented to my office for help with gynecomastia that he says he has suffered with since puberty. On a scale of 1-10, where 10 was the worst, he says he has a “13″! He has a history of anxiety and depression and the condition runs in his family. With all that he has to deal with, his gynecomastia doesn’t help at all.
On examination, he indeed has the round appearance of breasts. He is about 10 pounds overweight, is relatively muscular and in good shape. He has well localized, dense tissue palpable in an elliptical shape at the level of his nipple-areola complexes. He does not have “puffy” nipples as some men do. He has very significant thoracic (rib cage) asymmetries on examination (his ribs project more on one side of his chest than the other).
He is seen here about nine months from gynecomastia treatment with surgical removal of the tissue alone through an incision along the lower half of his areola. No liposuction was performed. About 85 grams of dense breast tissue was removed from each side — essentially a mastectomy was performed (breast removal).
He says he is very happy with his results. He says it now is a 3 out of 10 on the “gynecomastia scale”. He is able to appreciate his chest wall and rib asymmetries now that this tissue has been removed.
Aggressive treatment of gynecomastia so that all of the tissue is removed can result in significant flattening of the chest area. Although this is perfectly ok for some patients, others may find this concerning. For this reason, it’s important for a patient to express to there surgeon that they will accept that some fullness will remain after surgery so that the outcome appears more natural. This is an important point to consider because some patients “want it all gone” while others want a more contoured or conservative approach, with results that more closely approach “normal”. The big problem with many gynecomastia patients is that many don’t know what is “normal”. Finding the right balance in the individual patient is my overriding goal.
Age: 28 Gynecomastia/Breast Reduction
This is a 28 year old male who is 5’7″ and 175 pounds who presented to my practice complaining of gynecomastia. He says he had it since puberty. In terms of how much his condition bothered him, he rated it an 8 out of 10, where 10 is the most severe.
You can see that he had some fullness around the area of the nipple-areola complex on both sides. He said the left side was larger than the right. He is seen here about eight months after an excision of the gynecomastia. Tissue removal measured 110 grams on the left and 72 grams on the right. No liposuction was performed.
The tissue found at the time of surgery was surprisingly large. This was all removed through a small incision that followed the bottom border of his areola. This tissue was rubbery in nature and certainly not something that can be treated by liposuction of any type (including laser liposuction). It’s interesting that even though such a huge amount of tissue was removed, the photos are really not that dramatic in appearance. However, there is a huge improvement noted by the patient for sure and he says that he is well on the road to recovery. He has no problem wearing tighter shirts, is no longer thinking about his condition all day long, and will even take his shirt off in public. The burden of gynecomastia is as real as the rising sun, and the treatment of this condition is the first step to recovery.
Age: 29 Liposuction/Breast Reduction
This patient, 5’9″ and 170 pounds was evaluated for lipodystrophy. He has struggled with his weight as of late. On examination he certainly had excess fat of his abdomen and love handle areas. I also noted that he had fullness of his chest and he acted surprised that I mentioned that area. He says that has always bothered him and that it affects him negatively.
He is overweight for sure. I told him it would be best for him to lose weight and then come back for another evaluation. He says that no matter what his weight, he always has fullness in the breast area.
He is seen here after a liposuction of the abdomen, flank and breast area. I removed 5300cc of fat in total. He is seen here four months after his procedure and he has gained about 4 pounds. Every 1000cc of fat translates into about 1 pound of weight loss so I alone helped his weight go down by 5.3 pounds.
I offered to perform his procedure without first losing weight because I felt that it would give him the “boost” that is needed to be successful. I also felt that it would benefit him psychologically if the fullness in his breasts was treated. I was able to treat his gynecomastia with liposuction alone because he had pseudogynecomastia – this refers to fullness in the chest area that is predominantly fatty and is usually related to being overweight. In most cases of gynecomastia, tissue removal or even a mastectomy is needed to obtain the best result (actual breast tissue cannot be suctioned.)
I am not pleased that he seems to be gaining weight. It will compromise his results significantly and negatively impact his health in the longer run. I made it clear to him that he needs to get his act together and weigh himself every day and find the right balance of food intake and exercise to help lose weight.
Age: 27 Gynecomastia/Breast Reduction
This patient, a married male who is 5’11″ and 220 pounds says he has had gynecomastia since puberty. He is seen here after removal of about 100 grams of tissue each side through an incision about the lower half of the areola (essentially a mastectomy).
When I spoke with him in the office he was sort of unimpressed until I showed him his before and after pictures. Suddenly he was amazed at the difference. As I have said before, it’s easy to forget what you used to look like. It’s important for me to show my patients their pictures so they are more pleased with their investment.
Speaking of investments, he told me one of the biggest differences he has noticed since his procedure is that he no longer spends time in the mirror checking how he looks in the chest area. He also said that he would have spent “a few hundred thousand dollars” to take care of his problem. Fortunately for him, the cost was a lot less!
It is uncommon in my experience to effectively treat gynecomastia by liposuction alone. In most cases direct tissue removal is needed as it is hard rubbery-like tissue. On another note, gynecomastia is known to occur not infrequently as a side effect from treatment of prostate cancer.
Age: 17 Gynecomastia/Breast Reduction
This is a case of a patient who has had gynecomastia since puberty. On a scale of 1 to 10 on how much it bothers him he told me a “13″. It has had a tremendous impact on his life in a negative way. He is 5’11″ and 212 pounds (he is overweight). He is seen here after a bilateral reduction of tissue by using liposuction and direct removal of tissue with an incision about the areola. I removed 850cc of fat and about 85 grams of tissue from each side.
He is seen here at four months. We anticipated that he would have loose skin around his areolas as they were quite large. He has several creases in his areolas from incomplete retraction of the skin. The plan at this time is to let an additional five months pass and then we can evaluate him for a scar revision to improve on the results. He states that the procedure has made a HUGE improvement in his life and that he doesn’t hesitate to take off his shirt in public. He also says that he would love to tell me that he is “cured” but unfortunately he still carries some of the scars from having gynecomastia. This is one of the primary reasons why I believe that the condition should be evaluated and treated if it doesn’t resolve in about a year after its development. He also has been instructed to lose about 15-20 pounds to look his best. He is to continue massaging the scars beneath his chest area as this will improve and soften over a year’s time.
Age: 22 Gynecomastia/Breast Reduction
This patient is 5’7″ and 122 pounds. He has a history of developing fullness in his breasts shortly after taking over the counter muscle building products. He was seen by an endocrinologist who placed him on medications. Despite this, his fullness continued and we opted to remove the tissue. He is seen here four months after direct removal of the tissue through and incision about his areola. Caution must be taken when using over the counter muscle mass products as they are esentially pre hormones that can cause the development of gynecomastia. Usually stopping the use of the products will result in an improvement in breast fullness.
Age: 38 Gynecomastia/Breast Reduction
This is a patient with gynecomastia who had fullness in and around the areola bilaterally. I removed fibrofatty tissue in this region through an incision around the bottom of his areola. He is seen here at four months after his procedure. Note the flattening in the areola area and the improved appearance in the size of the areola. He will continue to improve over the next year or so. Take a look at his lateral view to see the flattening of the breast area.
Age: 35 Gynecomastia/Breast Reduction
This patient lost twenty pounds and was interested in liposuction. On examination I noted fullness in his chest area. If I were to perform liposuction of his abdomen and love handles alone without treatment of the fullness in his chest it would look even more prominent. Fortunately for him, the chest area was contoured successfully with liposuction alone and did not require an incision around his areola with removal of fibrous/breast tissue. Pseudogynecomastia refers to fullness in the chest area that is fat and not actual breast or fibro fatty tissue. Men who are overweight can also gain fat mass in the chest area that can appear like gynecomastia. Examination of the chest by a qualified expert can usually determine if the fullness in the chest is fat or fibrous/breast tissue. Fat can be removed with liposuction whereas fibrous/breast tissue requires surgical removal through an incision about the areola.
