Male Breast Reduction (Gynecomastia)

Enlarged breasts in males is actually quite common, especially during puberty. It is connected to the changes in their estrogen levels (yes, men have estrogen too!). Older men also get them due to medications such as antibiotics, heart and anti-anxiety medicines, and chemotherapy. Steroids and drugs like marijuana and heroin can also cause enlarged male breasts.

Before considering cosmetic surgery, sufferers should consult their primary care doctor to rule out any underlying health issues, which may include:

• obesity
• pituitary tumors
• adrenal gland dysfunction
• kidney disease
• high levels of estrogen

Treatment options for enlarged male breasts depend on the amount of breast enlargement and the amount of associated excess skin.  

The breast is generally composed of fat, breast tissue, and skin. The degree of enlargement and excess of each of these structures will determine the surgical option that is appropriate for you.  

Patients with minimal yet distressing breast enlargement can be treated by simple liposuction.  

Simple Liposuction

Simple liposuction can be performed under general anesthesia or under local anesthesia in the office setting. The procedure involves a small 2-3 mm incision in each breast through which small suction cannulas are introduced. The cannulas are used to remove the fat from the breast. 

There is often a small to moderate amount of harder breast glandular tissue located directly beneath the nipple. This tissue cannot be removed by liposuction and may require surgical excision.

Liposuction with periareolar excision of breast tissue under the areola:

Liposuction will be performed as explained above. If there is a visible or conspicuous amount of breast tissue, it will need to be removed by surgical excision. The breast tissue is a harder substance than fat and can be sucked through the cannula.

This is generally performed by a small incision located along the bottom margin of the nipple areola area.

Surgical breast reduction with excision of excess skin and breast tissue:

As the breast tissue enlarges, the fat and breast tissue can begin to stretch the surrounding skin. The skin can cause sagging of the breast tissue similar to that found in women.  

Surgical excision of the extra skin will be required if the breast has enlarged to this degree. The approach at this point is similar to that taken for female breast lift and reduction and will depend on the amount of extra skin and the degree of sagging.  Surgical scars may be required around the areola for simple cases, and may even require an anchor pattern if there are very large degrees of sagging tissue.

Good candidates include men who are:

• uncomfortable with their breast size
• nonsmokers and don’t use recreational drugs
• healthy, stable weight and have been at that weight for a number of months
• not obese – the recommendation would be to go on a weight loss program first
• teenagers who are unhappy with their breast size (they may require an additional procedure later as an adult if breast tissue continues to develop)
• not suffering from an underlying health reason for the enlarged breasts

The decision to treat gynecomastia by liposuction or by surgical excision depends on the amount of breast enlargement and if the enlargement has stretched the surrounding skin enough to cause sagging of skin and breast tissue.  

• Patients with skin excess that is sagging will require surgical excision of the skin to properly tailor the skin tissue
• Patients with visible breast tissue under the nipple complex may need surgical excision of the breast tissue
• Patients with only extra fat in the breast without significant skin excess may be treated by simple liposuction

Dr. Chang will discuss the best treatment options with you during your consultation.

After surgery you should rest at home and let yourself heal. Dr. Chang will send you home with a detailed recovery plan. There are a number of different ways to help aid recovery:

• All patients will need to wear a compression vest for about 4 weeks.  
• Final results should not be expected for at least 6 months to a year. Over that time, the breast shape will change dramatically so you have to be extremely patient; swelling will decrease dramatically as will the shape of your breasts.
• Most patients are presentable without drawing attention in 1 to 2 weeks.
• Sutures, if any, are removed in 10 to 14 days.
• Strenuous exercise (aerobic and weights over 20 pound) should be avoided for 2 to 4 weeks to help in the recovery process.
• Apply aquaphor ointment to exposed sutures and incisions should be applied twice a day until the sutures are removed.
• Most patients will take 5 to 7 days off of work.
• Pain can initially be moderate to severe if excess skin has been removed. Narcotic medication will be prescribed to help for the first 3 days. Advil or tylenol will work after.
  
• don’t drive for 7 days or until you have stopped taking narcotic medication.

As with any surgery, there are associated risks. Only you can decide whether the procedure can achieve your goals and if the recovery and risks are acceptable to you. Complications are rare but can include:

• Local bleeding or bruising
• Infection particularly from the absorbable sutures
• Loss of sensation although rare
• Widened or thickened scar
• Asymmetry (unevenness between two sides)
• Delayed wound healing with skin or tissue necrosis
• Extra skin at the ends of the incisions
• Under-correction
• Over-correction

Unsatisfactory results may require additional procedures. Patients will generally be responsible for any associated facility fees. 

Depending on the type of procedure you have:

For liposuction:

Most patients treated by simple liposuction will return to work in 3-5 days.

You will, however remain sore and will be wearing surgical compression garments at this time.

For surgical options:

Most patients treated by liposuction and skin excision will return to work in 7-10 days.

You will, however remain sore and will be wearing surgical compression garments at this time.

Puffy or pointy nipples may be caused by glandular gynecomastia.

If you are concerned about this, tell Dr. Chang at your consultation. He will personalize your surgical plan to select the best incision pattern and technique to improve your nipples. Oversized areolas may also be corrected in surgery for gynecomastia.It is crucial to be honest with Dr. Chang about all your concerns and wants during your initial consultation, so he can help you attain the results you want.

Your cost for male breast reduction will depend on the type of technique needed. It is important to consider the expertise of the surgeon and your desired results over the cost. See the pricing card below.