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Male Breast Reduction Surgery
All men normally have a small amount vestigial breast tissue. Overgrowth of breast tissue is a surprisingly common problem in adolescent boys and older men. This is called gynecomastia. The condition arises from a number of causes including benign hormonal changes at puberty, as a side effect of certain medications, from endocrine (glandular) dysfunction, disease states that affect hormone balance, and chromosomal abnormalities. Most cases are not related to disease states and while breast cancer is a concern it is rare. Excess fat tissue in the breast area from being overweight is called pseudogynecomastia and is not breast tissue per se.
Gynecomastia can be psychologically distressing, particularly in any social situation. While most cases of gynecomastia arising from hormonal changes at puberty resolve (90%), for others the changes persist more than 2 years and may benefit from treatment. Underlying medical causes are sought out and treated medically where appropriate, but most longstanding gynecomastia cases require surgery and do not reverse with medication alone. In teenage boys, a waiting period of two years is usually appropriate before surgery as this condition may subside spontaneously over time.
Most commonly surgical treatment involves a combination of liposuction and excision of breast glandular tissue through an incision around the pigmented skin (the areola) surrounding the nipple. If there is significant skin laxity, excess, or sagging of the breast, skin removal may also be required. A staged approach for skin removal after breast tissue removal at the first operation may be recommended in specific cases. The goals of surgery are to create a natural male contour with as inconspicuous a scar as possible. Surgery is done under general anesthesia as an outpatient. Drains are usually used for 5-7 days. Most patients are pleasantly surprised that the discomfort is mild to moderate. Patients are followed closely for the first 6 weeks and then less frequently for a one year period. Compression garments are prescribed for 4 weeks 24 hours a day initially and then another 4 weeks just at night. Antibiotics, pain medication, and a Medrol Dosepak for swelling are prescribed. Swelling goes down and redraping of skin takes place over one year. Minor irregularities often resolve with time. A touch up may be desired in about 20% of cases, but these are usually minor.
Gynecomastia patients are frequently very sensitive about any perception on their part of residual breast tissue after surgery and counseling about realistic expectations and what looks natural and proportionate to the patient’s individual anatomy is part of the consultation and aftercare process. It is important to remember that what we leave behind is as important as what we take out in contouring procedures. Most patients have an excellent result and are very pleased.
Please read Frequently Asked Gynecomastia Questions for more information.