The common misconception:

Many people have the idea that liposuction is a weight loss procedure. Actually, liposuction goes best when you are at, or near, your normal weight. The point of liposuction is not to reduce your weight but to remove bulges that may show through  clothing.

Liposuction is often done in connection with gynecomastia surgery. In most guys, there is some fatty tissue over the main chest muscle, the Pectoralis  major. That can be liposuctioned with good results but the dense, fibrous tissue lying under the nipple must be surgically excised.

Liposuction is also used in another procedure that men like, the Torsoplasty. Once many guys have a flat chest, they eyeball the rest of their torso more critically and decide the flabby stomach and love handles should also go.

(Check out some Torsoplasty and gynecomastia before and after pictures for yourself.)

Liposuction is done on those locations, big time. But only where the fat is what we doctors know as superficial, that is, lying just under the skin.

If you have a rotund pot or beer belly, that fat is too deep down around your internal organs for liposuction and you must remove that on your own – with serious workouts and a reasonable, low calorie diet.

Women most often request liposuction of:

• Thigh bulges
• Love handles
• Flabby upper arms

Now for the news I mentioned: For the first time, the International Society of Aesthetic Plastic Surgery (ISAPS) has compiled the numbers and types of cosmetic plastic surgeries done worldwide in 2009.

The most popular procedure in the world? You got it, liposuction! It accounts for18.8 percent of all plastic surgery done globally but is second in America. (Breast augmentation is in first place here.)

The world’s most popular procedures two through five are:

• Breast augmentation – 17%
• Upper or lower eyelift – 13.5%
• Nose jobs – 9.4%
• Tummy tuck – 7.3%

Here’s another statistic you might find interesting.

The top 5 nations for performing large numbers of plastic surgery procedures are:

1. United States
2. China
3. Brazil
4. India
5. Mexico.

Here is my interview on WCBS-TV’s “The Early Show”. Go to: http://www.cbsnews.com/stories/2010/08/09/earlyshow/health/main6756741.shtml

A Better Size

You may already know me through this blog as a plastic surgery specialist who removes large male breasts through gynecomastia surgery.

But I also reduce the size of extremely large female breasts – and watch as the patients soon enjoy the medical benefits of the procedure.

It’s also a pleasure to know that, more times than not, health insurance will kick in and cover most of the procedure.

You must be wondering, though. Why cover it for women but not for men?

The list of health woes for a woman whose extremely heavy breasts may hang down to her belly button is pretty long, including:

• Back troubles
• Neck pain
• Shoulder discomfort
• Frequent infections of the skin beneath the breasts
• Breast pain

Insurance companies usually cover the procedure because eve they realize they will not have to expend funds to treat all those aches and pains in the future. Untreated, the condition can even lead to skeletal deformities.

However, the procedure for getting approval has become ever more demanding. (Read more about obtaining breast reduction coverage.)

Insurance coverage for a man or teen is much more difficult because the damage caused by overly large breasts is “only” psychological, and not physical. For a male, the procedure is usually considered cosmetic surgery.

Many times, a woman candidate for the procedure shows up in my office asking about breast reduction surgery and I immediately see that the weight of her bra straps has created notches in her shoulder blades. Surgery creates breasts that are smaller, lighter, firmer, balanced and lifted.

Many such women have tried losing weight, thinking the breasts will slim down, too.  Sometimes, they also try physical therapy and seek treatment for their various pains.

But the only real, lasting solution is surgery to reduce the size and weight of the breasts. Between the lines, I see many patients who enjoy moving their breasts from resting on their stomachs to  a position higher up on their chests where most womens’ breasts sit.

It makes daily life easier, too. With very large, or especially in gigantomastia cases, teen girls suffer extremely cruel remarks and behaviors from men and boys. After surgery, clothes fit better and exercise no longer causes breasts to flap around.

The trade-off for female breast reduction is long scars on the breast.

Of course, like all scars, they lighten and fade over time and are hidden by bras, swim wear and most tops.

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

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.

But in gynecomastia, the decisive moment can be the last straw that drives a teen or young man to make the decision to have male breast reduction surgery on his fleshy, female-like chest.

The excellent website, Gynecomastia.org has a forum in which males afflicted with “man boobs” recall their worst gynecomastia moments.

Not surprisingly, many deal with the lads’ experience with girls and women:

• A beautiful Russian woman and co-worker poked a guy in the chest and declared with a giggle to all present in a crowded bar : “You’ve got boobies!” Said the guy: “Any pre-surgery doubts I had went away in that second.”

• One wrote his gyno cost him the love of his life.

• Another was the victim of a sick practical joke. His buddies got together and arranged a blind date with a very attractive nurse…who was flat as a board. Neither the victim nor the nurse appreciated the stunt.

• In bed, a “hot girl” bluntly told her new boyfriend: “find a way to get rid of them boobs…” The same guy figures his gynecomastia is why he was still single at 36. (But he had gynecomastia surgery in 2008 and declared he now feels “new born.”)

• Wrote yet another: “In the seventh grade cafeteria, I was holding a tray of food in the cafeteria and a girl asked me what size cup I had. She was trying to pinch my breasts while I was trying not spill everything on the tray.”

Other guys can be no less cruel:

• ”At a union meeting, a guy who had been drinking grabbed my breast and yelled out: ‘Look at the tits on this guy!’ I wanted to crawl under a rock and die.”

• ”When I was 11, my friends called me ‘Breasts.’ Then in high school, I was known as ‘Chesty.’ I wanted to go home and cry each time; I know it has affected my self-esteem and confidence my whole life.”

• ”I had the nickname ‘Boobula’ in high school.”

• ”A group of friends in high school wrote in huge letters on my school notebook, ‘Logan Has Boobs!’ and that started me thinking about my gyno every single day. I’m 19 now, a college sophomore and am sending pictures of my chest to plastic surgeons for help.”

While some pediatricians and even plastic surgeons are against it – thinking the lad may outgrow the condition – the teen patient’s life can be hellish if the condition does not go away. Others say the breasts may grow back after surgery. (They don’t!)

According to the American Society of Plastic Surgeons (ASPS), 14,203 patients between 13 and 19 went under the knife in 2008 for male breast reduction.

(2009 statistics will be available soon.)

While I’m not a psychologist, anybody who hears these lads’ stories would conclude some damage is being done at a critical time in a young man’s life when he should be building self-confidence, not having his image torn down daily.

For the teen with large breasts (or “man boobs” as they are cruelly known) teasing and finger pointing can also destroy his fledgling ability to relate to both boys and girls.

Recently a teen gynecomastia patient complained of school bullies flicking his breasts as if he were a girl. And here’s what he said about his social life, which is usually very active for any teenager: “I don’t like going out because it seems like everybody is staring at me.”

It turned out that Tim’s father also suffered as a teen with large breasts and did not want to see his son go through the same thing.

One boy, pictured below, was only 12 when he and his family came to see me about male breast reduction surgery.  (Read The Post-Standard article from  Syracuse, N.Y. about teens with gynecomastia .) The after picture was taken in February, 2010.

After surgery, the youngster was so motivated, he lost 35 pounds through diet and exercise!

In another case, a mother wrote about her son whose breasts started growing when he was only 10.

Some female classmates said it would not be cool to have a boyfriend with bigger breasts than they had! Naturally, the lad was crushed.

(Read the touching letter of the mother whose son had gynecomastia.)

I’ve performed male breast reduction surgery on over 175 teens and recommend it, if certain diagnostic criteria exists like:

• Stability for at least two years.

Breast size have not changed

• Being emotionally mature.

He must understand treatment is an operation, with all that entails.

(Read more about when teens should have gynecomastia surgery.)

That may have been the case many years ago, but the world of sedation anesthesia now used in plastic surgery is more kind and gentle, thanks to a product you have perhaps read about.

That product, Propofol (trade name: Diprivan) used in the right hands and right places – specifically, used by an anesthesiologist M.D. or nurse anesthetist in a hospital or ambulatory surgical center – is a wonderful and unique anesthetic drug that has revolutionized office-based surgery.

Nonetheless, Propofol was abused in connection with the unfortunate death of Michael Jackson who called it “his milk” due to its milky white color.

That does not mean Propofol is safe to use at home, away from monitoring equipment and emergency equipment and, most especially, in hands not specifically trained in its use.

If we are to believe news reports, Propofol was used to lull Michael Jackson to sleep every night at his home.

But the drug was never intended nor designed for that use. Moreover, we don’t know how large the doses were nor how often they were administered.

(Side note: medical treatment in the absence of records is malpractice.)

Propofol is known as an hypnotic because it quickly induces sleep and then allows for a very fast recovery after cosmetic surgery with virtually no hangover, nausea, grogginess, sore throat or other undesirable side effects.

Among anesthetic drugs, Propofol is remarkable for clearing itself from the body extremely rapidly.

I commonly use it in my office, along with some other small doses of carefully selected medications. For gynecomastia surgery and other plastic surgery procedures, Propofol is administered by an anesthesiologist with whom I have worked for the last two decades.

Patients virtually always go into a relaxed sleep and have no memory of the procedure, experience no pain and gently wake up just as I’m placing the last stitch. Usually, the patient pleasantly chats with me as the bandages are being placed.

So if you have read about the circumstances of Michael Jackson’s case, don’t conclude Propofol is dangerous for use in an upcoming surgery.

In the right hands and setting, this drug works wonders!