GYNECOMASTIA AT POWER PLASTIC SURGERY

Gynecomastia may be associated with other medical conditions, medications, and lifestyle factors. A detailed medical history, physical examination, and other investigations may be performed to rule out an underlying cause. In some cases by addressing the underlying cause, gynecomastia may be reversible. The majority of cases of gynecomastia do not have an identifiable cause and are termed “idiopathic” cases. Surgery may be performed for persistent cases of gynecomastia to address enlarged breast tissue as well as redundant skin and fatty tissue.

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- DR. STEPHANIE POWER

What is Gynecomastia?

Gynecomastia refers to enlarged breasts in male patients. It ranges in terms of severity from excess glandular and/or subcutaneous fatty tissue to cases with excess skin as well. Many men express feeling self-conscious due to enlarged breast tissue, particularly when wearing tight-fitting clothing and when taking off their shirts. Others report localized discomfort due to enlarged breast tissue deep to the nipple areolar complex. Gynecomastia may occur in adolescence as well as in older men due to hormonal changes. Many cases resolve within 1-2 years.

Who is a candidate for male breast reduction?

A candidate for gynecomastia correction is otherwise healthy (or with well-controlled medical conditions) and has well-defined goals of surgery.  It is important for appropriate work up to have been completed to rule out an underlying reversible cause.  If a reversible cause is identified, it is recommended to wait for a period of time to assess whether the gynecomastia resolves.  For adolescent patients, this is also an important point since the majority of cases will resolve within 1-2 years.  A good candidate for male breast reduction has achieved and maintained a healthy body mass index (BMI) and is a non-smoker.  Smoking may increase the risk of developing an infection, wound healing complications, and potentially skin flap or nipple necrosis.  An appropriate candidate is able to understand the potential risks of surgery and able to comply with post-operative wound care instructions and activity modifications as healing takes place.

What are options for male breast reduction?

Options for male breast reduction vary based on clinical presentation. The most appropriate technique will depend on the individual patient’s appearance and may include resection of glandular tissue, liposuction, or a combination of these two approaches. In the most severe cases, resection of excess skin may also be required.

Minor cases of gynecomastia may present with a well-localized breast bud deep to the nipple areolar complex. A small focus of gynecomastia may be amenable to direct excision through a small incision along the lower half of the areola. The enlarged breast tissue may be removed through this approach, often leaving minimal scarring hidden at the junction between areola and breast skin. More pronounced cases of gynecomastia may present with more diffuse breast and fatty tissue enlargement. Liposuction may be an option to improve chest contour in these cases, occasionally requiring combined excision of enlarged breast tissue through a periareolar approach. Enlarged breast tissue may be too fibrous for removal with liposuction alone. The most severe cases of gynecomastia also present with skin redundancy. In these cases, a combination of liposuction and direct excision is generally performed.

Although redundant skin may be present, it may resolve in up to 50% of cases over 6-12 months post-operatively. Delaying removal of redundant skin may avoid further scarring in up to 50% of patients as the skin contracts. The most severe cases of gynecomastia may also require skin resection. The trade-off for this approach, although the most powerful in achieving breast reduction and chest contouring, is more prominent scarring.

In patients with significant skin redundancy, the nipple may also require repositioning to a more proportionate location on the chest wall, either through a breast reduction technique or free nipple graft. The most appropriate technique for male breast reduction will be discussed for your particular case during consultation and will be based on your clinical presentation and other factors.

Male breast reduction may achieve the following goals:

  • Reduction of enlarged breast and fatty tissue
  • Improvement of chest contour
  • Repositioning of a low and often enlarged nipple areolar comple

What are risks of male breast reduction?

Risks of gynecomastia correction include delayed wound healing, scarring, infection, hematoma, altered nipple sensation, and potential for skin flap or nipple necrosis.  Aesthetic complications may include nipple depression, asymmetry, or thickened scarring.  The most common complication is bleeding, which may occur in approximately 5% of cases.  If a hematoma develops (which refers to a collection of blood or ongoing bleeding within the breast), further surgery may be required to evacuate the blood collection and to stop any ongoing bleeding.  A compression garment is recommended for one month post-operatively, which applies gentle compression to the breasts.  This may reduce risk of bleeding and also reduce swelling as healing occurs.

What to expect during consultation for male breast reduction?

Consultation for gynecomastia correction is an important step in pre-operative planning.  Dr. Power wishes to understand your motivation for undergoing surgery and specific aesthetic concerns.  A detailed medical history will be performed, focusing on potentially reversible causes of gynecomastia.  There is a well-known association between gynecomastia and certain prescription medications, anabolic steroids, and marijuana, for example.  Other medical conditions (for example, liver, kidney, and endocrine disease) also pose increased risk of developing gynecomastia.  Clinical examination will be performed to record various breast and chest wall measurements.  It is important to assess whether skin redundancy is present in addition to enlarged breast tissue as this will potentially affect the surgical technique and outcome.  In many cases, skin redundancy may not be addressed during the primary surgery to avoid further scarring since it may resolve in up to 50% of cases.  Pre-operative photographs will be taken with consent.  Routine lab work and potentially other investigations will also be ordered to ensure that you are otherwise healthy and an appropriate candidate to undergo elective surgery under general anesthetic in an out-of-hospital facility.  OR paperwork will also be completed.  Dr. Power will address your specific concerns and questions.  If interested in proceeding with surgery, a second visit will be required to review operative details in more detail and to answer any remaining questions.

What to expect on the day of male breast reduction?

You will be given detailed information regarding when to arrive at the Surgical Suites on the 3rd floor of 199 Avenue Road.  It is essential to begin fasting (no eating or drinking) at midnight before surgery.  If any prescription medications are routinely taken, Dr. Power will advise whether to take on the morning of surgery with a small sip of water.  Dr. Power will see you upon arrival at the Surgical Suites to perform surgical markings and review aftercare instructions.  At that time you will also meet your anesthesiologist and nursing team before being taken into the operating room.  Surgery will be performed under general anesthetic and you will awaken in the post-operative recovery room.

What to expect after male breast reduction?

Following surgery you may experience localized chest discomfort over the first few days.  You may require prescription pain medication over this time period.  The prescription will be given in advance and should be filled pre-operatively.  A chest binder will be in place following surgery, which will apply gentle compression to the surgical site to reduce swelling and risk of bleeding.  Once you are comfortable, tolerating fluids, and walking short distances, you will be discharged home with detailed aftercare and follow up instructions.  You will require a responsible adult to drive you home following surgery and to stay with you for 24 hours following the general anesthetic to ensure personal safety.  Dr. Power will call you on the evening of surgery to assess your progress.  You will be given 24 hour contact information should any concerns arise during your recovery.  You may resume showering the day after surgery and will be given information regarding appropriate wound care.

What is anticipated recovery following male breast reduction?

Prescription pain medication will generally be required for a few days following surgery.  It is recommended to transition to Tylenol plain or extra-strength as soon as tolerated.  You will generally be able to return to school or light office work within a week of surgery.  It is important to refrain from exercise or strenuous activity for one month post-operatively to decrease swelling and to lower risk of bleeding.  It is recommended to wear the compression garment full-time except when showering over the first month following male breast reduction.  Once no longer taking prescription pain medication and able to turn and mobilize sufficiently, you may resume driving.

Male breast reduction is performed as out-patient surgery and is generally a well-tolerated procedure in appropriately selected patients.  Patients often report enhanced self-confidence and high satisfaction rates.  Results following direct excision may be apparent within a few weeks post-operatively.  Swelling may settle more slowly following liposuction and early results may be apparent within 2-3 months.  Scar maturation and final results are apparent by one year post-operatively.

Male Breast Reduction FAQs

Can guys develop breasts?

Males can develop enlargement of breast tissue. This may be seen in relation to hormonal changes in infants, adolescents, and older men. It may also be related to marijuana or anabolic steroid use as well as certain prescription medications and medical illnesses.

Can gynecomastia be cured without surgery?

Most cases of gynecomastia in adolescent males resolve within two years without surgery. Approximately 20% of cases remain by age 20. If related to marijuana, anabolic steroids, or other prescription medication, gynecomastia may resolve when the offending agent is discontinued. Any changes in prescription medication should only nbe made under the direction of your physician.

Can gynecomastia grow back after surgery?

Gynecomastia generally does not recur once breast tissue has been removed. If related however to a prescription medication, marijuana, or anabolic steroid use, risk of recurrence is higher if the medication or substance is continued.

Can thyroid problems cause gynecomastia?

Hyperthyroidism may cause gynecomastia. Men with hyperthyroidism (an overactive thyroid) also have increased sex hormone-binding globulin, which reduces the amount of free testosterone and may result in gynecomastia.

Does gynecomastia come after surgery?

Gynecomastia generally does not come back after surgery. Risk of recurrence may be higher if breast enlargement is related to an underlying medical condition, prescription medication, or ongoing lifestyle choices (e.g. marijuana, anabolic steroid use).

Does gynecomastia go away with weight loss?

True gynecomastia refers to enlargement of breast tissue and generally does not resolve with weight loss. Pseudogynecomastia may have a similar appearance, but is related to redundant fatty tissue. Pseudogynecomastia may therefore resolve with weight loss.

Does gynecomastia surgery leave scars?

Gynecomastia surgery leaves scars, which vary based on the extent of surgery. Mild cases of gynecomastia may be treated with liposuction through small incisions or by direct excision through the lower half of the areola. If removal of redundant skin is also required, longer scars will result.

How can gynecomastia be prevented?

Certain cases of gynecomastia may be prevented by avoiding marijuana and anabolic steroid use.

How long do you have to wear a compression garment after gynecomastia?

It is recommended for you to wear a compression garment for 6 weeks after gynecomastia surgery.

How long does it take to recover from male breast reduction?

Most patients recover from male breast reduction within a week. You may then return to office-based work. It is generally recommended to avoid exercise for one month to lower risk of bleeding as well as further bruising and swelling.

How long till swelling goes down after gynecomastia surgery?

The majority of swelling goes down over the first 6 weeks after gynecomastia surgery. Final results gradually become apparent by one year as skin contraction occurs.

How many cup sizes can you go down with breast reduction?

Breast reduction may reduce your breasts by one cup size or more depending on your aesthetic goals, symptoms related to large breasts (e.g. back, neck, and shoulder pain, shoulder grooving, etc.), and appearance. It is important to remember that there is no true cup size measurement as bra sizes vary across manufacturers.

When should I start massaging after gynecomastia surgery?

You should generally start massaging at two weeks after gynecomastia surgery to reduce discomfort, soften any areas of nodularity, and reduce swelling.

Can you get rid of gynecomastia without surgery?

If you are an adolescent with gynecomastia, you may get rid of gynecomastia by being patient and waiting for a couple of years. Approximately 80% of cases resolve by age 20. If gynecomastia is related to an underlying medical condition or prescription medication, please discuss with your physician. Drug-induced gynecomastia may improve if you are able to take an alternative medication. Stopping marijuana and anabolic steroid use may also be effective in getting rid of gynecomastia.

Can you reduce breast size without surgery?

If breast size is related to fatty tissue enlargement, weight loss may help reduce breast size without surgery. If you have gynecomastia with a known medical cause, addressing the underlying condition or medication may also reduce breast size. Most cases of adolescent gynecomastia resolve non-operatively on their own.

What is the best treatment for gynecomastia?

The best treatment for gynecomastia depends on the underlying cause. If related to hormonal changes during adolescence, the best treatment is to wait as most cases resolve within two years. If related to an underlying medical condition or medication, please discuss with your physician. Treating the underlying cause may also address the gynecomastia. If related to lifestyle choices (e.g. marijuana, anabolic steroids), it is recommended to stop the offending agent to assess whether the gynecomastia resolves. If you have ongoing concerns, see a board-certified plastic surgeon to discuss surgical options.

What causes gynecomastia in males?

Gynecomastia is often related to hormonal changes in infants, adolescents, and older men. Certain medical conditions may also cause gynecomastia, including thyroid, kidney, and liver disease. Testicular tumors are another potential cause of gynecomastia related to circulating hormones. Gynecomastia may also be drug-induced, caused by certain calcium channel blockers, ACE inhibitors (both used to treat high blood pressure), antibiotics (e.g. Ketoconazole, Metronidazole), anti-ulcer medications (e.g. Ranitidine, Cimetidine), among many others. Marijuana, anabolic steroids, and alcohol use may also cause gynecomastia.

Is it worth getting a breast reduction?

Whether it is worth getting a breast reduction is up to you. If you are self-conscious about your breast size or experience symptoms related to large breasts (e.g. neck, back, and shoulder pain, rashes under the breasts, shoulder grooving related to bra straps), you should discuss your concerns with a board-certified plastic surgeon.

Is gynaecomastia surgery painful?

Gynecomastia surgery is not usually a painful recovery. Most patients require prescription pain medication for a few days and report soreness during early healing.

How do you shower after gynecomastia surgery?

You should resume showering the day after gynecomastia surgery. Remove your compression garment and gently wash your chest with soap and water. You may then place light gauze over the incisions and replace the compression garment after showering.

How do I know if I need a breast reduction?

If you have aesthetic concerns relating to your breasts or symptoms including back, neck, and shoulder pain, you may be a candidate for a breast reduction.

How do I know if I have gynecomastia?

If you think you have gynecomastia, you should see either your family physician or board-certified plastic surgeon for a full examination. Gynecomastia generally presents with enlargement of firm breast tissue underneath and extending around the nipple area. If your breasts are enlarged due to extra fatty tissue, they will generally feel softer.

How can you tell the difference between gynecomastia and Pseudogynecomastia?

You may often tell the difference between gynecomastia and pseudogynecomastia based on how your breasts feel. If you have gynecomastia, you will generally feel a firm region of enlarged breast tissue underneath and extending around the nipple. It usually feels like a firm disk. Pseudogynecomastia refers to extra fatty tissue. It generally feels softer on examination, similar to fatty tissue at other sites (e.g. abdomen, flanks). Ultimately it is important to see a board-certified plastic surgeon for clinical examination and diagnosis.

Does a breast reduction make you look thinner?

A breast reduction may make you look thinner by reducing breast size and achieving a more proportionate result. You may go down a shirt size or two depending on how much breast tissue is removed.

Do you lose weight after breast reduction?

You will lose weight after breast reduction, which depends on how much breast tissue is removed. Removal of 250g per side, for example, would result in weight loss of just over 1 pound.

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