Gynecomastia Surgery

Prior to an important decision of having surgery you have to do your homework. In the US the number of Gynecomastia procedures is about 18,000 a year which is not a big number compare to breast augmentation(500,000) or other plastic surgery procedures. It mean that you should find experienced board certified plastic surgeons. The main cause is enlarged breast glands which in my experience is present in 90% of the gynecomastia patients suffer from,for this reason liposuction alone,regardless the type of liposuction, may not be sufficient for most patients. Again you have to do your homework and choose the right procedure for you. 

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

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

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.
 

Gynecomastia is a common condition in men, and is usually treated with great results.  If you are interested in having male breast reduction and have not consulted with a surgeon first,  you should definitely see a board certified plastic surgeon.  Laser liposuction or regular liposuction are excellent ways to improved male breast enlargement, but often times some direct excision of the breast tissue is needed, thus the need for a visit for a consultation.  Ask friends or relatives if they know a plastic surgeon with a lot of experience in that area.  If you don't want to discuss it with other people, then search the internet for a practice that has several good pictures.  Then give them a call and see how you are treated on the phone.  That is usually a good indication of how your overall experience will go.  After surgery, it is not usually too painful and you should take a few days to one week off from work so you can properly heal before returning to your normal activities.

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

If you have both glandular tissue and excess fat, the appropriate procedure would be formal excision of the glandular tissue.  This cannot be performed using Vaser or liposuction alone.  Liposuction can be used in combination with resection of the glandular tissue.  The operation is not known for being very painful because it does not involve the muscle.  To find a doctor with proper credentials, you can access the website of the American Society of Plastic Surgeons.  Far more women undergo breast reduction than men having gynecomastia surgery but some of the principles are synchronous so inquire whether your plastic surgeon performs a large number of breast reductions, male or female.   Many non-plastic surgeons have access to the Vaser but are not familiar with other methods of resection so they should be avoided. 

Thank you for the question.

Gynecomastia comes from the Greek meaning "gyne" meaning woman and  "mastos"  meaning breasts.  It refers to abnormal development of large mammary glands in males.  The diagnosis can be made by physical examination where relatively firm tissue  (breast gland tissue) can be differentiated from relatively soft tissue (adipose tissue).

Breast prominence due to excessive adipose tissue is called pseudo-gynecomastia or lipomastia.  The differentiation of true  gynecomastia  from adipose tissue is important because the surgical treatment may differ. Usually  physical examination by a well experienced board-certified plastic surgeon is sufficient to make the diagnosis  and to determine the best course of treatment.

I have found that gynecomastia is often best treated with  partial excision of the prominent glandular tissue  as well as liposuction surgery of the peripheral chest area.  If the prominence of the chest wall is caused by adipose tissue, then liposculpture surgery alone may suffice.

I would strongly suggest that you make sure you are working with a well experienced board-certified plastic surgeon. You will find that this recommendation will be more important than any specific “miracle technology” that you will undoubtedly hear about.
 

I hope this helps.

Web reference: http://www.poustiplasticsurgery.com/Procedures/procedure_gynecomastia.htm