What are the different procedures that treat gynecomastia and which is best?
Doctor Answers 4
Surgery for gynecomastia should focus on two primary concepts: limiting surgical incisions and the associated permanent scars as much as possible, and respecting the fact that skin laxity may limit the amount of fat and breast tissue that can be removed in a single surgery. No one with gynecomastia wants to trade the appearance of having excess breast tissue for a set of obvious scars, or for sagging skin that looks like surgery gone wrong. Either way you still won’t want to take off your shirt at the pool.
First, the scars: incisions limited to the inferior areolar border will result in most cases in scars that are faint to even invisible. In many patients that is the only incision you need. In patients with significant chest hair, small liposuction access incisions in the subpectoral fold (the crease at the bottom of the male pectoral area) are acceptable as they will be invisible, but not in patients with little to no chest hair. When needed, an axillary incision can be used for liposuction cannula or arthroscopy shaver access, and a well-designed incision in that location is also minimally noticeable to invisible in most cases. Surgeons who are experienced with and proficient at gynecomastia surgery limit the incisions to areas where the scars will be imperceptible.
Second, skin laxity: if there is some degree of skin laxity and or skin excess, it is important to avoid reducing a patient’s gynecomastia to the point that the skin is even looser and sagging. For patients with this issue, I perform gynecomastia surgery in stages that are scheduled 6 to 12 months apart. The first procedure removes as much fat and breast tissue as possible within the limits of a patient’s skin laxity in order to avoid a ‘saggy’ appearing breast area, and then 6 to 12 months later a secondary liposuction +/- direct tissue excision procedure is performed. This approach takes advantage of the fact that in youthful skin (teens, twenties, thirties and in some patients even in their forties and fifties) the chest area skin will shrink and tighten over several months, allowing a secondary procedure to be performed that produces an aesthetically ideal chest contour without any skin excision. And without unsightly surgical scars.
Patients with droopy or saggy skin at the outset have to be treated by total excision of gynecomastia with removal and replacement of the nipple/areola complex as a full-thickness skin graft. This approach creates a long scar in the subpectoral fold, and should be restricted to patients who have too much skin laxity to be treated by a limited-incision, two-stage (and in some cases, even a three-stage) approach. If that is the approach you need, make sure that the surgeon you choose has a proactive and comprehensive program of scar treatment, to help you achieve a scar appearance that is as faint as possible.
A surgeon’s ability to create aesthetically ideal and natural-appearing gynecomastia results will be apparent from their ‘before and after’ photos. Make sure that the surgeon you choose uses an approach that is designed to avoid the two issues that may leave you still self-conscious about taking off your shirt once you’ve recovered from surgery: obvious scars, and saggy-appearing skin.
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