Thirty-five years ago, when we established our plastic surgery practice in New York, gynecomastia patients weren’t as numerous as they are today. The World Wide Web did not exist as we know it, no sitcoms had dealt with man boobs and men generally weren’t talking about the topic too much. Indeed most men weren’t accustomed to thinking about plastic surgery for any reason—except, perhaps, rhinoplasty—let alone for enlarged male breasts.

Looking back on the first gynecomastia patients we met, some dating back to med school days, we observed that the techniques used at the time seemed somewhat unsophisticated, making the operations long and invasive. Correspondingly, recovery was lengthy and results were disappointing for many patients. Men were left with unsightly scars and uneven contours. Some felt that the final outcome was worse than the original problem.

Those first New York gynecomastia patients we consulted with—many who sought revision surgery—inspired us. We designed our own set of surgical instruments specifically for gynecomastia. These implements can perform liposuction and breast gland excision, treatment most patients need for optimal results. The slender instruments allow us to perform precision contouring while causing minimal trauma to adjacent tissues.

With these special instruments in hand, another goal could be met: a minimal scar approach to male breast reduction. The majority of our gynecomastia procedures call for a tiny nick in the skin near the armpit. If another entry point is needed, we make a small incision around the edge of the areola. The resulting scars are nearly invisible for most patients.

Through the years, we have perfected our approach to male breast reduction surgery. Employing a sense of artistry along with the science involved, we take great pride in creating a natural looking, masculine result for each individual patient, whether he is a body builder with a muscular physique, a teen whose moobs have persisted over time or a mature man with a heavier build, and whether the operation calls for liposuction, tissue excision, fat grafting, skin removal or a combination of all these techniques.

More than thirty years down the road, we are thankful that male breast reduction is a topic most people can discuss without undue embarrassment. And we still feel a tremendous sense of sympathy for men who suffer from man boobs and for their partners who care about their well-being. That’s why we will be as pleased to help the next patient who walks through our door as we felt during our very first gynecomastia consultation.

We would be delighted to talk with you in person or on the phone to discuss your individual needs. You may send in our online contact form anytime or call our Manhattan plastic surgery offices at 212-570-6080.

Photo by AmazonCARES, available under a Creative Commons attribution license.

As we tell our New York gynecomastia patients, it’s essential that each male breast reduction procedure be fine-tuned to the specific needs of the patient. And that means some decisions must be made in the operating suite as the gynecomastia surgeon gets a close up look at exactly what kind of tissue is present throughout the entire chest area.

Through our experience working with 2,000 gynecomastia patients over two decades, we’ve learned a great deal. We know enough to make educated guesses about what we’ll find under the skin during surgery, and we’re right most of the time. Still, we make final decisions during the male breast reduction procedure to achieve optimum results for each man. It’s important to understand that no one, not even a plastic surgeon well versed in male breast surgery, can predict exactly what type of tissue lies beneath the skin prior to making incisions.

We think of the surgical process as a “decision tree.” We start with a tiny nick near the armpit and perform liposuction with instruments we’ve designed for this purpose. In about a third of our patients, we discover a modest amount of breast tissue that can also be removed with a cannula through this same incision.

When we find a larger amount of dense breast gland that can’t be taken out this way, we make small incisions around the edge of the areolas. This allows us to remove the balance of the breast tissue and achieve a smooth, contoured appearance.

The decision tree doesn’t apply to the breasts alone. We also take a look at surrounding areas and determine whether there are stubborn fat deposits along the sides of the chest or into the armpit that should be removed. Each case is unique, but the goal is the same: to achieve a natural looking, masculine result.

We understand that every patient hopes for the least invasive male breast reduction procedure possible, and that’s our goal as well. But even when our New York gynecomastia patients need multiple small incisions to achieve a great-looking outcome, we assure them that scars will be minimal, or even nearly invisible. Take a look at our before and after gynecomastia photos to see what we mean.

Photo by David Mican, available under a Creative Commons attribution license.

Gynecomastia results from excess fat, overdeveloped breast tissue or a combination of the two.  When the culprit is too much breast tissue, the underlying condition is typically decreased testosterone levels.  With testosterone levels low, estrogen levels can climb and breast tissue may form.  Low testosterone levels can be the result of a number of factors including alcohol consumption.

Heavy drinking can also contribute to gynecomastia by affecting liver function.  Men with liver problems, including cirrhosis, may experience hormone changes that allow breast tissue to grow.  In addition, certain medications for liver disease can trigger the appearance of enlarged male breasts by affecting hormone levels.

Finally, there’s the simple matter of calories.  Many people do not realize how many extra calories they add to their diets each month by consuming beer, wine and cocktails.  Courtesy of the Task Force on College Drinking, a project undertaken by university presidents, researchers and students across the nation in partnership with the National Institute on Alcohol Abuse and Alcoholism, here are some sample calorie counts (per one serving):

• Regular beer:  149
• Light beer:  110
• Liqueurs: 188
• Red wine:  80
• Martini:  140
• Margarita:  168

You can see how quickly calories add up, even for a social drinker.  Since the typical male stores extra fat in his abdomen and chest, the implication is clear: overconsumption of alcohol can trigger the development of fatty man boobs.

If you have enlarged male breasts, the best way to understand the underlying cause or causes is to consult a board certified plastic surgeon with substantial experience in treating gynecomastia.  New York area residents and men across the country suffering from “moobs” can contact our office with questions or for a consultation.  We have a special interest in this area of plastic surgery and enjoy helping men from all corners of the nation look better, enjoy more activities and gain confidence.

Photo by T. Narik, available under a Creative Commons attribution license.

Swelling is the body’s natural response to injury or surgery (we often refer to surgery as “controlled trauma”).  It is simply the movement of fluid and white blood cells to the surgical area and the body’s effort to heal.  Post-op swelling is different for every patient.  It can be diffuse and spread over a fairly wide area, or localized.  The swollen area can feel hard or soft.  Fluid can accumulate soon after surgery, or build up a few days later, and the swelling can be different on the two sides.  Maximum swelling usually occurs around 48 hours after surgery – but the body’s urge to swell can last for weeks.

The important thing to note is that moderate swelling is generally not a concern.  The body wants to swell for a few weeks after surgery, not just the first few days.  We tell our New York gynecomastia patients that it will almost always resolve itself over several weeks, as long as they follow instructions.  These normally include wearing a compression garment for at least four weeks.  We use compression vests and/or binders for most of our patients; other plastic surgeons use different types of compression garments.

Other measures our New York gynecomastia patients take to minimize swelling include:

• Taking it easy after surgery as directed
• Resting in an elevated position when possible
• Limiting arm movements and lifting for several days
• Avoiding all strenuous exercise for four weeks

Very rarely, a patient may develop a complication following gynecomastia surgery.  Excessive swelling may indicate the presence of a seroma, or fluid collection under the skin.  A simple procedure to drain the fluid may be performed.  Swelling can also indicate the presence of a hematoma, or pool of blood, within the breast.  A visit to the surgeon is then needed to determine whether immediate or delayed treatment is in order.

The risk of developing a seroma or hematoma is low, but we always suggest our male breast reduction patients call our New York office if they have any concerns.  Certainly, any patient should contact his plastic surgeon to report extreme pain, asymmetric chest enlargement, significant bruising, bleeding from incisions or any other post-op problems.

We’ve already discussed how gynecomastia causes extreme embarrassment, social withdrawal and can ruin a person’s self-image, making him feel worthless.

Truth be told, there is plenty of pain to go around!

On one website supporting a petition asking insurance companies to cover gynecomastia surgery, you can see lives being held back.

For instance, Bruce blogged:

“I opted out of a promising military career because I would not disrobe…I suffer from depression and often isolate myself. (Health) insurance will pay for tummy tuck and breast reduction in women but not for gynecomastia. Would somebody explain why?”

Mark B. wrote:

“The emotional impact can lead to feelings of hopelessness, depression and thoughts of suicide…there is pain and tenderness when jogging..gynecomastia plastic surgery has nothing to do with cosmetics. All we want to do is live normal and productive lives.”

Giovanni V. added:

“It is not normal to have breast tissue if you are a man!”

Louis P shared:

“Having gynecomastia as a teen, I put on a lot of weight because I thought I could hide it…I’m now 40 and trying to lose the 100 pounds I put on…An adolescent boy should not have to suffer through what I did!”

Porta S. wrote:

“At age 15, my son’s breasts are larger than mine; he can easily fill a size B bra. This otherwise healthy, athletic boy has to deal with kids gasping in horror when changing clothes in gym.”

Chase, 18, blogged:

“I have not led a full life due to my gynecomastia and it kills me! I try not being depressed but I can’t help it. Insurance coverage would give me the second chance I so desperately need.”

Jim, 48 said:

“In high school, my girl friend said ‘What the hell is this?’ while we were swimming. To this day, I won’t take my shirt off in public.”

Dedan L. wrote:

“I developed gynecomastia at 13. Whether I was 135 or 235, it made no difference. Even at my largest and leanest, 215 and 8 percent body fat, I still wore a rash guard (a spandex athletic shirt) to the beach.”

Karen added:

“My 13-year-old son has gynecomastia; it’s heartbreaking to see him worry so much about how much breast shows through his shirt.”

56-year-old Paul blogged:

“I have considered taking razor blades and performing surgery on my man boobs. My entire life has been affected by gynecomastia.”

Many times, it comes down to a question of how the patient wants to look after surgery:

• With a shirt on
• Without a shirt

In some cases, all that’s needed to produce a flatter chest is liposuction.

The exception is when actual, glandular breast tissue – yes, mammary gland tissue — sits under the nipple; that type of tissue does not easily yield to liposuction and must be excised away.

That can usually be done through the areola – the dark areas surrounding the nipples – so the surgical scar is well concealed at the edge of the areola.

Liposuction requires only small puncture wounds about one-eighth inch long. Those scars soon fade.

If a young person has very large breasts, removal of the excess underlying tissue will allow the skin to shrink spontaneously – much like letting air out of a balloon.  So rarely, if ever, is additional skin removal required.

If there is residual skin, six to eight months after the original operation, then a much smaller second procedure (with fewer scars) can be done to remove the excess skin.

If an older person has lots of excess skin as well as breast tissue, then he can elect to have everything removed and tucked at one time.

But that results in a trade-off of scars (which fade) for a trimmer contour.  Alternatively, he can elect a two-stage procedure, as described in the previous paragraph.

Before your first consult with a plastic surgeon, you can get a rough idea what’s needed by the position of your nipples. If they are in the center of the chest muscles, liposuction and breast tissue removal may be just the ticket. That leaves about a one-inch scar in the lower part of your areola. It’s not very noticeable.

Shirts off guys, take delight!

But if the nipples are pointing south, some skin will also probably have to be removed. That can result in a longer scar above, around or through the areola and nipples. After healing, you’ll have a flatter chest and look good in a T-shirt.

But for shirts off-guys, take heart. Those longer scars don’t last forever; they lighten and fade over time.

Depending on the person’s particular case and how much fat, breast tissue and scars must be removed, scars can be located:

• From side to side above and below the areola into the chest
• Under the areola into the chest area in a U-shape
• Under the areola but well hidden in the fold where the breast mound meets the chest

In some cases with a lot of sagging skin, the areola is repositioned higher on the chest.