Fortunately, when men are willing to share their experiences on websites like this, they can help others avoid being taken by “cures” that can only shrink the wallet. One gynecomastia.org member recommends that others refrain from trying a so-called easy fix and save for male breast reduction surgery instead.

Is it realistic to save for plastic surgery? How do people go about it?

We’ve heard some great ideas on the subject from our New York gynecomastia patients, as well as from men and women planning a face lift, tummy tucks and other procedures. Here are some tips we can pass along.

One of our favorite strategies patients use to save for plastic surgery is to jump start the campaign with a tax return, a bonus or even a travel reimbursement check. It can be very encouraging to move your effort forward with a few hundred dollars or more when you’re just getting started.

You can use your bank as a tool to help you save. One way is to create a separate account for the sole purpose of paying for your procedure, then make sure money flows in and not out. One woman set $20 aside for cosmetic surgery every time she went to the ATM.

Some patients commit to modifying their routines for a while to save money every week. Brewing your own coffee at home and making lunch to take to work can save a surprising amount if you’re consistent. For patients who have already tightened their belts in this economy, a second job for a short period of time may be the answer. Some get busy selling things they no longer need on auction websites.

One way to make the process of saving more rewarding is to download a “savings ticker” from a site like tickerfactory.com and use it to chart your progress.

Another option many patients use is to finance plastic surgery through a company that specializes in this type of loan. We partner with two different surgical loan companies to give our New York gynecomastia patients a variety of options.

We don’t want to give the impression that we encourage patients to have gynecomastia surgery, or any other procedure for that matter. We are always very careful to supply complete, objective information and we support our patients to make the decisions that are right for them.

But we know the anguish and embarrassment man boobs can cause—we hear about it from our patients weekly. If you know that frustration firsthand, don’t compound the situation by wasting money on pills or potions. Saving or a combination of saving and financing plastic surgery may be a better choice.

Photo by Ken Teegardin, available under a Creative Commons attribution license.

Men can have tuberous breasts just like some women do, and the condition is equally frustrating for both sexes. Some people learn to make peace with boobs that protrude a little like tubers—hence the name—while others seek cosmetic breast surgery to correct the condition.

To get a sense of what tuberous breasts in men look like, and the kind of surgical result that’s possible, take a look at our before and after gynecomastia photos. Pay close attention to patients 68, 71 and 77. Each one had a clear case of tuberous breasts, and all three patients were very satisfied with their surgical outcome.

Another frustrating aspect of tuberous breasts—sometimes called tubular breasts, zucchini breasts, Snoopy breasts (referring to the famous beagle’s nose) and other unflattering names—is that no one knows exactly why they occur. We do know that in patients with tuberous breasts the base diameter of the breast is somewhat constricted, causing growth in a narrow corridor instead of in a pleasing, rounded shape.

In women, breasts are usually smallish as well as misshapen and sometimes droopy, nipples and areolas can be large and puffy. It’s also not unusual for a marked degree of asymmetry to be present. When men have tuberous breasts, the growth of the breast gland is generally restricted to an area beneath the nipples. The result is usually the hated “puffy nipples” and often some sideways spread as well.

Treating a male patient involves making a small incision around the rim of the areola to enable the gynecomastia surgeon to remove the excess breast gland. Liposuction is almost always needed as well, not just to help remove gland and fat but to loosen and redistribute skin so the breast gains a normal contour. For the majority of patients, the formerly large, puffy nipples and areolas shrink to an average size after the procedure.

When a man decides to explore the idea of cosmetic surgery for tuberous breasts, the most important move he can make is to find an experienced gynecomastia surgeon. Not every plastic surgeon treats dozens of patients with man boobs each year, and even fewer see many male patients with tuberous breasts.

If you have this condition, do plenty of homework on the Internet first. Identify board certified plastic surgeons who specialize in gynecomastia surgery and have demonstrated experience with tuberous breasts. View the before and after gynecomastia photos to ensure this is indeed an area of specialty for a prospective surgeon.

Then arrange consultations with at least two, even if you have to send photos and have a discussion long distance. You may need to be prepared to have male breast reduction in New York or another large city to ensure you’re working with someone who can deliver the outcome you’re seeking.

These are questions every man who’s considering male breast surgery asks at some point, whether he’s online doing research at gynecomastia.org or chatting with us in the consultation room in New York.  Gynecomastia patients are actually luckier than patients seeking some other plastic surgery procedures in this regard.  Here’s why.

Every surgical procedure leaves a scar as the body heals with tissue that’s more fibrous.  In the case of relatively extensive plastic surgery where skin is delicate and there is tension on the wound —such as abdominoplasty, for instance—scars tend to be quite noticeable.  In a less invasive procedure, especially in an area where scars can be disguised, the traces of surgery can be almost unnoticeable after healing.

This is the case for most male breast reduction patients.  Our own New York gynecomastia surgeries usually involve a 1/8 inch “nick” in the skin on the side of the chest near the armpit where post-op scars are unlikely to be noticed. These heal to look like blemishes.

Sometimes we also make incisions around the areolas.  As these small incisions are made along the border of chest skin and the darker skin of the areola, the eventual scars are almost invisible.  Take a look at some of our before and after gynecomastia photos to see if you agree (scroll down to the bottom of the photo gallery).

Of course every patient is different, and scars are inherently unpredictable.  As you consider surgery, talk with your plastic surgeon about this.  Share any worries about scarring you may have, especially if you or a close member of your family has a history of unfavorable scarring.  And take note of what you can do to ensure your incisions heal properly, including wearing your post-op compression vest or bandages and limiting strenuous activities that can pull at scars and cause them to widen.

Good news about scars:  If a wound heals poorly, plastic surgeons have lots of tricks to improve the resultant scars – so all is not lost.

In any decision about plastic surgery, there are tradeoffs to be considered.  One of those tradeoffs is whether the scars that are likely to result are worth the aesthetic and/or functional improvement.   Most men suffering the embarrassment of man boobs decide that the scarring they can expect as a result of gynecomastia surgery is well worth the improvement in contour.

While the majority of our male breast reduction patients have a chest structure that can be viewed as “normal,” a few men are more unique.  And the more a patient’s body is a bit different than that of the average guy, the more the surgical strategy must be adjusted to achieve as much symmetry as possible–but patients must realize that absolute symmetry is very difficult to achieve.

For instance, some patients present with a measure of scoliosis, or curved backbone.  For these men, the spine/rib cage foundation for chest muscles, fat and skin is already asymmetric.  Others have a straight spine with slight rib cage asymmetry, with one side flatter or wider than the other side.

It’s also not unusual for some of our New York gynecomastia patients to exhibit sternum deformities.  The most common one, called pectus excavatum, is defined by the Mayo Clinic as a condition in which the breastbone is “sunken into the chest,” causing the chest itself to bow inward.  The opposite condition, sometimes called “pigeon chest,” is pectus carinatum.  In this case, the sternum projects outward.

A few patients we see have different sized chest muscles.  In some cases, their pre-surgery appearance does not reveal this problem.  It may be only after surgery, when the excess tissue has been removed, that the actual muscle or skeletal asymmetry is “unmasked.”  In some cases, the disparity between the two sides of the chest is quite noticeable prior to male breast reduction.  The most dramatic condition is called Poland’s syndrome in which one side of the chest does not develop.

If you have one or more of these conditions, does that mean you should not pursue treatment for man boobs?  Not at all.  No matter what your pre-op chest is like, plastic surgery should achieve vast improvement for you.  But these variations in the male physique are yet another reason why it’s so critical that patients seek a highly experienced, board certified gynecomastia surgeon.  Only when a plastic surgeon has performed hundreds of procedures will he or she have operated on men with a variety of chest shapes.

In consultation with a prospective gynecomastia surgeon, ask questions like these:

• Does the structure of my chest fall within normal ranges?
• If not, do you see any congenital conditions I should be aware of?
• If I’m “normal,” is there still asymmetry I should know about before surgery?

The fact is, whether a congenital deformity is present or not, most people’s torsos (and faces) have at least some asymmetry to begin with.  In fact, in nature, absolute mirror-image symmetry is exceedingly rare.  We find it’s quite comon for patients to notice they’re not 100% identical from side to side after surgery.  That’s partly due to the fact that no one’s body is “perfect,” and partly because post-op patients scrutinize their physiques like never before!

No matter where you live or how far you might be willing to travel, here are some steps you should follow.

Research Prospective Surgeons

One place to start gathering names of plastic surgeons is with people you know.  Friends who have had plastic surgery are obvious resources, though you will want to qualify their recommendations.  Also consider asking other doctors.  If you have an internist, dermatologist or other physician you see and trust, you might ask them if they know any highly respected plastic surgeons in your area.

Check out the referal resources of the American Society of Plastic Surgeons, whose members are only board certified plastic surgeons.

The Internet is another place you can seek prospective gynecomastia surgeons.  Plug terms like “gynecomastia” and your city or state in a search engine and see what comes up.

Qualify Your Choices

Once you have some prospective plastic surgeons in mind, spend some time online researching their backgrounds.  Go to forums and message boards—gynecomastia.org is a great example—and find out what the community might know about your choices.

Be sure to visit your state’s department of health website and find out if any of your prospective gynecomastia surgeons are facing disciplinary action.

Examine Web Sites

As you start narrowing your choices, invest time in browsing each prospective plastic surgeon’s website thoroughly.  After making sure they are certified by the American Board of Plastic Surgery and their other credentials are solid, see what they have to say about gynecomastia.  Ways to tell that the surgeon has a meaningful focus on male breast reduction include:

* They have been sought by the media for interviews on gynecomastia

* They have authored books, textbook chapters or articles on the subject

* Their website has at least an entire page devoted to gynecomastia

* Their before and after gynecomastia photo gallery is quite large

Not every plastic surgeon has extensive experience in male breast reduction.  Even in New York, many surgeons only treat a few cases each year.  If you are lucky enough to find a few experienced gynecomastia surgeons to choose from, the next step is arranging consultations.

More on that next time.

Photo by Spirit-Fire, available under a Creative Commons attribution license.

It’s understandable that men want to know the makeup of their man boobs.  Some think that if their problem is largely fat, they can embark on a strict diet or choose a liposuction-only solution for male breast reduction.  Others simply seem horrified at the thought of having female-like breast tissue under their nipples and just have to know what’s inside.

If you frequently poke and prod your chest in an effort to identify what’s beneath the skin, we have a suggestion: stop. We’d like you to consider that it really doesn’t matter all that much what’s inside those moobs.  Here’s why.

First, it can be a real challenge to determine from the outside exactly what kind of tissue you’re feeling with your fingers.  Fat can sometimes feel dense and lumpy–just as you might imagine glandular tissue to feel.  Even if you could determine that most of your excess breast tissue is fat, know that it can be very hard to reduce the size of your man boobs through dieting.  Men tend to put on weight most readily in their bellies and chests, and unfortunately those pounds can be quite stubborn to banish.

Actual breast tissue, which all men have to some extent, can also feel like fat to the touch.  It takes an experienced gynecomastia surgeon to get a sense of what’s behind a man’s moobs, and even experts can be wrong.  A patient can’t be expected to figure this out.  Moreover, in our practice we find that nearly every one of our New York gynecomastia patients has at least some measure of breast tissue that needs to be excised during their procedure.  That’s why we would never suggest a patient choose liposuction-only male breast reduction in the consultation room.  If the plastic surgeon is not ready to address whatever he or she finds after using the scalpel, the patient is likely to be dissatisfied with the results.

Let’s face it–when it comes to the male chest, what matters is contour.  You want to look masculine and sleek whether your arms are raised or at your sides, whether you’re pumping iron or at rest and whether it’s hot or cold.  The exact ratio of fat to glandular tissue is not something others will poke you to find out, and it’s not a vital factor in your overall look.

If you do find yourself preoccupied and unhappy with your chest, what we do suggest is a consultation with an experienced male breast reduction specialist.  Even if you’re not thinking of surgery but simply wanting some answers, it’s a good investment to seek expert input.

Photo by JoelK75, available under a Creative Commons attribution license.

At the heart of your decision is the trade off between your convenience and your surgeon’s expertise.  If you live in a fairly populous area and you’re interested in a mainstream procedure, you’re likely to find a few good plastic surgeons to choose from.  For instance, if you’re seeking liposuction and you live in Dallas, or perhaps an eyelid lift in San Francisco, you may not feel the need to travel outside your area.

On the other hand, if what you need is a more specialized procedure or a revision of a prior surgery, it may indeed make sense to research the right plastic surgeon and fly to his or her city.  After all, there are additional benefits of having your procedure performed out of town, including the chance to recover away from the demands of daily life and additional privacy.

When we talk with candidates for male breast reduction outside New York, we advise them to seek a plastic surgeon—whether local or not—with not just dozens, but hundreds of cases to their credit.  Each patient’s physique is different, and it’s critical that the surgeon has the experience to recognize when breast tissue should be removed, when fat should be eliminated through liposuction, and when a little of both should be done.  Also, only experience allows a plastic surgeon to re-contour the male chest so it looks both masculine and natural.

You can evaluate the level of a plastic surgeon’s gynecomastia expertise in several ways.  Examine his or her website closely to see if male breast reduction is presented as a specialty or as an afterthought.  Take a look at the before and after gynecomastia pictures displayed; again, you’re looking for many cases, not just a few.  If you decide to have a consultation with a prospective plastic surgeon, ask for referrals to patients you can speak with personally.

If you’d like to explore male breast reduction in New York with us, give our office a call at (212) 570-6080 or contact us online and our staff can help you work through the logistics.  We can assist with travel arrangements, accommodations and even tips for what to do while you’re here.

Photo by Poorna Kedar, available under a Creative Commons attribution license.

For men, nipple reduction can be performed in conjunction with gynecomastia surgery or as a standalone procedure. When performed on its own, treatment is pretty straightforward, usually requiring less than an hour and just local anesthesia. We can reduce the diameter of the nipple, the projection from the chest wall or both. Small, dissolving sutures are placed to close the tiny incisions, and that’s about it.

Recovery involves a bit of soreness for a few days. Patients can usually resume most activities immediately, but we advise them to avoid strenuous exercise for at least two weeks after surgery. Scars should be nearly invisible after nipple reduction and complications are rare. Occasionally a patient will report reduced sensation in one or both nipples after healing.

One thing to be clear about is that nipple surgery does not change the look of the areola, the pigmented circle of skin surrounding the nipple. We find in most cases enlarged areolas result from excess breast tissue, or gynecomastia. Our New York patients with this condition most often need male breast reduction surgery rather than a procedure to reduce the size of their areolas. Once the excess tissues have been removed, the chest skin and the areola itself will shrink in diameter – right on the operating table. It is like letting air out of a balloon. (We’ll discuss areolar reduction in a future post.)

Whatever your concern about your chest may be, talk to your plastic surgeon candidly. He or she will evaluate your entire chest and make a recommendation about the best way to achieve the change you’re hoping for.

If you’d like to consult us about gynecomastia, large nipples or any other aesthetic issue, just contact us online or give us a call at (212) 570-6080 and we’ll arrange an appointment. We often work with out of town patients, as well as men seeking treatment for gynecomastia from New Jersey, Long Island, Westchester, Connecticut and surrounding states.

The answer to this question from our perspective is, “It’s not yet clear.”  There is some evidence that lavender and tea tree oil may contribute to gynecomastia, particularly in young males, but the proof is far from conclusive.  Here’s the story.

It all started early in 2007 when the New England Journal of Medicine published a study by a University of Colorado pediatric endocrinologist.  The physician found enlarged breasts in three of his male prepubescent patients and discovered that each had used personal products like lotion containing lavender, tea tree oil or a combination.  In addition, after the boys discontinued the use of such products, the gynecomastia disappeared.

A researcher at the National Institute of Environmental Health Services, or NIEHS, then tested the essential oils.  He found that the substances mimic the action of estrogen, which stimulates breast tissue growth, and/or inhibit androgen, which governs male attributes and limits breast development.  The NIEHS researcher said that the combination of effects made the essential oils “somewhat unique as endocrine disruptors” (see http://www.nih.gov/news/pr/jan2007/niehs-31.htm).

All this may sound convincing, and if you’re concerned about enlarged male breasts in adolescents it is something to consider—to a point.  There are several factors to weigh when deciding how worried to be about lavender and tea tree oils.  First is the small size of the study—just three boys.  Much larger groups would have to be studied, including control groups, for the findings to be notable.

Also, the boys used different personal care products, most not identified in the study, containing unknown concentrations of these essential oils.  In addition, there are many other endocrine disruptors the boys may have also been exposed to, such as ingredients found in pesticides.

Scientists have spoken up since 2007 to point out the shortcomings of the lavender and tea tree oil study.  And even while stating that the case histories of the boys and the tests on the oils showed “an association” between the substances and gynecomastia, the NIEHS itself said the strength of the association remained unknown and called for further research.

To our knowledge no further studies have yet been published.   So here we stay for the time being: there may be a link between the use of lavender and tea tree oil and gynecomastia in boys.  When our New York gynecomastia patients ask what they should do, we point out that when it comes to shampoos and lotions, there are plenty of choices these days.  The best answer we can give now is “better safe than sorry.”

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

In some cases, the message we communicate is “no revision is the best revision.”  Why is this?  We find that sometimes, those who consider themselves revision candidates have forgotten one or more of a few principles that need to be carefully considered:

• The wisdom of patience when dealing with swelling
• The importance of getting it right the first time (leaving well enough alone)
• The value of realistic expectations

The most common input we give revision candidates is that they should wait much longer for all swelling to subside before determining how satisfied they are with the initial procedure.  As we examine patients, we find residual swelling months—sometimes even a year or more—later in many.  It can be frustrating to wait so long for the final result after suffering the embarrassment of gynecomastia, but sometimes a little patience makes all the difference.  You can hear from one man about this very notion on gynecomastia.org.

The next thing all plastic surgery patients should keep in mind is the importance of getting it right the first time.  For most areas of the body, revision plastic surgery is much more challenging than a first time procedure because the original structures have been altered and scar tissue has formed.  Occasionally we advise against a second surgery because we feel the chances for major improvement aren’t high enough weighed against the risks.  This means we sometimes tell patients who seek consultation for a second male breast reduction in New York that they’re better off sticking with the outcome their original surgeon created.  (You might also think of this as the Michael Jackson’s nose principle.)

As an aside, this is why it’s critical to choose the right plastic surgeon for your gynecomastia procedure.  Not just a board certified physician—a surgeon who’s certified by the American Board of Plastic Surgery.  Not just a talented plastic surgeon—one who is very experienced in male breast reduction.  And not just one who says they handle a lot of cases like yours—one with the before and after gynecomastia photos to prove it.

Closely related to getting it right the first time is the notion of realistic expectations.  Let’s face it, male breast reduction surgery will not turn you into a male cover model unless you were already there in every respect except for your gynecomastia.  With each New York patient we discuss this prior to surgery, looking to hear an expectation for improvement, not perfection.

If you follow all these principles and are still not content with your surgical results, by all means, schedule revision consultations. See your original surgeon first, then visit two or more plastic surgeons who specialize in male breast reduction and have many successful revision surgeries to their credit.

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