What is Gynecomastia?
The enlargement of a man’s breasts is a condition known as gynecomastia. About 50% of men – and even teenage boys – have enlarged breasts, and they can interfere with the quality of life that a man has due to the psychological impact. Teens could have enlarged breasts because of changing levels of sex hormones, and in 90% of these cases, the enlarged breasts will resolve on its own. However, for adult men, this is not the case.
Gynecomastia is a condition that has a successful surgical solution. The large breasts may be corrected or improved in a safe way through male breast reduction surgery.
What Causes Enlarged Male Breasts?
If your body has accumulated excess fatty tissue in the breast region, this is called pseudogynecomastia. The good news on this cause is that diet and exercise can improve it and you may not need surgery.
If your nipples have become enlarged, it’s an indication that the glands in the breast also have enlarged. With this type of gynecomastia, diet and exercise won’t be enough to eliminate it. You’ll most likely need breast reduction surgery along with liposuction.
There are several different reasons why your breasts could have enlarged.
- Your body is accumulating estrogen mimickers from environmental chemicals and/or pollution, which causes the production of excess breast tissue. Extra estrogen can always be expected to cause larger breasts.
- Your levels of testosterone have dwindled due to old age and your estrogen levels have risen too high, due to excess fat tissue.
- You are taking medications that cause an enlargement in the breasts. Believe it or not some antibiotics, cancer drugs and other medications can cause this condition.
- An overactive thyroid gland can cause enlarged breasts in men.
- Liver or kidney problems may cause gynecomastia.
- Sometimes, a tumor may cause gynecomastia.
- Vitamin and mineral deficiencies or calorie malnutrition may cause enlarged breasts.
See a doctor to determine the exact cause of your gynecomastia.
Are You a Candidate for Male Breast Reduction?
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.
- 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.
Before undergoing male breast reduction, you will need to provide a complete medical history. This will allow your surgeon to check for a range of medical conditions that may have caused gynecomastia. These include impaired liver function and the use of anabolic steroids or medications containing estrogen. Smoking marijuana or drinking alcohol excessively has also been shown to lead to male breast development. Its possible, these medical causes could be corrected without surgery. If not addressed prior to male breast reduction surgery, medical causes could result in the development of additional breast tissue following your procedure.
The Best Way to Select Your Surgeon
Whenever you are opting for a surgical procedure, it’s best to choose a doctor with the most credentials and the most experience. The best doctor is one who has completed surgical training specifically on gynecomastia surgery and has performed hundreds of male breast reduction procedures with successful outcomes.
To find a surgeon who meets this criteria, you’ll need a board-certified plastic surgeon; one who is a member of an accredited association such as the American Board of Plastic Surgery, American Society for Aesthetic Plastic Surgery or the American Society of Plastic Surgeons. Any doctor who has undergone this extra training is proud to show it on the wall of his office or display the association logos on their website.
What Is Discussed During the Initial Consultation?
Your initial consultation is an important time because it gives you an opportunity to check out the surgeon to see if he meets your requirements. At the same time, the doctor will be checking to see if you meet his requirements as a good candidate for the surgery. No surgeon wants to perform surgery on anyone who is not fit for the surgery.
Below is a list of topics that will be covered during the initial consultation:
- Do you currently have any medical conditions? Your overall health affects all surgical outcomes.
- Have you had any medical issues in the past? A complete health history is always important so the doctor understands all potential risks.
- Are you currently taking any medications? What are they? Your doctor wants to know this answer because it could be the cause of your gynecomastia. It’s possible that a change of medications will eliminate your gynecomastia.
- Are you allergic to any drugs? Doctors always want to minimize any potential drug reactions.
- Are you taking any vitamins and minerals? Vitamins and minerals may interfere with your blood’s ability to clot after surgery, and thus prolong your healing.
- Do you take any herbal supplements? Herbal supplements may also interfere with the ability of the blood to clot after surgery, and thus prolong your healing.
- What types of cosmetic procedures have you had in the past? Your doctor would like to know the outcome of these procedures, and whether or not you were satisfied with them.
- Do you drink alcohol? Alcohol interferes with your body’s ability to heal.
- Do you smoke? Smoking is well known as a habit that interferes with your body’s ability to heal.
- Do you use recreational drugs? Recreational drugs may interfere with you’re the ability of your blood to clot after healing.
- Why do you want male breast reduction surgery? Are you doing it for yourself or for someone else?
- How do you think your life will be different after this procedure? Do you imagine that women will flock around you after the surgery and your chest looks better? Your doctor is gauging your expectations of the surgical results
- Have you ever had keloids? Keloids are an indication that your body has a difficult time healing.
- What are your overall aesthetic goals? Your goals should match what’s possible. If what you are looking for is not possible with gynecomastia surgery, your doctor will offer extra options such as pectoral implants.
At the first initial consultation, you will most likely have photos taken. A computer then manipulates these photos to show you the type of surgical outcomes.
Your plastic surgeon will discuss the various options that are available for you, as well as any surgical risks or complications that could occur.
Questions To Ask Your Doctor
Write down these questions prior to your initial appointment.
- What are your credentials? Are you certified by the American Board of Plastic Surgery? You want the best possible surgeon and the most qualified one.
- Where is the surgery going to take place? There are three possible answers here: a hospital, the doctor’s office or another facility. Any facility where this type of procedure is done must be set up for surgical operations.
- If the procedure will be at a hospital, do you have privileges to perform surgery there? You want a match of privileges at the hospital where the surgery will be performed with your doctor. You may also call the hospital to verify that he does have privileges there.
- How many male breast reduction procedures have you done? The correct answer is hundreds.
- Can I see a book of before and after photos of your patients? No book means there’s a question of whether or not your doctor has performed this procedure.
- What do I need to do to prepare for surgery? You will receive a list of things to do prior to the surgery in your pre op instructions from the surgeon.
- How likely is it that a complication could occur based on my history and health status? The answer should sound logical and should be based on your doctor’s experience.
- Could you describe the surgical technique you plan on using? During your initial consultation, your surgeon should be able to tell you the surgical technique that would be used to treat your gynecomastia.
- What type of incision will you be making and where will they be? Along with explaining the surgical technique, the doctor should be able to tell you where the incision will be made.
- How long is the procedure? Surgical times may be as little as one hour and up to two hours in most cases.
- What type of medications are prescribed after surgery? Your surgeon will be able to provide you with medication after your procedure to help with any discomfort.
- How long is the recovery period? Your doctor should tell you how long it takes to recover to 100% daily activities. On average most patients are able to resume daily activities within 2-3 days and moderate exercise 2 weeks post op.
- Will there be restrictions after surgery, and for how long? Any restrictions should be explained in your post operative instruction manual.
- How much does it cost? Your doctor should give you a quote after your consultation explaining all the fees involved.
- If complications arise, are you available to help? You want to know whether your surgeon will be available or not and how many follow-up visits you are expected to have.
- What happens if the results are not what i expected? You want a straightforward answer from the doctor to this question.
All About the Male Breast Reduction Procedure
Surgical Options Used During Gynecomastia Surgery
This question is always one that is important to know the answer because you want to take off your shirt after you have healed. You want natural-looking results for your chest and the scars to heal well.
How elastic your skin is will contribute greatly to the recovery and how well the scars heal. Another factor is how much excess breast tissue you have. If you have a lot of tissue, the incision will be larger; however, men are satisfied with their results even in the case of having a lot of excess tissue removed.
Some surgical methods used to treat gynecomastia include:
- The Webster Incision: This is one of the most common methods used to treat gynecomastia. An incision is made underneath the areola (nipple itself) in the dark skin and is only in the lower half.
- The Minimally Invasive Method: In these methods, a very small incision is made at the edge of the nipple. The incision is about 5 mm for the excess glandular tissue to be removed following liposuction. The major benefit of this technique is the smaller incision.
- Ultrasonic Liposuction Method: Ultrasound may also be used to correct the breast enlargement if the cause of the breast enlargement is not glandular. In this method, the chances for nipple distortion to occur are low however few patients can be adequately treated with liposuction by itself.
The scars are smallest if the enlargement is fat alone and larger if your chest is similar to female-looking breasts. However, your surgeon will use their surgical mastery to hide the incision in creases so the scars will be less obvious.
Preparing For Male Breast Reduction Surgery
First, ask yourself if you are ready for the surgery with these soul-searching questions:
- Am I healthy enough right now to do this surgery?
- Am I realistic about what will happen with this procedure?
- Am I considering having gynecomastia surgery because I want it or am I influenced by someone else to get it?
- Did I see enough plastic surgeons for an initial consultation or am I settling for the first one?
- Is the timing good for me for the surgery and the recovery?
- Do I have enough funds for this surgery, as well as extra funds for potential complications?
- Do I understand the procedure, the risks and the potential complications?
- Am I ready to do what it takes to get good results? If I’m supposed to lose weight prior to surgery, how will I do this without starving myself?
- Am I ready to take the results of gynecomastia surgery no matter what?
Things Not To Do Before Surgery
One Month Before Surgery
- Stop smoking or the using any nicotine containing products.
Two Weeks Before Surgery
- Avoid long periods of time in the sun and as well as tanning booths.
- Discontinue aspirin since it interferes with blood clotting.
- Discontinue the use of any medication that causes blood thinning.
- Discontinue the use of any vitamins or minerals that cause blood thinning. Ask your doctor for a complete list of these items.
- Schedule a leave of absence from work.
- Make a list of any responsibilities to your family, friends and work you will need to complete before surgery.
- Collect books and movies to keep busy and keep your mind off negative things after the surgery.
One Week Before Surgery
- If you get sick in any way, inform your doctor to see if he wants to reschedule the surgery.
- Make arrangements for help to and from the hospital, and for aftercare.
- Obtain the surgery chest compression garments, which will be brought with you on the day of your surgery. Make sure they fit
- Pack a few extra shirts as well, ones that are comfortable.
- Complete all items on the list of what to do before surgery.
- Rearrange your bathroom and kitchen cabinets so you won’t have to reach far for them after surgery.
Male Breast Reduction Recovery
Following male breast reduction, patients can expect to feel some discomfort or tenderness in the chest area. Any pain you feel can be controlled with medications provided by your doctor. Common side effects include bruising, swelling, and temporary numbness caused by the disruption of nerve connections. These side effects can be expected whether you undergo excision-only breast reduction or a procedure involving liposuction. Most of these side effects should subside within a week or two, although some degree of swelling or numbness may last for several months.
In many cases, your doctor will 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. Although they can be a bit uncomfortable until you get used to wearing them, compression garments are essential to the success of cosmetic surgery. They should be worn 24 hours per day for at least a week. Some patients then wear the garment only at night for an additional one to two weeks, because the garment can be seen under certain types of clothing
When Will I See the Results?
You will start to see the best results around three months after surgery. At that time, all the swelling should be gone.
The results from the gynecomastia surgery will stay with you as long as your weight stays right around where it’s at. If you gain weight, some of the weight gained may go back to the chest area.
What’s the Cost of Male Breast Reduction?
The average cost for gynecomastia is between $4,500 and $7,500. However, this amount may not include additional fees such as:
- Compression garments used after the surgery
- Medications after surgery
Its important to understand that every case is different. Some men may have very large breasts and need extensive surgery while others only need minimal surgery. Therefore, the surgical technique used will also affect the cost. For example, if liposuction is used, you can expect the cost of liposuction to be included in the overall fee. Ask your doctor for a total cost before the surgery.
Many doctors’ offices have financing plans available since health insurance often will not cover the procedure.
Q: How long does the surgery take?
A: On average male breast reduction procedures take between 1 to 2 hours.
Q: Is general anesthesia used during the procedure?
A: Yes; however, there are times when local anesthesia maybe be used. Ask your doctor which type will be used during your surgery.
Q: How will I know what to do after surgery?
A: Detailed instructions will be given to you and your caregiver by your plastic surgeon. These instructions will include post op recovery tips to ensure a successful outcome.
Q: What types of motions will I be restricted from doing the first few days after surgery?
A: You will be able to walk around, sit and rest the first few days after surgery. It’s important to rest your shoulders and never lift your arms up, especially over your head.
Q: What will I do for the pain?
A: You will be given pain medications by your doctor. If the pain, swelling and redness does not lessen over time, it’s important to call your doctor. You can always call your doctor at any time after the surgery. You will also be given antibiotics to prevent any infections.
Q: What types of complications could result from surgery?
A: There are some potential complications such as:
- Allergic reactions or adverse reactions to medications or anesthesia
- Bleeding or blood clots
- Reduced nipple sensitivity
- Damage to other anatomical structures during the surgery
- Results less than what was desired and a need for additional surgery
Q: What is the average time period for recovery so I can go back to work?
A: It depends on the details of your procedure, but on the average if liposuction was done along with breast gland removal, give yourself about a week.
Q: Do I have a follow-up appointment after surgery?
A: Yes, about 5-7 days after the procedure your doctor will schedule a follow up appointment to see how the healing process is coming along.
Q: When can I start exercising again?
A: Give yourself at least 2-3 weeks for non-weight bearing exercises and up to six weeks for the weight room.
Q: I heard that my nipples will be numb after the surgery. Can you explain this?
A: There is a temporary loss of sensation in the nipples that could last up to a year.
Q: I also heard that the size of my areola will decrease after the surgery. Can you explain this?
A: You can expect a decrease in the whole areola of up to 50% if the glands have been removed.
Q: How long will it take for the swelling to decrease?
A: After surgery, it could take about three months for the swelling to decrease.
- Gynecomastia: Author: George Ansstas, MD; Chief Editor: George T Griffing, MD
- Enlarged Breasts in Men (n.d.)
- Gynecomastia: Clinical Evaluation and Management (n.d.)
- Aetna: Breast Reduction Surgery and Gynecomastia (n.d.)