What is Gynecomastia?
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Gynecomastia Male Breast Reduction
Gynecomastia, or male breast enlargement, is an increasingly common reason that male patients schedule consultation in our practice. Gynecomastia may occur on one or both sides of the chest, may be localized primarily behind the nipple and areola or involve the entire pectoral area, and may arise in the teen years or in retirement years. As the manifestations of gynecomastia vary significantly from patient to patient, the surgical treatment must be carefully individualized.
Some enlargement of male breast tissue commonly occurs during puberty, and the incidence of noticeable (transient) pubertal breast enlargement has been reported to be as high as 60%. For most males this hormone-related breast enlargement is temporary, but for a few individuals the breast tissue proliferation will persist and in some cases even continue.
For the majority of patients with gynecomastia, no clear causative factor can be identified. However, because this phenomenon may be associated with endocrine (hormone) disorders, testicular tumors, and the use of some medications/drugs, a careful medical evaluation is an absolute necessity prior to surgical treatment.
Over the past two to three years I have evaluated and treated a number of male patients who developed gynecomastia after using 'prohormone' and steroid supplements as part of a bodybuilding regimen. These agents are known to increase estrogen activity in some individuals, which may stimulate the proliferation of breast tissue and result in visible breast enlargement. The breast enlargement generally persists after the cessation of supplement use, requiring surgical treatment.
Patient evaluation, treatment planning and surgical management are carried out with complete discretion in this practice. Some gynecomastia breast surgery patients have related that prior to scheduling an appointment, they were concerned about 'feeling awkward' while sitting in a plastic surgeon's waiting room before their consultation. Because we are a medical spa offering a variety of services, including laser treatments and massage, no client in our office can ever be presumed to be a surgical patient.
The Surgical Options
Gynecomastia may be treated surgically by direct excision (removal) of breast tissue, liposuction, and in some cases by removal of breast skin, when indicated. The majority of patients have at least some degree of glandular tissue proliferation immediately behind the nipple and areola, which is usually removed through an incision placed at the inferior border of the areola. The incision can be limited, in many cases, from about the 4 o'clock to the 8 o'clock position of the areola. The color difference between areolar skin and chest skin serves to conceal this incision nicely for most patients.
Some patients have proliferation of primarily fatty breast tissue over the pectoralis major muscle, which can be effectively reduced by liposuction. In many of these cases there is actually little glandular breast tissue present, and this situation is sometimes referred to as "pseudogynecomastia". For the majority of liposuction procedures, whether involving the chest/breast area or other sites, I perform power-assisted liposuction. The surgical device involves an electrically-driven handpiece that pistons a modified liposuction cannula several thousand times per minute, enhancing the efficiency of fat removal.
The power-assist handpiece turns an 'elbow grease' operation into a sculpting and finesse operation. For patients with densely fibrous breast tissue, and for planned 'second stage' liposuction procedures for gynecomastia, I generally prefer to use an ultrasonic liposuction device. Ultrasonic liposuction uses heat energy to emulsify (liquefy) fat, allowing removal of fatty tissue that may not be extractable by suction alone, and is also highly effective in assisting the passage of the cannula through densely fibrous areas.
Areolar reduction and breast reduction
Even with minimal breast tissue enlargement, an enlarged areolar diameter tends to produce a feminized breast/chest appearance. For patients with an enlarged areolar diameter, I perform an areolar reduction in addition to direct excision of breast tissue and liposuction. This requires an incision, and thus a scar, that encompasses the entire circumference of the areola. However, the scar is usually obscured fairly well by the color difference between areolar skin and the adjacent chest skin, and the reduced areolar diameter is critical to producing a more masculine appearance of the anterior chest. A peri-areolar incision is also useful for removing excess breast skin, with or without an enlarged areola, in cases where the skin excess is not severe.
Whenever possible, I avoid making incisions outside the areola (except for the very small, strategically-placed incisions used for liposuction), as such incisions are generally not well-concealed and can be a continued source of self-consciousness for male patients. Many gynecomastia breast surgery patients relate that prior to being treated they have been unwilling to remove their shirts in public (and some in private as well), and extensive chest area scarring typically does not improve that situation.
With the goal of limiting the need for surgical scars in mind, I not infrequently will stage gynecomastia breast surgery, with the initial procedure designed to remove as much breast tissue as possible, primarily by liposuction, without 'deflating' the breasts. The second procedure, performed several months later, is designed to remove additional tissue, usually by means of ultrasonic liposuction, after the breast/chest skin has had time to contract. While a staged surgery may seem less convenient than a single trip to the O.R., the possibility of avoiding scars that are essentially non-concealable makes the staged surgery preferable in many of these cases.
A few gynecomastia patients have a degree of breast enlargement that requires what is essentially a 'male breast reduction', using the standard 'inverted-T' pattern of breast reduction incisions/scars. This surgery is reserved for patients that have very feminized appearing breasts including significant skin excess, who can not be treated effectively with staged liposuction procedures, or with skin excision limited to the immediate peri-areolar area.
Recovery and downtime
Breast surgery for gynecomastia is performed on an outpatient basis under general anesthesia. Patients who fly in or drive more than two hours to the surgical facility stay in the hospital overnight or at a hotel convenient to the office so that they may be evaluated on the first postoperative day.
I have patients wear a postoperative compression vest around-the-clock (except for bathing and garment washing) for the first two weeks following surgery, and for half the day (either daytime or nighttime) for an additional two weeks. Many patients find the garment to be quite comfortable and wear it for longer than the prescribed amount of time.
Most gynecomastia breast surgery patients take one to three days off from work, depending on the extent of their surgery. Patients with minimal, retro-areolar gynecomastia are allowed to return to vigorous physical activity about two weeks postoperatively, while patients undergoing more extensive procedures are required to wait about four weeks.
Gynecomastia is overgrowth of male breast tissue
Gynecomastia is very common. In fact, in Los Angeles 1/6th of all males have had Gynecomastia throughout their life. In older men, especially those over 60 years old, the prevelance of Gynecomastia is nearly 100%. Gynecomastia is caused by an overgrowth or hypertrophy of the male breast gland as well and increase of male breast fat. many things, including genetics, environmental and hormonal factor can trigger gynecomastia. In Beverly Hills, most plastic surgeons such as me perform a combination of breast gland excision and chest liposuction for the treatment of gynecomastia.
What is Gynecomastia?
There are many potential causes of adult gynecomastia. It can simply be a remnant of youth; however the following bring on the majority of causes:
Persistent adolescent gynecomastia:25 percent
Drug-induced: 10 to 25 percent
No detectable abnormality: 25 percent
Liver disease and malnutrition: 8 percent
Primary hypogonadism (atrophy of the testes): 8 percent
Testicular tumors: 3 percent
Secondary hypogonadism: 2 percent
Hypothyroidism: 1.5 percent
As shown above, 25 percent of cases that present are the remnant of adolescent gynecomastia. For the most part, the rest either have unknown causes, or are drug- or hormone-induced. As men age, testosterone is increasingly converted to estrogen. The gradual decrease of testosterone production accounts for many hormone-induced gynecomastia cases in adult men. Drugs, over-the-counter or otherwise, are another common cause of gynecomastia. For this reason, it is especially important to carefully review and think about any potential risks that may be associated with a substance you are considering taking. In some cases, breast cancer may be present; however, this is seen primarily in men over 70 years of age.
Pseudogynecomastia is male breast enlargement with fat deposits, rather than glandular enlargement, which is the case with gynecomastia. This is commonly associated with significant weight gain. In these cases, the typical patient will state that his breast enlargement was not present as a teenager, but developed later in life as his weight increased. For these patients it is often a possibility to produce a desirable result using liposuction alone.
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What is Gynecomastia?
Thanks for the post. Gynecomastia is an enlarged breast in a male due to excess glandular, or breast tissue. There can be excess fat as well. There are many causes of gynecomastia, such as certain medications, endocrine disorders, family history, and certain tumors, just to name a few. To determine whether someone has gynecomastia I recommend they be evaluated by a plastic surgeon experienced in gynecomastia treatment where a detailed history and physical can be performed and if necessary hormone testing.
What is Gynecomastia?
See a board certified plastic for more information.
John T. Nguyen, MD, FACS, FICS
Double Board Certified Plastic Surgeon
Gynecomastia and its treatment
GYNECOMASTIA = Breast Enlargement in Men, below are some basic information to know about the procedure and if it is for you:
Gynecomastia or breast enlargement in men can be corrected by a variety of plastic surgical techniques. This condition often creates a psychological poor self perception and many males of all ages do not take their shirts off because of this stigma. Candidates are men who have over-developed or enlarged breasts which may occur as the result of hormonal changes or hereditary conditions.
Candidates are healthy men, whose condition cannot be corrected through exercise, weight reduction or other non-surgical treatments. Appropriate preconditions for surgery are the stabilization of breast development (no further breast enlargement) and localized areas of excess breast tissue and fat.
The procedure intends to reduce the breast size and redundant breast tissue to enhance the contours of the chest. The surgery often reduces physical discomfort associated with the area, as well as physiological and emotional dissatisfaction with the area.
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. Other specific techniques can reduce the areola when needed or reposition the nipple to create the appearance of a more natural contour.
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. Occasionally, if the prominence of the chest wall is caused by adipose tissue, then liposuction 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”, pill, or supplement that you will undoubtedly hear about.
I hope this helps.
What is gynecomastia
Gynecomastia is simply excess chest tissue in males that results in the chest area having a more feminine appearence. The tissue can be either fat if the individual is overweight or glandular/fibrous if there has been a hormone issue (via genetics, supplements, or otherwise).
All the best,
What is gynecomastia?
Male breast development. It can be bothersome. It can be embarrassing. Most importantly, It can be fixed, with surgery. N. Huq
Gynecomastia you @ me / comprehensive information
Gynecomastia is a social and physical problem that is caused by enlarged male breast. A patient said to me once: " It is a beautiful day and I can't enjoy it" the reason is that I can't take off my shirt in the pool,beach or other public places.This is a very harsh statement and is characteristic to people who suffer from the more sever form of the condition that is called Gynecomastia. Psychologically it can be devastating,especially in adolescence and can influence there social life. They are often teased by their friends and can become introverted and socially handicapped.In reality this condition is enlarged male breasts and to many it is a sign of femininity which of course is the opposite of masculinity. Their are many reasons and cases to the formation of gynecomastia and some are related to hereditary,hormones, varies medication,several syndromes and weight problems. The main cause is excess Glandular tissue,but sometime there is exess fatty tissue and skin. Exact clasification,definition,pathlogy,pictures and more can be found in wikipedia. .