Male Breast Reduction
Written by Annie Tye, PhD
Overdeveloped breasts in men, or gynecomastia, is not uncommon. By some estimates, up to 65% of men will meet criteria for enlarged breast tissue on one or both sides of their chest at some point in their lifetime.
Although it is often benign, gynecomastia can be uncomfortable and embarrassing and may cause psychological distress, body dysmorphia, and depression. Gynecomastia may also be indicative of a serious underlying health problem. If you are concerned by enlarged breasts, see your doctor to rule out serious health issues.
Enlarged breasts in men is the result of an imbalance in the hormones testosterone and estrogen. An increase in estrogen or a decrease in testosterone can trigger the development of breast tissue in men. There are a number of factors that can contribute to hormonal imbalance, including:
- Environmental chemicals or pollutants
- Prescription medications
- Recreational drugs (including anabolic steroids)
- Vitamin or mineral deficiencies or calorie malnutrition
- Testosterone deficiency
- Age (adolescents and men over the age of 50 are at the highest risk for gynecomastia)
- Genetics (especially Klinefelter syndrome)
- Overactive thyroid gland or other endocrine disorders
- Metabolic disorders
- Liver or kidney problems
If you are concerned about overdeveloped breasts, the first thing to do is to make an appointment with your doctor to determine the exact cause. In rare cases, enlarged breast tissue in men is indicative of a serious health issue that should be addressed quickly.
There are two types of tissue that may be involved with enlarged breasts. Glandular tissue is involved in hormonal regulation and requires tissue excision while excess adipose tissue (fat) can often be addressed with liposuction.
- Gynecomastia is caused by excessive breast glandular tissue in men, which is a normal type of tissue that is involved in hormonal regulation
- Pseudogynecomastia indicates excessive adipose tissue (fat) and is often associated with high body fat content; additionally, men who have lost substantial amounts of weight are often frustrated by persistent pseudogynecomastia
In some cases, both gynecomastia and pseudogynecomastia are present simultaneously.
How do I Tell if Gynecomastia is Caused by Fatty Tissues or Breast Tissues?
In many cases, you can differentiate between gynecomastia and pseudogynecomastia by how the excess breast tissue feels. Homogeneously soft breast tissue is likely indicative of pseudogynecomastia, while firm or hard tissue suggests gynecomastia. A physician can conclusively determine whether you have gynecomastia, pseudogynecomastia, or a combination of both.
You might be a good candidate for male breast reduction if you are:
- Healthy and emotionally stable
- Within your ideal body weight
- Affected by gynecomastia on one or both breasts
- Over 18 years old. Teens are advised to wait until after puberty as the breasts may still be developing
- Have good skin elasticity
You may not be a good candidate if you are:
- Unhealthy, or have serious medical conditions making you unfit for surgery
- Unrealistic about what to expect
- Mentally unstable
In order to undergo a safe and effective male breast reduction surgery, you will need to provide your surgeon with a complete medical history. This will allow your surgeon to determine the cause of gynecomastia as well as identify health concerns that may need additional treatment. For example, impaired liver function may contribute to gynecomastia and may also be indicative of an underlying health problem that, if not treated, may lead to a recurrence of breast tissue development post-surgery.
It is important to be honest about any recreational use of prescription or illicit drugs. Anabolic steroids, marijuana, and excessive alcohol use may contribute to male breast development.
- In rare cases, gynecomastia may return after male breast reduction surgery. This may be caused by incomplete removal of excess glandular tissue, untreated medical issues, or an unhealthy lifestyle. The best way to prevent gynecomastia recurrence is to work with an experienced surgeon and to maintain a healthy lifestyle after the operation.
- Male breast reduction surgery will leave a small scar in the lower part of the areola (nipple area), and liposuction can leave tiny scars in the armpit or on the chest. In most cases, any scars will be inconspicuous. Make sure to discuss potential scarring with your surgeon during your consultation.
- Don’t be afraid to ask questions during your initial consultation. Your surgeon should be able to answer your questions clearly and provide you with an overview of the technique he or she will use, and why it is the most appropriate one for you.
- Although results of the surgery will be apparent immediately, it will take several months before final results can be fully appreciated.
The surgical procedure to remove excess male breast tissue will vary depending on the type of tissue that is causing breast development. In some cases, liposuction alone is sufficient to achieve the desired results. In other cases tissue excision with or without liposuction is required.
Common surgical methods used to treat gynecomastia include:
- The Webster Incision: This is one of the most common methods used to treat gynecomastia. A small incision (~1 inch) is made in the pigmented periareolar skin underneath the nipple and excessive glandular tissue is excised. This method can be combined with liposuction.
- The Minimally Invasive Method: In this method, a very small (~5 mm) incision is made at the edge of the nipple, allowing for both liposuction and glandular tissue excision to be performed. This method leaves the smallest scar.
- Ultrasonic Liposuction Method: Ultrasonic liposuction is a technique that liquifies fat cells prior to liposuction, making it more effective than traditional liposuction. This method is appropriate for cases of pseudogynecomastia (fatty tissue) but cannot remove excess glandular breast tissue associated with gynecomastia. Ultrasonic liposuction can be used with either of the above techniques and is often done in conjunction with glandular tissue removal.
Gynecomastia that is caused by excess glandular tissue (as opposed to excess adipose, or fatty, tissue) is only effectively treated with surgery.
Pseudogynecomastia is associated with excess adipose (fat) in the chest. In this case, weight loss through exercise and a healthy diet are recommended before surgery is pursued. Other non-surgical options that may reduce breast size in men with pseudogynecomastia include:
- Radiofrequency (VelaShape®)
- Ultrasound (UltraShape® Power)
- Radiofrequency plus ultrasound (Exilis Ultra™)
- Cryolipolysis (CoolSculpting®)
- Laser (SculpSure®)
These techniques are effective ways to break down fat cells (lipolysis), but because they do not physically remove the remnants of the fat cells, they do not deliver immediately visible results (although there may be an initial, temporary reduction in breast tissue volume due to cellular dehydration). Furthermore, multiple sessions may be required, each of which might be associated with discomfort and a recovery period of weeks to months. A combination of two or more of these procedures may be required for best results.
Non-surgical treatments for pseudogynecomastia have not proven to be as effective as liposuction and, in most cases, they are not effective substitutes for surgical procedures.
There are no FDA approved pills or medications that treat gynecomastia. Currently, surgery is the only effective treatment option for excess glandular tissue (gynecomastia). Excess fat (pseudogynecomastia) is best addressed with weight loss through exercise and a healthy diet.
In cases where excess breast tissue is caused by an underlying endocrine disorder, prescription medications that treat the disorder may indirectly address gynecomastia. However, these medications will not treat gynecomastia in men who do not have an endocrine disorder.
It is important to find a surgeon who has demonstrated excellence in surgical treatment of gynecomastia. Look for a surgeon who is board-certified and holds current membership in one or more of the following:
- American Board of Plastic Surgery (ABPS)
- American Society of Plastic Surgeons (ASPS)
- American Society for Aesthetic Plastic Surgery (ASAPS)
Although membership in any of these societies does not guarantee a successful outcome, surgeons who are members have demonstrated that they meet stringent criteria and have extensive surgical training and experience.
If you have any concerns about a surgeon you are interviewing, contact your state’s medical board to confirm that the surgeon is licensed to practice in your state and to make sure there have not been any disciplinary actions taken against them. In some states you can find this information online, but other states require that you request the information by mail.
There are some potential complications to male breast reduction surgery, including:
- Allergic reactions or adverse reactions to medications or anesthesia
- Bleeding or blood clots
- Reduced nipple sensitivity
- Damage to other anatomical structures during the surgery
- Insufficient reduction of breast tissue and a need for additional surgery
Working with a board-certified surgeon who is experienced with male breast reduction surgery is the best way to minimize the risk of complications during and after the surgery.
Whether you have excision-only breast reduction or a procedure involving liposuction, you will experience some side effects after the surgery. Side effects that are commonly associated with breast reduction surgery include:
- Temporary numbness
- Pain or discomfort
These side effects will begin to subside in the first few days after the surgery and are typically fully resolved within a few weeks, although minor swelling may persist for several months. Your doctor may provide medications to control pain if over-the-counter pain medications are insufficient.
Recovery times will differ between individuals, but most people are able to return to work or school within 3-10 days after the surgery.
Your doctor may recommend you wear a compression garment over the chest area for at least one to two weeks. Elastic compression garments reduce swelling and result in a shorter recovery period. This garment supports the tissues in their new position, helping the skin adjust to its new contours and reducing the possibility of skin looseness.
It is imperative that you carefully follow all directions provided to you by your surgeon in order to minimize recovery time and achieve the best long-term results.
Initial results will be apparent immediately following the surgery, but final results will take 3-6 months to become fully visible.
Results of male breast reduction surgery often last for a lifetime in people who maintain a healthy lifestyle.
Rarely, a recurrence of gynecomastia can occur after male breast reduction surgery. The most common cause of recurrence is incomplete removal of glandular tissue.
The average cost for gynecomastia is between $4,500 and $7,500. However, this amount may not include additional fees such as:
- Anesthesia fee
- Liposuction fee
- Compression garments used after the surgery
- Medications after surgery
The type and extent of the surgery will substantially affect the overall cost. Men with extensive breast tissue who require both excision of glandular tissue and liposuction will have a higher overall cost than men who undergo minor liposuction.
It is very important that the quote you receive from your surgeon includes all applicable costs and fees, not just the surgeons fee.
Many doctors’ offices have financing plans available since health insurance often will not cover the procedure.
In most cases, male breast reduction surgery is not covered by insurance. However, there may be exceptions, particularly for cases of persistent gynecomastia (glandular breast tissue) that cause pain or discomfort. Pseudogynecomastia (fatty breast tissue) is typically not covered by insurance. Breast reduction surgeries are generally not covered when they are performed to improve mental health and emotional wellbeing, regardless of the type of tissue.
Cases where breast reduction surgery for men may be covered include:
- Documented endocrine disorders
- Klinefelter syndrome
- Persistent, painful adolescent onset gynecomastia
Insurance companies that cover male breast reduction surgery will often require photographic documentation, preoperative tests to confirm the presence of glandular breast tissue, and laboratory tests to rule out hormonal imbalances.
If you have questions about whether your insurance plan will help you defray the costs of breast reduction surgery, contact your carrier. If you think your insurance may cover your surgery, contact your surgeon to see if they can get preauthorization.
Can gynecomastia be corrected with chest exercises?
Gynecomastia that is caused by excessive glandular breast tissue (rather than fat) cannot be corrected with chest exercises, although exercise may modestly improve the appearance of the chest.
Pseudogynecomastia is caused by excessive adipose tissue (fat) in the chest area, and exercise and a healthy diet may substantially improve the appearance of the chest.
Can anything be done to improve my chest musculature after already having gynecomastia surgery?
In most cases, a normal exercise routine can be resumed within 3 weeks after surgery. Chest musculature can be increased by following a chest-oriented weightlifting regimen that includes heavy weights and low repetitions. Make sure to discuss this with your doctor before you begin lifting weights.
Should I try to get in better shape before gynecomastia surgery?
In most cases, trying to get in better shape before gynecomastia surgery will not have a significant impact on the outcome. However, there may be some cases where losing weight before the surgery may improve the outcome. For example, very obese men who lose weight may have excess skin that can be removed during the surgery. Your surgeon can provide you with a customized plan if they think pre-operative exercise may be helpful.
What can be done about asymmetry caused by gynecomastia surgery?
The final results of breast reduction surgery may not be fully apparent for up to 6 months following surgery, so asymmetry in the first few months post-surgery may resolve over time. If it has been more than 6 months since your surgery, a revision surgery may be appropriate. In this case, a technique called fat grafting (transferring fat from another part of your body) can help minimize asymmetry.
Is there any treatment for post-operative loose skin/armpit bulge?
If your surgery was more than 6 months ago and you are concerned about loose skin in the chest/armpit area, additional surgery or liposuction may be warranted. Seek a consultation with a board-certified plastic surgeon to learn about your options.
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