Gynecomastia is defined as enlargement of the male breast(s) and characterized by excess localized fat and/or overdevelopment of glandular tissue with or without excess breast skin. The causes of gynecomastia are multiple, and can be the result of hormonal changes, heredity, obesity, excessive alcohol consumption or illicit drug use, and the side effects of certain prescription medications. Consequently, any reversible causes of gynecomastia need to be excluded before surgical correction can be considered.
Gynecomastia can be a source of emotional discomfort and decreased self-confidence and may even cause some men to avoid certain physical activities just to hide their chest area.
Surgical correction of gynecomastia is aimed at reducing breast size and enhancing the contour of the chest through the removal of excess overdeveloped glandular breast tissue and/or excess breast fat.
Before & After photographs shown on this site are actual patients of Dr. James Lee who have given their permission to have their photos published online. They are for illustrative purposes only; individual results vary. We do not guarantee outcomes and no prediction of outcome is implied. Individual healing characteristics and unexpected complications can affect the outcome of any surgery.
2. IDEAL CANDIDATES
Ideal candidates for gynecomastia correction are healthy, non-smoking men with realistic expectations who:
- Are not known to have a reversible or medically treatable form of gynecomastia
- Have a stable and relatively normal body weight
- Have completed chest/breast development
- Are bothered by the fact that their breasts are too large
3. THE PROCEDURE
- The procedure can either be performed under general anesthesia or under local anesthesia with intravenous sedation.
3.2.1. LIPOSUCTION ALONE
- One to several small (~4 mm in length) incisions are made in inconspicuous areas of the breast and/or the axilla (i.e. at the margin of the breast skin and areola) such that the liposuction cannula (thin hollow tube) can access the areas requiring treatment
3.2.2. EXCISION TECHNIQUE
The incision pattern used will ultimately be dictated by the specific issues that need to be addressed in order to successfully correct gynecomastia and achieve an aesthetically pleasing result.
3.2.3. COMBINED LIPOSUCTION AND EXCISION TECHNIQUE
- Similar to when the excision technique is used alone, the incision pattern will depend on the specific components of the enlarged breast(s) that will need to be addressed
- There will also be 1-4 small incisions in inconspicuous areas of the breasts and/or the axilla so as to allow the liposuction cannula to access to the areas requiring treatment
- Please refer to section 3.3.3 below
3.3. REMOVAL OF EXCESS FAT, GLANDULAR BREAST TISSUE, AND/OR SKIN FOR GYNECOMASTIA CORRECTION
3.3.1. LIPOSUCTION ALONE
- Liposuction alone can be used to treat gynecomastia resulting primarily from excess fatty tissue
- The areas of the breast to be treated are infiltrated with a dilute local anesthetic solution
- A liposuction cannula is then inserted through the access incisions and passed back and forth in a controlled fashion to loosen the excess fatty tissues
- The excess fat is then removed by applying suction the cannula
- Please see “Liposuction” under the “PROCEDURES” heading for additional information.
3.3.2. EXCISION TECHNIQUE
- Surgical excision is necessary when gynecomastia results from the overdevelopment of glandular breast tissue or if excess skin must be removed to correct any drooping (ptosis) of the breasts. An excision technique is also indicated in cases where the areola will need to be reduced or the nipple will need to the transposed (lifted) to a higher location on the chest wall
- The incision pattern used will ultimately be dictated by the specific issues that need to be addressed in order to successfully correct gynecomastia and achieve an aesthetically pleasing result. For instance, in the absence of excess skin and an enlarged/malpositioned nipple-areola complex (i.e. the darker pigmented skin of the breast), an inferior periareolar incision may be all that is necessary to successfully access and excise the underlying glandular breast tissue. Once healed, the periareolar incisions are well hidden and are quite inconspicuous.
3.3.3. COMBINED LIPOSUCTION AND EXCISION TECHNIQUE
- In the presence of excess breast fat with either excess glandular breast tissue, excess breast skin, and/or an enlarged/malpositioned nipple areolar complex, both liposuction and excision techniques can be used in the same operative setting in order to optimize aesthetic results.
- Liposuction can be used to remove excess fat (contour) from a breast’s periphery while an excision technique with a more central incision pattern can be used to excise any glandular breast tissue (and/or skin).
4. PREOPERATIVE CONSULTATION
During your consultation, Dr. Lee will discuss the various treatment options and help you determine which procedure is right for you. Dr. Lee will perform a thorough medical evaluation during your preoperative consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.
Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively1.
Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram 1-2 weeks before surgery. Dr. Lee may make additional recommendations once he reviews the results of your tests.
The operation is most often performed on an outpatient basis and most patients are permitted to go home a few hours after surgery.
You will have a dry dressing over your incisions, and a compression garment (or an elastic bandage) around your chest to help reduce swelling. We will ask that that you wear your compression garment at all times, and for a total of 6 weeks, so that your skin remains in contact with your newly contoured chest as you heal. This not only decreases your risk for developing certain post-operative complications, but also expedites your recovery and ultimately optimizes your final result. It is preferable for you to sleep on your back for the first four weeks after your surgery.
You will experience some discomfort however, this can be controlled with the pain medications which you will be prescribed. In addition to swelling, there will be some bruising, but these should resolve 2-3 weeks after surgery.
Patients are encouraged to walk immediately following surgery and most are capable of returning to work in 2-3 days. Light exercise is permitted at 2 weeks, and full exercise and activities can be resumed at 4 weeks.
Before leaving our facilities, you will be given specific instructions on how to care for your breasts and surgical wounds throughout your recovery. It is important that you follow these recommendations in order to minimize the appearance of your scars and ultimately achieve your best possible result. Dressings should be left in place until your first post-operative visit with Dr. Lee, at which point he will assess your wounds and if necessary, apply new dressings.
6. RISKS AND COMPLICATIONS
As with any surgery, there are risks associated with gynecomastia surgery. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.
- Risks associated with anesthesia
- Bleeding (hematoma)
- Fluid accumulation (seroma)
- Changes in nipple or breast sensation that may be temporary or permanent
- Breast contour and/or shape irregularities
- Fat necrosis
- Breast asymmetry
- Prolonged swelling
- Deep vein thrombosis
- Cardiac and pulmonary complications
- Possible need for revision surgery
Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.
It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.
Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery.