Male Breast Reduction. Gynecomastia? 2 Different surgical recommendations (Photo)

57 yo male. 5'8" ; 168 pounds; lost 45 lbs. Ultrasound. Fatty tissue. Negative for excess breast tissue. Consult 1: Breast reduction- lipo, some breast tissue excision & skin tightening with long horizontal incisions. Nipples would be moved. Consult 2: Lipo & possibly breast tissue removed.No skin tightening. Very confused & concerned about scar with consult 1 & possibly having to undergo a 2nd surgery if # 2 is performed. I am planning to have this procedure performed with a TT. Thanks!

Doctor Answers 7

Types of Gynecomastia & Treatment Options

There are several common factors which contribute to gynecomastia. These include excessive levels of #estrogen, natural #hormone changes, use of recreational drugs or alcohol, medications and their associated side effects, and, various health conditions. Also, there are different types of #gynecomastia.

Normal Gynecomastia is usually apparent in boy between the ages of 12 to 15 years old and older men 65 years old or more who experience a drop in their testosterone levels. This type of Gynecomastia takes about one to two years to regress on its own.
Pure Glandular Gynecomastia is seen more commonly in body builders and is caused by steroid use. Surgical removal of the gland is required for treatment.
Adult Gynecomastia – Fat deposits are apparent in the glandular tissue. This type of gynecomastia is the most common. Doctors may recommend surgery for treatment of the condition.
Adolescent Gynecomastia is hereditary and usually appears in 30% to 60% of boys between the ages of nine to fourteen. Many cases of adolescent gynecomastia resolve on its own as the boy grows into adulthood. Some may choose to undergo surgery to correct the situation, this usually happens at the age of 18 or above. In severe cases in young boys, the physician and child development specialists will need to speak to the parents regarding the severity of the gynecomastia and if surgery is an option before the age of 18.
Assymetric or Unilateral Gynecomastia appears in either one or both breasts at different degrees. In many cases one breast appears larger than the other. Surgery is a common treatment for this type of gynecomastia.
Pseudo-Gynecomastia is composed of adipose tissue instead of glandular tissue. This type of gynecomastia can be treated with diet, liposuction or surgery
Severe Gynecomastia commonly affects those who have lost skin elasticity at an older age and those who have been obese or overweight at one point in their life and lost weight may have saggy skin and breasts that are severely enlarged. Surgery is the recommended treatment for severe gynecomastia.
There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case. Consulting with a board-certified plastic surgeon in person, is highly suggested in order to determine if you are a surgery candidate and what treatments are best for you.

Orange County Plastic Surgeon
5.0 out of 5 stars 107 reviews

Male Breast Reduction. Gynecomastia? 2 Different surgical recommendations

If you are concerned with the scar, you can have what was suggested at consult 2.   You can heal and then determine if skin removal is necessary.

Kenneth Hughes, MD

Beverly Hills, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews


It appears from your pictures that you have true gynecomastia. If so, this represents glandular tissue and probably will change very little with exercise or further weight changes. After weight loss, you may have lost skin elasticity, so recoil of skin is less predictable after gynecomastia glandular excision.  I would probably recommend a glandular excision at first stage with some additional liposuction, if needed.  Allow some healing, and then judge results.  It might be necessary several months later to do a skin reduction, but maybe not.  If you are concerned about the appearance I would recommend that you seek consultation with an experienced  board certified plastic surgeon.

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 26 reviews


There are going to be many opinions because there is not one right answer.  I often go with lipo first and see how things retract before considering a skin excision.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Gynecomastia and weight loss

go with the more conservative approach and do just the tissue removal whether it is fat or gland or both at this time. Allow for your body's natural skin shrinkage to take place over six months to a year. If skin removal is necessary it could always be done at a later time. Even if you need skin removal you will probably have smaller scars. 

Sherwood Baxt, MD
Paramus Plastic Surgeon
3.8 out of 5 stars 25 reviews

Treatment of gynecomastia

The facts:  you do have gynecomastia.  

You are also 58 years old and have lost lots of weight.  Those two factors have diminished the natural elasticity of your skin.  When minimal scar surgery is performed for gynecomastia, we surgeons depend upon the natural skin elasticity to tighten the skin on its own.  While a young, never-overweight person has dependable skin elasticity, a person in your situation does not.  But not all is lost -- because there is always some residual  degree of residual elasticity.  Hence, I would absolutely try doing minimal scar surgery first -- and then give your own body at least six months or more for the skin to tighten as much as it can.  And then re-evaluate.  The result may not be perfect -- but may be perfectly acceptable to you -- and without lengthy scars.  On the other hand, if you do feel you wouold like some additional improvement, then some type of skin tightening may be entertained.  But since predictably there would have been at least some skin tightening, the amount of excess skin would be less and thus the anticipated scars would be much smaller.

Food for thought!

For further info, please consuylt my website captioned below which is exclusively devoted to treatment of gynecomastia.

Elliot W. Jacobs, MD, FACS
New York City

Elliot W. Jacobs, MD
New York Plastic Surgeon
4.4 out of 5 stars 34 reviews

Liposuction for gynecomastia

I agree with consult number 2. 80% of the time I need to do liposuction only with no direct tissue excision but never know till during the surgery. But I limit the incision to the edge of the areola. I have liposuctioned much larger breasts than yours without need for skin excision with the large scar. I occasionally do the big skin excision, but only on the patients with extreme excess skin and extreme sagging. You have neither one. Good  luck.

Scott W. Vann, MD, FACS
Savannah Plastic Surgeon
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.