Gynecomastia, or excess development of breast tissue, occurs in as many as 40-60% of men. The cause is not always known, but the incidence increases with certain drugs (digitalis, anabolic steroids, Tagamet, and spironolactone), use of marijuana or alcohol, and obesity.
This condition can cause extreme embarrassment, social inhibition and self-consciousness for boys and men who suffer from it. If you think that you have this condition, you should consult with your general practitioner first to rule out a more serious condition such as liver or endocrine disease. If you are otherwise healthy, breast reduction surgery may significantly help your appearance and self-image. This procedure is used to remove fat and glandular tissue from the breasts. In extreme cases, skin is removed as well. The result is a flatter, firmer and more masculine-looking chest. If you're considering male breast reduction, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer.
Frequently asked questions about Gynecomastia by Dr. Michael A. Kremer:
This procedure can improve the appearance of the chest in cases where diet and exercise have failed. The results of the procedure are significant and permanent. Most men who have had surgery for gynecomastia have been very satisfied with the results.
During the consultation, you and Dr. Kremer will discuss the changes that you would like to make in your appearance. He will discuss the procedure in detail, and will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required.
Dr. Kremer will then examine your breast. He may also require you to have a mammogram (breast x-ray).
Be sure to ask all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.
Note: Some insurance companies will pay for breast reduction if it's considered medically necessary. However, be aware that they may have specific requirements such as a letter from Dr. Kremer, a referral from your general practitioner, and/or photos or other documentation. Be sure to find out what your insurance company requires if you intend to use insurance to pay for this surgery.
The type of procedure used by Dr. Kremer will depend on the degree of breast enlargement. The options include removal of the tissue under the breast, or liposuction of the chest wall. For those men with tissue that is more glandular in nature, an incision is made on the lower half of the nipple area (areola) and all breast tissue under the nipple is directly removed.
If the tissue is more fatty in nature, liposuction can provide excellent results. During liposuction, a small suction rod (cannula) is inserted into the incision to remove fat and other tissue.
In a few cases, if there is a large amount of extra skin, it may be necessary to remove this tissue, which may result in a large scar. This may also become necessary secondarily in case skin shrinkage after liposuction is less than expected.
Generally, the procedure usually takes 1 ½ to 2 hours.
This procedure is mostly performed in an outpatient surgicenter as day surgery. Many breast reductions are performed under local anesthesia combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, you won't feel any pain.
The longer the procedure is expected to take, the more likely that general anesthesia will be recommended. You may be allowed to return home within a few hours of the surgery, and spend the night in the comfort of your own home.
You will feel some discomfort during the application of local anesthesia in case you decide for this option. Depending on the extent of surgery, postoperative pain can vary and will last a couple of days. You will be given oral pain medication that usually is quite effective.
Usually, the chest is temporarily swollen and bruised after the surgery. You may also experience numbness or a burning sensation.
You will usually be fitted with a compression garment at the end of the procedure to wear for several weeks after surgery in order to promote edema reduction, wound healing and skin shrinking.
Light activities can be resumed within a few days, although your chest will be sore. Most people are able to return to (sedentary) work within three to seven days, and resume more strenuous activities in two to three weeks. You should avoid exposing the operated area to the sun for at least six months to prevent permanently altering the skin pigmentation.
Routine physical activity and exercising (especially lifting, pulling and pushing motions) should be avoided for at least 6 weeks. This will help the scars to heal. Dr. Kremer will advise you on the level of physical activity that is appropriate for you as recovery time and privacy needs vary from person to person. Some degree of swelling may last for 3 to 6 months.
After healing, most men are very happy with the results. The scar around the areola usually is not very noticeable. A recurrence of male breast enlargement is rare, unless you gain a lot of weight, suffer from an endocrine or liver disease, or take anabolic steroids.
In general, the best candidates for breast reduction are:
- Experiencing embarrassment and/or social inhibition due to breast enlargement
- Knowledgeable about the procedure
- Having good skin elasticity
- In good physical and psychological health
- Wanting to improve their appearance and/or comfort
- Realistic in their expectations
- Not using marijuana or anabolic steroids
- Not heavy user of alcohol
The above is only a partial list of the criteria that Dr. Kremer will consider in determining whether or not this procedure is appropriate for you.
In teenagers, it is best to wait for at least one year to see if the condition resolves spontaneously.
In all candidates, discontinuing alcohol, marijuana or anabolic steroids may resolve the problem without surgery.
Overweight men may find that losing weight will reduce breast fullness.
All surgery has some potential risks, including the risks of bleeding, reaction to the anesthetic, and infection. In this surgery, serious complications are quite rare. Other risks include:
- Rippling of the skin
- Excessive scarring
- Pigmentation changes
- Altered sensation