I see many male patients who complain of enlarged breast tissue- also called gynecomastia, who seek surgical treatment and correction. The first questions I ask them is whether or not they take any medications that are known to cause gynecomastia such as Cimetidine, anabolic steroids, Valium, AIDS medications, heart medications and some herbals. Another known cause of gynecomastia is excessive marijuana and alcohol usage, heroine, methadone and amphetamine usage. The first issue is to identify any medical etiology known to cause gynecomastia if there is one. I will refer patients to see an Endocrinologist to rule out an endocrine cause such as tumor, hypogonadism, hyperthryoidism or other medical condition. This specialist consult is covered by most insurances. Any male with a family history of breast cancer and enlarged breast tissue should be considered to undergo a mammogram, since breast cancer in men, although very rare, is much more aggressive and should be caught as early as possible. The vast majority of cases of gynecomastia are "ideopathic" in nature, which just means we don’t why it occurs, but the good news is that it is a benign process. The surgical treatment for gynecomastia depends on the severity and nature of the enlarged breast.

For very mild cases of gynecomastia where the majority of excess tissue is fatty in nature, liposuction alone may be an adequate treatment. Tumescent liposuction will flatten the breast that is diffusely enlarged due to fatty tissue. The nature of one’s breast tissue can be determined during the physical exam.

For gynecomastia that is due to excess glandular tissue, usually a combination of liposuction in conjunction with an excisional procedure is required. There may be a "breast bud" behind the areola- and this can be palpated during the exam. The typical history is that a man’s breast size does not change with significant weight loss and/or weight-training. Also, there may be some herniation of the breast tissue out through the areola causing a "pooching" out or puffiness of the areola that might also be excessively wide and enlarged. The areola can also be reduced at the time of surgery.

If there is excess breast/chest skin that is mild, then you might be a candidate for laser-assisted liposuction. Addition of the laser cannula prior to performing the liposuction does mainly 2 things: 1) the laser helps break up the fibrous tissue and melt the breast fatty tissue and 2) the heating up of the dermis internally from the inside helps with postop skin-retraction afterwards. Often the laser-liposuction is used in conjunction with an excisional procedure. The liposuction can also remove tissue laterally (the "tail" of the breast")- tissue that goes around the sides of the chest beneath the axilla.

The excisional procedure is typically done with an incision that can be done partly around the areola (if the areola is of normal size) or from an incision that goes all the way around the areola (ie via a circumareolar mastopexy incision) if it requires reduction in size and correction of herniation. Moderate cases of gynecomastia typically require both laser liposuction combined with an excisional procedure.

Severe cases of gynecomastia may require a more extensive excisional procedure called a "male breast reduction" if there is a lot of extra, hanging breast skin and the nipple drops down below the level of the inframammary fold (called excessive "ptosis" of the breast). In these cases, it may be necessary to create a scar that goes down the center of the breast and/or a scar that follows the inframammary fold beneath the breast. This operation is necessary when there is just too much skin that requires removal to make the breast flat.

Recovery from gynecomastia surgery depends on the amount of surgery performed. After liposuction, it is important to wear a tight-fitting chest post-surgical garment for about 4 weeks- or until the chest is no longer swollen. Immediately after surgery, there will be some swelling and bruising, however the flattened appearance of the chest will be immediate and the results will only improve over time. There is a small chance that there may be changes in sensation to the nipple. Immediately after surgery, I place a special foam (called Reston Foam) over the chest skin to help with the results, then place you in your compression garment. This is generally changed about 2 days postop- after which, you will go home, shower, then place antibiotic ointment over your incisions and put on a fresh garment. For this reason, I have all liposuction patients purchase at least 2 garments so that you always have a clean, fresh one to change into. The garments require hand-washing and air-drying- so it is imperative to have at least 2 on hand at all times. You will be sore for the first several days and this will improve over the first week. I generally recommend patients take off at least 4 to 5 days off work and a week before returning to any more strenuous types of work. You can wear your compression garment at work. Bruising and swelling should be resolving by the second week. You should feel like your old self again by the third week. You may return to regular exercise once you are no longer swollen or tender. Again, results are immediate, only improve with time, and there is an extremely high "satisfaction" rate with this procedure!