Male Breast Reduction (Gynecomastia)
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.
