Dr. Steven Robinson of the Plastic Surgery Group

Male Breast Reduction – Gynecomastia

Do you feel that your chest is larger than it should be for a normal male? Does it look like you have breast tissue where you want to show only muscle definition? This might be gynecomastia. Gynecomastia is the condition of abnormal breast development in males.

This problem usually occurs during puberty, but can also happen in adulthood. About 10% of boys develop the swelling and hardness under the nipple and areola (dark skin of the nipple) that is the hallmark of gynecomastia. This usually occurs at ages 12 to 14. In roughly half of these boys, the condition will go away be itself within 2 years. If gynecomastia persists after 2 years, it is likely permanent and will require intervention to correct. True gynecomastia is not caused by overall weight gain and does not go away with weight loss.

Gynecomastia can be painful. Many boys with this will complain of their chest hurting after sports or activities. They can even have a dull ache that is not related to any physical activity at all. Frequently, the nipple area is tender to touch and some boys avoid sports and activities altogether because of the discomfort and embarrassment.

Gynecomastia

What Causes Gynecomastia?

Most cases of true gynecomastia occur spontaneously in individuals without any known cause or reason. In a minority of instances, there might be a family member who also has this condition. Most boys and young men who develop this do not have a family history of it. Many studies have been done on the hormone levels of boys with gynecomastia. For the vast majority, the levels of testosterone and estrogen are normal. It is thought that the development of excess breast tissue in these boys is an exaggerated reaction of this tissue to normal levels of estrogen.

Causes of Gynecomastia

  1. Most have no known cause
  2. Genetic – sometimes gynecomastia runs in families
  3. Medications – Tagamet and Risperdal are known to cause this in some
  4. Smoking marijuana

Does Everybody with Gynecomastia Need Surgery?

The answer is “no”. However, the only way to remove gynecomastia that has been present for over 2 years is surgical. There is no medical necessity to treat this, but many good reasons to have this procedure done.

Reasons

  • Embarrassment over having what looks like breasts
  • Teasing at school or by friends
  • Not participating in sports because of embarrassment
  • Social withdrawal
  • Depression

If you are experiencing any of these problems due to gynecomastia, you may want to look into treatment options, such as plastic surgery.

What is the Treatment for Gynecomastia?

No matter what the cause, there is a surgical treatment for gynecomastia. There is no medical therapy known to reverse the development of breast tissue. No drugs have been effective in shrinking this tissue. Once it has been present for over 2 years, it must be surgically removed. Fortunately, there is a procedure designed just for this purpose. It allows for the safe removal of excess tissue while restoring a masculine contour to the entire chest area.

This surgical procedure is done as an outpatient usually performed in a fully accredited ambulatory surgery center with a board certified anesthesiologist present to ensure the comfort of the patient. General anesthesia is the preferred method during this particular surgery, but sometimes for those who have a minor excess of tissue, local anesthesia is adequate.

The procedure itself usually consists of 2 parts in order to fully correct this problem. First, a small incision is made at the bottom border of the areola and normal skin junction (fig. 1). Through this small incision the hard, nodular breast tissue is removed. This part of the operation is done under direct vision using traditional surgical instruments. The next part of the procedure is liposuction of the entire chest region. This takes care of extra body fat that also accumulates with gynecomastia and leaves a very masculine contour of the chest. The goal is to remove all extra tissue between the skin and the pectoral muscles thus allowing the muscle definition to be visible.

Gynecomastia

What to do before surgery?

There are several things that most surgeons will want their patients to do prior to surgery. First is to avoid any of the blood-thinning medications that would cause excess bleeding and swelling after the procedure. These most commonly include aspirin, vitamin E, omega 3 or fish oil supplements, and many other herbal supplements that you may be taking. It is very important to give your surgeon a complete list of the medicines, vitamins, supplements and any other health or fitness drinks or food that you are eating to ensure that you are not taking something that might prolong the recovery process after surgery. You may be asked to stop certain medications before the procedure. Be sure to ask your Surgeon when you can start them again.

What Is The Recovery Time After Gynecomastia Surgery?

Recovery time varies depending upon the Surgeon and technique used. Please be sure and ask your surgeon for specific instructions. However, the post-operative restrictions that I use in my practice will be similar to those of most other Plastic Surgeons. My patients may shower the next day after surgery. They are fitted with a compression vest that they must wear day and night for a month. You may take it off to shower of to wash it, but then it needs to be worn.

Patients are allowed to go back to work in 2 or 3 days provided that they feel up to it and their work does not require strenuous activity. They may exercise in a gym in one week and go back to normal physical activity without restrictions in 2 weeks. Again, these restrictions may vary slightly with different surgeons, so be sure and check with yours.

Final results may take several months to be seen. While the majority of swelling is gone in one month, a small amount can persist for a few more months. In addition, if there is a lot of excess skin, this will also take several months to contract. The skin still may not be tight if there was a large amount of excess before the procedure. Be sure to discuss expectations of the final appearance with your surgeon. In rare instances, some excess skin may need to be removed after healing has taken place to achieve optimal results. Also be sure to discuss the possibility of needing revisions with your surgeon.

Results

Included are some typical results of boys and men who have had gynecomastia tissue removal, or what is sometimes called “male breast reduction”. Most of the “after” pictures were taken at 3 months post-op to show complete results. By this time the scar has healed nicely, swelling is gone, and most of the skin contraction has occurred. However, most people are able to remove their shirt at the gym or pool within one month after surgery.

Gynecomastia

Gynecomastia FAQ’s

Q. – How old do I need to be to get this operation?

A. – Gynecomastia usually occurs about the time of puberty. In about half of the cases, it will go away all be itself in the first 2 years. If it has not resolved in 2 years, then you could be a candidate for the procedure to remove it. D. Robinson has done this procedure on those as young as 14 and there is no upper age limit.

Q. – Do you cut out the gynecomastia or do liposuction?

A. – In most cases of true gynecomastia, there is the presence of both hard gland tissue as well as the softer fatty tissue. Dr. Robinson believes that for the majority of people cutting the hard tissue out and doing liposuction for the softer fatty tissue will give the best result. Dr. Robinson performs both parts of the procedure in the vast majority of gynecomastia surgeries. This consistently gives a more masculine chest contour and allows more muscle definition to show.

Q. – Is this procedure done in the office?

A. – No, in most cases gynecomastia correction is best done in an outpatient ambulatory surgery center with an anesthesiologist present to insure your comfort. Dr. Robinson believes that this is the safest way to perform gynecomastia surgery and gives the best results.

In rare occasions, those with only minor gynecomastia tissue can have this removed under local anesthesia. Be sure to discuss this with your Plastic Surgeon before having the procedure.

Q. – How long is the recovery time?

A. – Recovery from the gynecomastia correction procedure is fast. Most people are back to work or school in a few days. Dr. Robinson does ask that you refrain from exercising or heavy lifting for 2 weeks after the operation. You can shower the very next day and do normal, non-strenuous activities. It is best to wait about a month before engaging in contact sports.

Q. – When can I expect to see the results of the surgery?

A. – While there is some swelling after the procedure to correct gynecomastia, this is usually minimal and you will see some of the results immediately. However, Dr. Robinson gives you a compression vest to wear that helps reduce the swelling quickly. This way you can see the full results of the procedure in 2 to 3 months. At that time you can also take off your shirt at the gym or pool and no one will be able to tell that you have had a procedure done.

Q. – Can gynecomastia grow back again after it is removed?

A. – No, gynecomastia cannot return once it has been removed. The hard, glandular tissue forms only once at about the time of puberty. However, if one gains a considerable amount of weight, you can put on body fat in the chest area. This is different from true gynecomastia and can be treated with liposuction alone.

The exception to this is if you begin taking medications or drugs that can induce gynecomastia to form. The most commonly known medications that may cause gynecomastia are Tagamet, Risperdal, and smoking marijuana. Taking anabolic steroids can also sometimes cause this.

Q. – What if I just have it on one side?

A. – Gynecomastia can occur on just one side, although it is more common on both sides. Dr. Robinson has treated many men with this condition on just one side. The procedure can be performed to make the affected side more closely match the normal side.

Q. – What if I have already had a procedure to correct gynecomastia but am not happy with the results?

A. – Dr. Robinson has treated many people who have had initial procedures done. The most common reason for unhappiness after this procedure is if not all of the tissue was removed. This leaves a residual “fullness” or sometimes visible contour irregularity. These can almost always be improved upon with a secondary procedure done by a highly experienced Plastic Surgeon.

Gynecomastia Consultation

At your consultation, board-certified plastic surgeon Dr. Robinson will discuss the procedure with you in detail. You will also see male breast reduction before and after photos of others who have had the surgery. If you wish, Dr. Robinson will take pictures of you to serve as your “before pictures”. After your recovery period, he will take “after pictures” and give you both sets of photos. It can be exciting to compare the differences, but we remain sensitive to the confidential nature of male breast reduction surgery and never share photos without the consent of our patients.

When you’re ready to restore a masculine appearance to your chest, Dr. Robinson invites you to take that next step and schedule a consultation to discuss male breast reduction at one of our offices: 1 Plastic Surgery Plaza, 4850 Red Bank Expressway, Cincinnati, OH 45227 or 7162 Liberty Centre Drive Suite C, West Chester, OH 45069. You may contact us by the email form provided. You may also call us at (513) 791-4440 for the Cincinnati location or (513) 769-3223 for the West Chester location.

(513) 791-4440 (Cincinnati)

(513) 769-3223 (West Chester)

(614) 326-4661 (Columbus)

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1 Plastic Surgery Plaza
4850 Red Bank Expressway
Cincinnati, OH 45227
(513) 791-4440

7162 Liberty Centre Drive
Suite C
West Chester, OH 45069
(513) 769-3223