Gynecomastia

Gynecomastia is the excessive enlargement of breast tissue in men. Some temporary enlargement is often seen in adolescent males at the time of puberty due to hormonal stimulation but in some males this becomes persistent and even worsens over time due to a variety of factors.  While the cause of gynecomastia is unknown and benign in most men, it may be related to medication use, hormonal imbalance, supplementsor other medical conditions.  Patients most often seek correction due to the abnormal appearance and occasional tenderness and pain associated with this condition.

Best candidates

When you are first evaluated, we will examine you and ask you about underlying medical conditions or medications that may be contributing to your gynecomastia.  In some cases, we may have you seen by another physician, such as an endocrinologist, if we feel that your gynecomastia may be a symptom of an underlying medical condition.  Of course, it is important that if there is an identifiable cause to the condition that this be treated first prior to undergoing surgical correction.

Best candidates are otherwise healthy and should be at a stable weight.  In adolescent males, we prefer to wait until the breast enlargement has stabilized, usually in the mid teens.

Types of Gynecomastia correction

The way we perform your gynecomastia correction depends on the amount and location of the excess tissue that will need to be removed.

Direct excision

In the simplest case, the excess tissue is confined to a limited area just under the areola in the central part of the breast.  This dense, fibrous tissue can be removed from this area through a direct excision approach, usually through a small incision along the lower edge of the areola.  The incision is made, the tissue removed under direct visualization, and the incision is closed with dissolving sutures.  This can often be done in our office under local anesthesia during a 1-2 hour procedure.

Liposuction

In cases where there is a greater amount of tissue distributed on the chest wall, we often approach this using liposuction.  This is done in the operating room under a general anesthetic, as we have found it difficult to adequately anesthetize this large area sufficiently to allow comfortable removal of this fibrous tissue.  One or two small incisions are made on each side, a dilute local anesthetic is infiltrated, and excess tissue is removed with liposuction during this 1-2 hour procedure.

Liposuction plus direct excision

We sometimes use a combination of both liposuction and direct excision to remove the excess tissue.  Suctioning is first performed to remove the more widely distributed tissue on the chest wall, then the concentration of dense tissue in the central part of the breast is removed through an incision along the lower edge of the areola.  This procedure is done in the operating room under a general anesthetic and takes 1-2 hours.  In most cases, the skin is able to shrink up adequately with this approach after the underlying tissue is removed, making removal of the excess skin unnecessary

Removal of tissue and skin

In a small number of cases the degree of gynecomastia is significant and removal of this excess underlying breast tissue leaves redundant skin which must be removed.  In these cases we may have to leave longer scars located around the areola and on the underside of the breast.  We try to avoid doing this whenever possible, as skin is usually capable of shrinking a significant amount making actual removal unnecessary.  When this technique is used we do our best to minimize scar length and make the scars fade as well as possible.  These cases tend to take a bit longer, usually 2-3 hours, and are done under a general anesthetic.

The operation

The operation is performed either in our office under local anesthesia or in the operating at the Lawrence Surgery Center .  The procedure varies in length depending on the extent of surgery we need to do, as discussed above.  After the procedure we typically place you in a chest wrap or vest to provide compression on the area and minimize pain, swelling, and bleeding.  Pain is typically mild to moderate and controlled with oral pain medication.

Recovery

Most patients are on their stronger pain medications for 1-2 days after the procedure, then transition to less sedating medications.  We will keep you in a compressive vest for at least a week and sometimes longer, especially if extensive liposuction is performed.  The time before you can return to work and everyday activities varies from patient to patient, but ranges from a few days to about 1 week.  We have patients refrain from strenuous work and exercise, especially those involving the chest muscles,  for 1 week and then gradually return to their exercise routine.  Swelling and bruising are typically present, especially in the first week.  Significant improvement is typical right after surgery but the final result may not be apparent until up to 2 months after surgery when all the swelling has subsided.

Insurance coverage

Insurance coverage is usually not  available for treatment of gynecomastia.  However, if we think insurance coverage is a possibility we will write a letter to your insurance company prior to the procedure and determine what benefits may be available.  We have found that companies are more likely to cover this in the case of adolescent males where the degree of gynecomastia is very significant.

Fast fact

It’s more common than you think!  Around 25,000 gynecomastia procedures were performed in the US in 2018.  This compares to 110,000 breast reduction procedures in women.

5 Reasons why you should have your gynecomastia procedure performed at Lawrence Plastic Surgery:

  • Experience– We have been performing this procedure for over 20 years using a variety of techniques which we tailor to meet the needs of the individual patient.
  • Accredited facilities–  When a general anesthetic is required we perform this operation at Lawrence Memorial Hospital or the Lawrence Surgery Center, both licensed and accredited facilities.
  • Choices– Gynecomastia correction is not a single procedure but may combine several techniques (liposuction, direct excision, skin removal) to achieve the desired appearance.  Any surgeon performing this procedure should be comfortable with all these various approaches.  We are glad we can offer you these choices, as this is definitely not a “one size fits all” procedure
  • Surgeon certified by the American Board of Plastic Surgery.  In addition, Dr. Thellman achieved board certification in General Surgery prior to his Plastic Surgery certification.
  • Personal attention– While we’re a busy practice, our doctor and staff will give you the personal attention you deserve.

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