A significant number of men in the United States will develop enlarged breast tissue in their chest. Some estimates suggest 40 to 60% of men can be affected to some degree. This condition is called gynecomastia and can be a source of significant embarrassment for some men. Our Denver-area plastic surgeons can help.
Gynecomastia can occur at any age. Often, men who suffer from gynecomastia will refuse to remove their shirt even when at the pool or gym because of social embarrassment. There are several ways to improve this physical problem by removing the unwanted enlarged chest tissue and skin. It is necessary, however, to look for underlying treatable medical causes prior to surgical correction.
What Causes Gynecomastia?
There are many causes for enlarged chest tissue in men. Many times several factors are involved; however, frequently, there is no identifiable cause. Some of the contributing factors include obesity, certain prescription medications, alcohol, marijuana, and steroid abuse. Many medical illnesses can contribute to gynecomastia such as thyroid disease, prolactinemia, renal failure, and even some benign and malignant tumors.
Is Male Breast Reduction Surgery Right for Me?
First, a correctable medical cause for gynecomastia should be sought. Once this has been done, most healthy men who are bothered by the appearance of their chest are reasonable candidates to be evaluated for surgery. Patients should be mature enough to understand the procedure, its limitations, and the resultant scaring (if any). Our board-certified plastic surgeons will determine if you are a good candidate for the procedure.
If you are an adolescent male who suffers from enlarged chest tissue, often the best advice is to wait until the end of puberty to allow hormonal changes to settle out. Gynecomastia will often disappear in adolescents and patients can avoid a scar from surgery. However, there are rare cases that warrant surgical correction earlier. We have some select photos of men who have had male breast reduction with one of our board-certified plastic surgeons available to view in our Before & After Gallery.
Preparing for Your Gynecomastia Surgery
Before your male breast reduction procedure, you will get a set of pre-operative instructions describing how you should prepare for surgery. Certain medications and nutritional supplements can thin the blood and need to be stopped 2 weeks prior to surgery. The need for a blood transfusion because of gynecomastia surgery is extremely rare and is not anticipated for this surgery. Patients should stop smoking one month prior to surgery because smoking is known to increase the risk of surgical complications, slow wound healing, and worsen scars.
There are several techniques for correction of gynecomastia depending on the severity of the physical characteristics of the breast gland itself. Each patient is different, so your surgeon will discuss with you the best option after examining you. Some techniques only address the underlying gland with minimal scaring of the skin. Other techniques for severe gynecomastia must remove extra skin as well as the breast gland which will leave larger visible scars.
Often the scars can be kept just around the nipple. For the worst cases, a scar along the bottom of the breast, mimicking the natural chest muscle fold (pectoralis muscle fold) is sometimes needed. Sometimes the surgeon will recommend a second stage to allow the skin to shrink from the first operation to keep from making a larger scar.
Liposuction may be used to remove excess fat and glandular tissue from the breast area in select cases.
Stitches are usually buried and dissolve. The patient will usually never see them or have the unpleasant experience of having multiple sutures removed in the office.
All Surgery Carries Some Uncertainty & Risk
Male breast reduction is a relatively straightforward case when performed by a qualified surgeon. Nevertheless, as with any surgery, there is always a risk of complications. These include excess bleeding, infection, poor skin healing, poor breast healing.
Because it is sometimes necessary to make incisions around the areola (the round, dark part of the nipple) to remove excess skin, the nipple can be at risk. In very rare circumstances, the skin of the nipple can lose its blood supply. If this happens, the nipple can die and cause permanent scarring. This can be corrected to a large extent after healing by rebuilding the nipple (as is done for female patients with breast cancer), but permanent scars of the nipple itself are still a rare risk of gynecomastia surgery. Smokers are at higher risk for many of these complications. It is important to stop smoking at least a month before surgery.
Delayed wound healing and dehiscence: In some instances, the incision site takes longer to heal than normal. Cigarette smoking, poor nutritional status and a compromised immune system can all cause delayed wound healing or wound separation.
Scars: A surgeon must often make incisions to remove excess breast gland and skin except in very select patients who may have their chest recontoured by liposuction alone. Any incision will produce a permanent scar. Your surgeon will discuss with you one of several options depending on your excess chest shape and size. However, most scars heal well and almost all patients are happy to trade these incisions for an improved figure and a greater sense of self-confidence. In the rare incidence, a scar will be thick and unattractive. If this is the case with your scars, your surgeon will provide several options to fix or improve them.
Asymmetry: Almost every patient has some natural asymmetry of their chest when comparing one side to the other. Your surgeon will endeavor to correct any natural differences in your breasts and chest wall and make the two sides of your chest match in size and shape. However, in any type of breast surgery, there can be slight differences in nipple position, breast/chest shape, fullness, and healing that are impossible to predict. If large differences occur after surgery, your surgeon is committed to provide you with the most pleasing result he thinks he can provide.
Breast Sensation: Breast and nipple sensation can be changed by any breast surgery and especially Gynecomastia Surgery. Depending on the amount of tissue that needs to be removed, some men experience reduced chest and nipple sensation because the nerves to the skin can be cut during surgery. These changes are usually temporary and tend to improve with time. However, numbness can be permanent and may affect your sexual response to breast/nipple stimulation. Many men will have no change in their sensation.
Pain: If you experience severe pain not relieved by pain medicine, notify your surgeon immediately. Some discomfort is expected after surgery and you will receive a prescription for pain medication. The intensity and duration of pain after Gynecomastia Surgery will vary among men. Prolonged or intense pain can be due to scarring around a nerve.
Infection: A small number of men develop an infection. This typically can occur several days to several weeks after the procedure. If an infection does not respond to antibiotic pills, a patient may need intravenous antibiotics in the hospital. Hospitalization is very rare.
Hematoma and seroma: A hematoma is a collection of blood under the skin, and a seroma is a collection of the watery portion of the blood under the skin. Hematomas or seromas typically develop within the first few days after surgery; however, they may occur at any time after injury to the chest. The body can reabsorb small hematomas or seromas. Larger ones require the placement of drains for proper healing. A small scar can develop at the surgical drain site.
After Gynecomastia Surgery
You will be given a comprehensive set of post-operative instructions prior to your surgery. You will have steri-strips covering your incisions. Some patients will have tape or bandages covering the chest to help shape or support the skin after surgery. You will be given a post-surgical garment to wear for approximately 4 weeks.
Some patients will need drains under the chest skin for a short time. If you have drains, you and your family will be instructed on how to care for them. Most patients are able to return to work 10 to 14 days after surgery if they do not have a very active job that requires heavy physical lifting or activity. It can take several months for the chest skin to “settle” and achieve its final contour.
Patients can experience random, shooting, discomforts or pain after surgery. This is normal and typically improves within several weeks to months. Some men will notice changes in their chest and nipple sensation after surgery. Some men are more sensitive, while others are less sensitive. These sensations tend to even out over time and return to normal, but in a few cases can be permanent.
In the vast majority of cases, your chest can be reshaped in one surgery. However, in some patients, healing can be unpredictable resulting in significant differences in breast/chest shape, symmetry, or nipple position. In some cases a second smaller “touch up” surgery is required to give you the best result possible.
Learn more about male breast reduction by contacting Park Meadows Cosmetic Surgery online or by calling (720) 457-4471. Our board-certified plastic surgeons are based in Lone Tree and serve Denver and all of Colorado.