MALE BREAST REDUCTION (GYNECOMASTIA) – LOS ANGELES

Plastic Surgery for Men. Everything you need to know about Male Breast Reduction (Gynecomastia) Procedures.

Sculpting the Male Chest

Many men present to a consultation, wanting to improve their chest, complaining of their “man boobs” or “MOOBS”.  While pectoral augmentation can add volume to the chest, other procedures may be needed to help better define the chest and sculpt it to a more pleasing shape.  In taking care of patients that present with excessively large chests or chests without sufficient definition, one frequently encounters gynecomastia and lipohypertrophy of the chest.

Gynecomastia

Gynecomastia is a benign proliferation of glandular breast tissue causing enlargement of the breast in males.  At its heart, gynecomastia is an imbalance between estrogens, female hormones typically responsible for breast development, and androgens, which are male hormones that act in opposition.  Gynecomastia can be caused by a variety of things but most commonly occurs because of drugs, malnutrition, hypogonadism, liver injury, hyperthyroidism, and kidney disease.

While breast cancer in males is quite rare, we recommend sending male breast tissue for pathologic evaluation as breast cancer in men accounts for approximately 1% of all breast cancers.

LIPOHYPERTROPHY OF THE CHEST

A condition that can mask gynecomastia is excessive fatty deposition in the chest.    While there are multiple causes for fatty deposition in the chest, the most common is obesity due to excessive caloric intake relative to calorie burned with activity.

MANAGEMENT

The management of gynecomastia is different than the management of lipohypertrophy of the chest.  Gynecomastia typically involves removal of the breast tissue through an incision at the border of the areola.  At times, a smaller incision can be made and the breast tissue can be pulled through/pulled out.  However, in the vast majority of cases with larger amounts of tissue a semi-circular incision is made at the border of the NAC (nipple areola complex) and the ball of tissues is removed as a whole.  The incisions are closed with absorbable sutures that tend to leave a minimal scar.

For patients that have true lipohypertophy (fatty deposition) in the chest, a liposuction can help to better sculpt and shape the chest.  As the male chest tends to have more fibrous fatty tissue, the use of power assisted liposuction is our preference as this not only helps to break up the fibrous tissue but can help in creating a more event and smooth result at the end of the liposuction procedure.  This is typically done with incisions in the armpit and at the edge of the nipple.  Fat can also be removed from the outer portion of the chest to produce a more squared off appearance in the outer chest (lateral thorax).

At times, liposuction can reveal a more prominent mammary gland (breast tissue) and this may require a combined approach to the management of the chest: performing liposuction of the chest and at the same time removing the male breast tissue.

POST OPERATIVE CARE

Patients are asked to wear a compression garment for 1 month after liposuction or breast tissue excision procedures to help better shape the chest and minimize the risk of collections.  Patients are asked to avoid strenuous activity for 3-4 weeks after surgery after which they can return to full activity.

RISKS/COMPLICATIONS

-Hematoma and bleeding

-Seroma formation

-Infection

-Contour irregularities including a depressed NAC

-Thick or excessive scarring

-Skin laxity

-Change in sensation (increase or decrease) à this is typically temporary but may be permanent in larger cases of breast tissue excision