Gynecomastia Surgery, I had this problem from my early 20’s, need recommendations for doctors.

Considering that gynecomastia involves growth of male breast tissue, Veser or other techniques of liposuction can NOT remove the actual breast gland. it might remove excess chest fat but it can not melt away or remove excess breast gland.

Web reference: http://www.beautifulself.com/p_breast_red_male.htm

So many gynecomastia patients have shared with me the self-consciousness, embarrassment, frustration and psychological stress that they have endured because of breast enlargement. Most never feel comfortable taking off their shirt at the beach or at the pool or wearing a snug-fitting shirt. Many use compression vests in an attempt to reduce the unsightly appearance of gynecomastia. Every patient I see feels that it has adversely affected his comfort and confidence in social situations. And many describe a feeling of discomfort and embarrassment with regard to sexual intimacy. If you have experienced any or all of these issues personally, I want to assure you that (1) you are not alone and (2) essentially every case of gynecomastia can be significantly improved, and most can be corrected completely.

The most common form of gynecomastia (‘mixed glandular/adipose’) requires ultrasonic liposuction and, in some cases, direct breast tissue excision as well. I believe that ultrasonic liposuction is without question the ideal approach to the majority of gynecomastia cases. Ultrasonic liposuction involves the use of ultrasonic energy to emulsify fat (turn it from solid to liquid) after the infiltration of tumescent solution and before the aspiration of fat. The ultrasonic energy is delivered using a solid probe that is extremely effective at breaking up the dense, fibrous breast tissue behind the nipple-areola complex. For this procedure, I use the VASER ultrasonic liposuction system produced by Sound Surgical Technologies Inc. VASER is a specialized probe developed specifically for gynecomastia.

Ultrasonic liposuction is often effective enough to eliminate the need to make an incision at the areolar border to directly remove breast tissue. This treatment method also appears to produce a degree of desirable skin retraction that is generally not seen with conventional liposuction techniques. This allows some patients who formerly would have required skin excision to be treated with a more limited and less invasive approach.

Whenever possible, I attempt to avoid skin excision due to scarring associated with this type of procedure. If the surgery leaves extensive scars, and the patient is very self-conscious about them, then the patient has merely traded one reason to never take off his shirt (‘man boobs’) for another (scars that show he had surgery for his ‘man boobs’). For that reason, I have treated a large number of patients by means of a staged surgical approach. In the first procedure, breast tissue is removed by ultrasonic liposuction with or without direct tissue removal – but only up to the point where a deflated or ‘saggier’ breast appearance is not produced. Several months are allowed to pass so that the final liposuction result can be evaluated. During this time, the skin tends to retract for two reasons: much of the distending breast and adipose tissue has been removed, and the ultrasonic liposuction energy has stimulated further tissue and skin retraction.

Take your time researching your surgeon. Look at several websites, go on several consultations, speak to other patients and of course view many many before and after photographs. Find a plastic surgeon who performs gynecomastia surgery often and with whom you feel comfortable.

Web reference: http://www.michaellawmd.com/gynecomastia-male-breast-reduction.html

Gynecomastia correction primarily involves the reduction of glandular fatty tissue through surgical removal. This technique is used in conjunction with liposuction of any surrounding fatty tissue to achieve an ideal result. In some cases, the excision of excess skin may be necessary as well. The skin has a tremendous capacity to shrink and contract after surgery; much like a stretched rubber band retracting back to its original shape/size.

These are the basic elements of gynecomastia surgery, but each case is unique and is evaluated on an individual basis. There are many types of chest deformity that can appear. It can be as minimal as "puffy" nipples, or as significant as a C or D cup breast size. The treatment plan and results a patient can expect will differ depending on the situation.

Only performing liposuction will not typically have the best aesthetic results.

Web reference: http://www.gynecomastiaspecialist.com

                  The surgical management of gynecomastia varies from patient to patient. This variation depends on the severity of the problem and the type of gynecomastia present.

                  When glandular tissue is present surgical excision is usually necessary. This is usually accomplished through a peri-areolar incision. The breast tissue is first separated from the skin and subcutaneous tissue. Once this is accomplished the breast tissue is separated from the underlying muscles and removed as a single unit.

                  When the breast tissue is predominately made of fat, liposuction can be utilized. This technique involves passing a canula through the breast tissue repeatedly while suction is applied to the canula. Cores of fat are removed and the area is effectively sculpted.

                  In some cases glandular and fatty components are present, and combination procedures are necessary. Following surgery patients wear a compression garment for four to six weeks. This helps remodel the tissue and minimize complications.

                  It’s important to realize that no two patients are alike and treatment should be individualized. If you’re concerned about gynecomastia, consultation with a board certified plastic surgeon would be appropriate. 

Web reference: http://www.talroudnerplasticsurgery.com/male/male-breast-reduction-gynecomastia-miami-fl/

Gynecomastia procedures vary patient to patient.  Gynecomastia can range from liposuction only techniques to treat a mostly fatty chest area, to a combined procedure with limited subareolar incision to directly resect glandular tissue not removed by liposuction (this includes laser and vaser assisted), to full breast reduction/amputation with free nipple grafting for men who have breasts that would qualify for a female breast reduction!

The goal of gynecomastia surgery is to flatten the chest mound into a more normal contour, which for men is nipple flush with the skin above the inframammary fold.  Liposuction can contour the chest about the nipple areolar complex, however, if there is a lot of glandular tissue, you need to either resect it or bring it out piecemeal as described by Dr Rohrich and his colleagues at UT Southwestern.  In chests where you can perform liposuction +/- direct excision, you can achieve more normal results.  Unfortunately if someone has gynecomastia that is so severe that a breast reduction technique has to be employed, there will be tell tale long scars about the chest, and depending on the technique, there can be loss of normal anatomic boundaries such as the inframammary fold.

At the end of the day, the key is not to overresect this tissue which can lead to a more difficult problem to fix and to go over with the patient that as with any bilateral procedures, there will be some minor asymmetries.

In terms of picking a surgeon, do your basic research ie. board certification, and then take the next step and go for a consult.  You should ask your surgeon what his or her experience is with this procedure and what techniques he or she uses.  As with any procedure, I would like whomever I would choose to be well versed in a variety of ways to treat you as an individual case rather than as  a peg for a square hole (you could be round, oval, octagonal, etc.) 

Gynecomastia is NOT just Liposuction (but it can be). Know who is doing it and what is involved.

Most important is not the technology but the surgeon:

• Verify Board Certification by American Board of Plastic Surgery (do this online)

• Member of American Society of Plastic Surgery (requirements beyond Board Certification)
• Member of American Society of Aesthetic Plastic Surgery (indicates extensive experience in aesthetic surgery - see below link)
• Look at online review sites - like RealSelf, Health Grades,RateMDs, Google, etc
• Look at Before and After photos
• What is my instinct or "gut reaction" as to who I relate to better, answers my questions more fully and who I basically trust the most.
• Finally ask yourself - if I was to have a complication, who would be the best to take care of me.

Procedure Description
General, Intravenous or local anesthesia are used for this procedure depending on the severity and type of procedure(s) selected by your plastic surgeon. It is performed on an outpatient basis.  For males with very large breasts staged procedures (more than one procedure) may be required. For example, the first procedure may be liposuction, then several weeks to months later after skin contraction has occurred, a separate procedure is done to remove excess skin. By doing a staged procedure, often the final scars are less.

Oftentimes, specific types of liposuction cannulas are used and often in conjunction with direct removal of excess breast glandular tissue through small incisions for mild to moderate gynecomastia. This can be the Vaser, Ultrasonic liposuction, or Power Assisted liposuction devices for better results. I prefer the Power Assisted liposuction device by Microaire. Other specific techniques can reduce the areola when needed or reposition the nipple to create the appearance of a more natural contour.

Larry Nichter, MD, FACS

Web reference: http://pacificcenterplasticsurgery.com/procedures/for-men/gynecomastia/

In my experience liposuction alone is rarely adequate to treat gynecomastia. Gynecomastia is due to increased tissue in the male breast.The increased  tissue may be fat or glandular tissue.The fat is amenable to liposuction while the glandular tissue is not.

Web reference: http://www.gynecomastiachicago.com

With the introduction of liposuction in the 1970’s, the treatment of gynecomastia has also evolved to utilize liposuction techniques. Through small incisions located at the periphery of the breast tissue, liposuction cannulas are introduced and traditional liposuction or ultrasound-assisted liposuction (click here to learn about Liposuction) is performed to remove excess fatty breast tissue. Because fibrous, glandular breast tissue is stronger and more compact than fatty breast tissue, the fatty breast tissue is easily removed with liposuction while the denser glandular tissue remains. This often produces the appearance of a “puffy nipple” with underlying fibrous breast tissue surrounded by a flaccid, abnormally flat, or even “rippled” chest wall where liposuction has been performed aggressively.