Yearly, the professional plastic surgery societies like  the American Society for Aesthetic Plastic Surgery (ASAPS) crunch the numbers on the previous year so we know the ages of patients having all the popular cosmetic plastic surgeries – like face lift and breast augmentation – plus the numbers of each procedure completed, the cost of plastic surgery and so on.

For the most recent set of statistics – 2009 — all plastic surgery procedures and techniques declined by two percent over 2008’s statistics, due to the recession. Surgeries declined 17 percent while nonsurgical procedures went up almost a full percent.

Along with the decline in procedures went prices.

For gynecomastia surgery, the average cost of cosmetic plastic surgery during 2009 was $3,294, $116 less than the previous year.

Of course, the $3,294 is the average surgeon fee. Usually, you must add on charges for the operating facility and for the nurse anesthetist or a board-certified anesthesiologist, along with some other items incidental to the procedure like medications, pathology fees, compressions garments and so on.

Currently, interest in all types of cosmetic plastic surgery is increasing which brings us to another question over which economists are always scratching their wizened heads.

When are prices going back up?

We would imagine that as more patients inquire about, and go ahead with, man boob surgery or other procedures, the prices will rise.

So, could now be a good time for a bargain if you’ve already been thinking about gynecomastia plastic surgery? Will prices go up in 2010?

Could be! Hey, we don’t have a crystal ball, either!

But if you combine a lowered price for surgery with other common discounts, you may realize quite a savings.

An all cash, paid-in-full arrangement is usually worth a three percent discount while agreeing to have your surgery during the doctor’s least busy time may be worth one to two percent. In many places, if you agree to fill in for patient whose surgery is canceled at the last moment, you could receive another one to five percent discount.

Best case scenario: 10 percent is nothing to sneeze at! That equals a possible savings of 329 smackers on the average ’09 gynecomastia surgery.

Surgical markings are where an open rhinoplasty begins

You may know me here mostly for gynecomastia surgery but I also do many other plastic surgery procedures.

One of my favorite and most frequently performed plastic surgery procedures is the “nose job” or rhinoplasty. Because a human nose is so small and intricate, with many interconnecting tissues, it is something like working on a living watch.

One of the first questions patients ask is about open and closed rhinoplasties. (Most of what we do is the closed).  I always explain that it is like a car repair:  lift the hood and repair the engine (open rhinoplasty) versus remove the front grill and repair the engine through a smaller opening (closed rhinoplasty).

When a cosmetic plastic surgeon starts a rhinoplasty procedure, there are two approaches. Those are:

• The open, or external, approach

Feel the tiny strip of skin that keeps your nostrils apart and note how small the area is. One finger tip can cover the place where surgeons start. An incision is made there and then the skin is lifted up and back to reveal the architecture of the nose.

• The closed technique

In this choice, the surgeon operates through the nostrils, without pulling back the skin of the nose. Some surgeons favor this approach although it requires extra training and is more demanding due to the small tolerances in the nose.

Also known as the endonasal approach, it offers some advantages, including allowing the surgeon to immediately visualize what the final result is going to look like.

When using the open technique, however, the nose skin must first be pulled back into place over the framework of the nose to get a concept what the nose’s outcome will be.

Another upside to the closed procedure: it heals faster. If the skin over the nose is lifted, the lymphatic drainage system is interrupted. That also causes more swelling.

Or, if the surgeon is not getting the results desired during a close procedure, he or she may go ahead and open the nose up for better visibility.  This is often done if there are severe distortions or asymmetries of the tip structures or if it is revision, or secondary, operation.

The thing is, if the surgeon starts with an open approach, he can’t go back to a closed and enjoy its particular benefits.

Which is best?

If you like the quicker healing of the closed approach, do the next logical thing and look at the surgeon’s before and after rhinoplasty pictures to make sure all the noses you see look natural, fitting and flatter the owners’ faces.

(Read more about a  rhinoplasty from Dr. Jacobs.)

Gynecomastia patient has one breast larger than the other

Occasionally, a patient comes into my office with one breast larger than the other and, to appear normal, wants gynecomastia surgery on just that one breast.

It’s a condition known in medicine as unilateral (meaning, one side only) gynecomastia which requires a unilateral mastectomy.

First, we make sure nothing else is happening — like a tumor.

But here’s the fly in the ointment: it is very difficult to operate on one breast and make it identical to the other. About the only way to accomplish the task is to perform surgery on both.

Otherwise, the outcome can be one breast that looks normal (the operated breast) but now the untouched breast may look odd — or even bigger in comparison.  And usually some excess tissue on the other breast also exists, but obviously not as much as the larger side.

So, most plastic surgeons want to perform surgery on both sides as well.

I usually recommend that both sides be done to provide the best and most optimal results possible.

While virtually all gynecomastia patients report being unhappy with their large, female-like breasts, having one breast that is far larger than the other only makes the problem worse.

Some body builders are extremely frustrated when they devote endless hours to weight lifting and then discover the large chest muscles they have developed only make the breast fat and tissue – known as “bitch tits” to them — stick out farther.

The one larger breast problem also occurs in teens and non-bodybuilding men.

Overall, you may be wondering how many men have – or will develop – any form of gynecomastia. If you look at the articles that have been written about the topic, it often depends on who counts.
Four M.D.s writing in a 1961 issue of the Journal of the American Medical Association (JAMA) reported that 65 percent of boys may have the problem but that it “typically resolves on its own.” (Also, typically, many do not!)

A military doctor, counting Navy patients on active duty in 1944 found eight percent had enlarged male breasts, or “man boobs.”

Other researchers, counting hospitalized men and  those in pathology labs, found about 40 percent have the condition with almost 60 percent of men over 70 having it.

One of the statistics I like the best is by Merl Yost, a psychoanalyst, gynecomastia patient, author of a book on gynecomastia and operator of the excellent website, Gynecomastia.org.

Yost wrote in a 2006 article for Men’s Health that about 91 percent of gynecomastia surgery patients were happy and would recommend the procedure to a friend.

All of which brings us to our next post: of the nine percent who were not happy, some had revision gynecomastia surgery.

Same patient as above after gynecomastia surgery

Body Builder Before Surgery

A professor of plastic surgery once explained that, not two, but three parties are actually involved in any cosmetic plastic surgery: the patient and the surgeon, of course, but Mother Nature and the healing process are also lending a hand.

Mother Nature stays in the mix quite a while afterwards — because any surgery is actually a very carefully controlled injury.

And because I never know precisely what the healing process is going to do, I can’t say with 100 percent certainly how any patient is going to finally heal.

But, please, give me this – I can improve things within a 90 to 98 percent certainty. And those aren’t bad odds!This controlled injury process we know as surgery also involves a trade off; in these cases, a flatter, more masculine chest for a few scars which do lighten into virtual nothingness over time.

After surgery

I often tell my gynecomastia patients that all men have some actual breast tissue. Male breast reduction is only indicated when that tissue is excessive and something resembling female breasts start to appear on a man’s chest.

In most cases, plastic surgeons remove both fat and glandular breast tissue. And, given a skilled surgeon, the outcome is normally a vastly improved chest that looks great in a tee shirt or with no shirt at all.

Nonetheless, the gripe most frequently heard is: “But, doctor, I can feel something under my nipples.”

No doubt. Something is probably there — perhaps scar tissue, firm fat or some very small amounts of glandular breast tissue. Even buffed out weight lifters may have a small layer of fat within their breasts.

But plastic surgery is judged by appearance. Indeed, how many people test the outcome of your surgery by poking and prodding at your chest? Not many, I would bet.

All this is considered within the realm of “realistic expectations.” It’s actually an issue in all of cosmetic plastic surgery.

If you would glance at our before and after gynecomastia surgery pictures, you can see patients who received a huge improvement in the appearance of their chest.

While those rejuvenations may not be 100 percent perfect, most are more than glad to have upwards of a 98 percent betterment.

The rub happens when a vastly improved patient – on the order of 93 to 98 percent better — wants perfection and asks for a revision surgery.

(Read more about revision gynecomastia surgery.)

After Gynecomastia Surgery

So many patients ask what happens after a male breast reduction procedure, I prepared a handout listing virtually all the questions that are most frequently asked. (FAQs.)

(I also have a handout instructing patients what to do before surgery.)

After any cosmetic plastic surgery procedure, the main concerns are:

• Infections
• Bleeding
• Fluid collections

The chest is usually – temporarily – swollen and slightly bruised at the surgery site. So you won’t be able to see the results of the surgery right away.

You may also be aware of some numbness, tingling, itching or mild burning that goes away after a few weeks.

Usually, I tell patients their chests will feel like they’ve done a very heavy chest workout like 300 push-ups.

A tight fitting compression vest is vital to stop fluid or pools of blood building up under the skin. Rarely, you may have some surgical drains under the vest.

And here’s where you have to be your own plastic surgeon and make yourself do what’s in your own best interest: wear the compression vest 24 hours daily, seven days a week except for showering.

And we’re talking three to four weeks after surgery. Not to worry; a compression vest fits nicely under your street clothes.

Here are some rare, but possible, post surgery symptoms for which you should get back to me or my staff immediately:

• Severe discharge, redness, tenderness or pain at the surgical site
• One side much more swollen
• Muscle aches beyond soreness
• Nausea
• An overall ill feeling with fever

Most guys are able to go back to sitting activities like desk work in two to three days.

More hardy exercise or sports can usually be resumed after about three to four weeks. But you’ll have to wait three to six months to see the full results of surgery on your chest.

Another rare, possible but totally unpredictable side effect is scar development on the chest or directly under the nipple any time after surgery. I’ll treat those at no extra charge for up to a year after your surgery.

Looking at the long term, the bulging, female-like breast tissue that was causing you so much embarrassment will not return. However, if you gain a lot of weight, some fat will appear on your chest.

But look on the bright side: if you protect your surgical investment, consume a sensible low-fat diet and continue with a reasonable exercise plan, you will only enhance the results of gynecomastia surgery!

Surgically closed incision

Complications are part and parcel of any cosmetic plastic surgery procedure – including gynecomastia surgery.

They can include, in order of severity: bleeding, irregular contours, cratering of the nipple, infections, and poor wound healing or scars.

But a couple of proven ways help decrease your odds of turning up with a pesky, time-consuming complication.

The first may not be obvious – but it involves the plastic surgeon. The secret is actually no secret at all: choose one who does a lot of gynecomastia surgery.

American medicine is very specialized today, so for example, even among heart surgeons, some specialize in surgery on heart valves while others concentrate on veins.

It’s no different in all of cosmetic plastic surgery: A surgeon who has performed a particular procedure many times over several decades disturbs less tissue and is more precise while doing his work.

It all actually starts before surgery.

For instance, it’s okay to ask a plastic surgeon during your first consult how many times he or she has done the procedure you want. Look for a doctor who performs that operation at least once weekly.

That translates into less bleeding, bruising and swelling because less tissue has been disturbed.

Even before you go see the surgeon for the first time, look at the before and after plastic surgery pictures on the doctor’s website. There should be many.

Much of complication avoidance is following –  to the letter — the doctor’s pre-and-post surgery instructions. For instance, halting aspirin or other blood thinning medications several weeks before surgery is very important. As is wearing the compression garment after surgery precisely as recommended by the surgeon.

Depending on your particular circumstances, the surgeon may want clearance by your personal physician, a physical or certain blood checks.

Why? All surgical patients must be healthy enough to undergo surgery.

Just before surgery, your surgeon may prescribe some antibiotics. These are preventive because the first cause of concern after any surgery is infection.

Personally, I have not – thankfully! — had a case of post-surgical infection for years.

Much of that is because my office surgical suite, is JCHAO (Joint Commission on Health Accreditation Organizations) certified and is as sterile – if not more so – than any hospital operating room you’ll ever find.

You should be in frequent touch with your doctor for the week leading up to surgery and make sure you are not ill just prior to surgery.

And don’t be surprised if your surgery is put off if you show up on the day of surgery with a cold, sinusitis, a skin infection like active acne or even a pimple on your chest.

Going ahead could be courting a serious infection!

Oh, I am SO ugly!

Just about anybody who is interested in plastic surgery has read and wondered about Heidi Montag’s many plastic surgical procedures.

Many are up in arms about Heidi having ten cosmetic plastic procedures in one day and wonder why somebody so obviously addicted to cosmetic plastic surgery is allowed to go under the knife.

But there’s a bit more here than meets the eye.

Heidi works in a highly competitive industry where appearance is not the only thing, it’s everything. Moreover, she has managed to keep herself in the public eye with all the comments about her procedures, including:

·         Liposuction

·         Rhinoplasty revision

·         Buttocks augmentation

·         Chin reduction

·         Breast augmentation revision

To the casual eye,  Heidi is young and strong.

Bear in mind I have not examined her but, off hand, I would agree that 10 surgeries in one day are a bit much but probably safe, providing that she has followed California law and had the required blood work, physical exam and medical clearance done before surgery.

But addicted to plastic surgery?

Probably not.

The official name of plastic surgery addiction is known as Body Dysmorphic Disorder, or BDD.

The hallmark of the disorder is dissatisfaction with one’s own body. Oftentimes, the perceived flaws are seen only by the patient and not by anyone else.

No amount of plastic surgery can correct what the victims sees as terrible flaws because it is a disorder of perception. The victim looks in the mirror and sees only ugliness – and is off to see yet another cosmetic plastic surgeon about correcting it

But plastic surgeons are trained to spot BDD. They must be –  the “victims” are famous for suing cosmetic plastic surgeons, claiming the outcome is shoddy, when, in fact, any rejuvenation surgery on a BBD patient is often found to be disappointing (at least to the patient).

Given Ms. Montag’s many appearances in skimpy bathing suits, I would venture to say that the young starlet could not be said to hate her appearance or her body. Just the opposite!

In a certain way, she is revelling in her new appearance and attention and is probably sifting with relish through the new offers of work she has received.

Over the years, I’ve found that many teens who develop the large, female-like breasts of gynecomastia, will gain needless weight on purpose to disguise their breasts. Sad as it may sound, it’s more acceptable in our culture for a boy to bulge all over due to overweight than to only bulge in his chest.

Still, male breast reduction surgery is possible. And I’ll be more encouraged than ever to perform the procedure if the boy admits he has been eating too much and promises to exercise and eat a more reasonable diet in the future.

Although many pediatricians and other surgeons prefer to be conservative and see if the condition just goes away, it’s very possible the youngster will suffer through his highly valuable teen years, waiting in vain.

But now, there is a new medical report out on teen gynecomastia patients observing male breast reduction surgery on obese and overweight boys.

I was also happy to see the researcher/ authors were plastic surgeons and experts in adolescent medicine at the Adolescent Breast Clinic at Children Hospital Boston and at Harvard.

The researchers studied the medical records of 69 teen boys who had male breast reduction surgery between 1997 and 2008. Writing in the April 2010 issue of Annual of Plastic Surgery, the authors noted they started the study because the roles of obesity or overweight on persistent gynecomastia are poorly understood.

The physician researchers were also sensitive to the fact that obese teens suffer greater psychological impacts.

Using the popular body mass index (BMI), the researchers carefully studied the records of 51 percent of patients who were obese, 16 percent who were overweight and 33 percent who were normal weight. (More about the gynecomastia study.)

They found major complications in four cases and minor complications in19.

Findings? The researchers found the obese patients required longer operations but that there was no different in the satisfaction of those patients or complications rates when compared to the normal weight group.

Conclusion? Obesity alone should not be used to rule out gynecomastia surgery.

Next: What does rule out teen gynecomastia surgery.

View teens’ before and after gynecomastia pictures.

After that, life for all gynecomastia patients is as predictable as it is miserable. Both boys and girls tease those kids without mercy because, really, boys are supposed to have flat, hard masculine chests.

Troy knows that wearing white will accentuate his large breasts so he takes great pains to dress in black or in large, baggy T-shirts with bold lettering. Of course, none of that will stop the daily badgering and belittling. And he dare not ever be seen with his shirt off.

The cruelest taunts of all include: “No girl wants a boyfriend with bigger boobs than she has!” and pointing fingers attached to others who shout  “Man boobs!”

Troy and his plastic surgeon, Elliot Jacobs, M.D., appeared on a recent television segment of The Doctors, along with Troy’s mom – who is now one very happy woman.

Why, you ask, is the mom so happy?

Because Troy had gynecomastia surgery about four weeks ago and is already enjoying the bliss of fitting in perfectly with his peers and not being singled out for a body feature that is seen by other teens as being something close to a freak of nature.

We can’t show you the actual television episode due to copyright restrictions but, thanks to the marvels of the Internet, we can provide a link at which you can watch Troy’s surgery as the actual breast tissue is surgically excised from his chest in a procedure also known as male breast reduction.

Watch the gynecomastia surgery at The Doctors’ website.

And for male breast reduction on a 15-year-old.

Be sure and watch for the cut-away model of a male breast with gynecomastia. It shows exactly how and where the problem occurs.

Before Male Breast Reduction Surgery

If you have a son in the teen years, you don’t want to miss Dr. Jacobs’ appearance on the nationally syndicated show, The Doctors on Monday, May 10^th.

Dr. Jacobs will be talking about adolescent gynecomastia and with one of his young patients who will comment on his own life and surgery shown in a film clip and some before and after gynecomastia surgery pictures.

If you’ve followed our blog posts, you know that large fleshy breasts on a teen boy can make his life a living hell.

The lad is:

• Belittled
• Ridiculed
• Shamed on a daily basis.

After Male Breast Reduction Surgery

This, at a time in life when a young man should be learning self-confidence, how to fit in with his peers and – above all – how to cope with the fairer gender. But instead, he spends all his time trying to hide his “man boobs.”

Sure, understanding girls and females can take the rest of any guy’s life. But a young man starts out completely behind the eight ball in the battle of the sexes if teen lasses reject him because no girl wants a boyfriend who has bigger boobs than she!

In New York, the show appears on WCBS-TV, channel 2 at 9 a.m.

In Los Angeles, The Doctors broadcasts on KCAL, channel 9 at 11:00 a.m.

To catch up on teens with gynecomastia, take a gander at our most recent posts on the topic:

• A cute teen girl in the school cafeteria pinches a boy with gynecomastia and asks what his bra cup size is.

• Teens ponder on telling others they have had male breast reduction surgery.

• Another teen with gynecomastia never left home because, if he socialized, he found “everybody staring at me.”