Age: 23 Gynecomastia/Breast Reduction
This is a 23 year old young man, 5’11″ and 188 pounds who presented to me for additional correction of a two previous gynecomastia procedures performed elsewhere. He had lost a very significant amount of weight in the past. He had liposuction of his chest area with some improvement, then he had a tissue removal though an incision around the areola with a second procedure.
He complained to me that he still had fullness of his nipple-areola complex’s and he could feel the tissue beneath them. He told me that he actually wanted me to excise skin on his chest because he felt that after he got older the skin on his chest would hang.
On examination I could feel that there was tissue beneath his chest that could be reduced with a resulting contour improvement. You can see somewhat of a rounded appearance in the areas of his nipples on both sides. When you look at the tissue that I removed at surgery, this was the exact cause of the fullness in that area. I reduced about forty grams of tissue from each side. You can also see on his pre-operative pictures that he had taped his chest so that the nipples would appear less noticeable. Note the frontal photos below with the yellow lines. His pre op photo has a rounded breast shape whereas the post-operative photos show more of an angulated, sculpted look (no doubt he has done some weight lifting since his surgery).
There was no need to excise skin in his case. Even in those who have had lost a lot of weight it would be uncommon to remove skin (this is best left to extreme skin laxity). This skin has an amazing potential for retraction. Liposuction treatment of gynecomastia alone is often going to leave breast tissue. The most common cause of gynecomastia “recurrence” is incomplete removal of the tissue at the time of surgery. Although his photos show some improvement, in “real time” he enjoys a HUGE difference. Sometimes the photos simply can’t pick up the improvements that I see when the patient stands in front of me.
Age: 17 Gynecomastia/Breast Reduction
This male patient, 5’7″ and 135 pounds has had gynecomastia since puberty. It hasen’t changed in years despite non-surgical medical management. He was told by some of his physicians that he should give it a few years and see if it would “go away”. He admits that having fullness in his chest area has been a psychological burden (to say the least).
I performed a bilateral excision of dense breast tissue. He was very thin with little to no body fat per say so he required no liposuction as well. In his post operative photos you can see that he has developed some scar hypertrophy especially on the left side. I will treat this with the injection of a small amount of steroids, massage and silicone scar strips. This will improve with time.
This case illustrates several important points to consider in patients with gynecomastia. In my experience, patients who develop fullness in the breast area at a younger age are more susceptible to psychological scars. Although most cases of puberty induced gyecomastia resolves after a year or two, in some cases it does not. These patients comprise the largest group of people that I see for treatment. If it hasn’t changed after a few years it’s time to consider removal of the tissue before more significant psychological trauma occurs. Also, if you look at the sample of tissue that was removed it’s amazing at how much was present and the fact that the difference, although very real, seems modest compared to this large tissue removal. The main goal of improving his “puffy nipples” certainly has been achieved.
