What is Gynecomastia?
Man-boobs, “moobs,” puffy nipples: gynecomastia is the medical term for enlarged male breasts. It refers specifically to enlarged glandular tissue, but it may also involve excessive fat in the chest area and/or redundant skin. There is a wide spectrum of appearances, from pointy nipples to highly-feminized breasts that hang down toward the belly button – most men tend to be somewhere in between. This spectrum is graded:
- Grade I: Mild extra glandular tissue and fat; no extra skin – often in the form of “puffy nipples”
- Grade II: Moderate extra glandular tissue and fat; no extra skin – full shape, but no sagging
- Grade III: Moderate extra glandular tissue and fat; mild to moderate extra skin – full shape and mild sagging
- Grade IV: Severe extra glandular tissue and fat; severe extra skin – female shape and hanging very low
The chest may be asymmetric or evenly enlarged. It can occur at any age and may be caused by genetics, hormonal changes, obesity, and the use of certain drugs including anabolic steroids, cimetidine, spironolactone, and marijuana among others. This condition is not rare, as some studies show that 50% of the male population in the U.S. is affected by gynecomastia. This condition can make a person feel extremely self-conscious and cause them to avoid public spaces. It may also affect intimate relationships and can inhibit one’s happiness altogether.
Is Gynecomastia Surgery Right for You?
If you are seeking a flatter, more chiseled appearance to your chest, then gynecomastia surgery may be appropriate. It is generally reserved for patients over eighteen years of age, who have had enlarged breasts or puffy nipples for at least two years without improvement. The potential benefits must outweigh the potential risks in each individual case, and the patient must be comfortable with having a thin scar. Prospective patients should be off of gynecomastia-inducing medications, and certain that other hormonal imbalances and endocrine diagnoses have been ruled out first. Non-smokers in relatively good health with realistic expectations tend to do best.
What Should I Expect During My Gynecomastia Surgery Consultation?
Your consultation is an opportunity to spend time with Dr. Donaldson, one-on-one, discussing your concerns, goals and expectations. You can prepare in advance by writing out questions you may have about the procedure, as well listing medications, allergies, and previous operations or medical treatments. Dr. Donaldson will take time to consider what might have caused your condition and what risks you may incur. He will examine your chest, take measurements, assess size and shape, note skin quality, nipple position and areolar diameter. Confidential photos will be taken for pre-operative planning and for before/after comparisons. Sometimes a primary care or endocrinology referral is made for additional testing. Once these steps are completed, Dr. Donaldson will review your options for surgery and anesthesia. He will share example photographs and help set proper expectations for recovery and results.
What Questions Should I Ask My Surgeon About Gynecomastia Surgery?
Here are some questions you may want to ask Dr. Donaldson during your consultation:
- Would you consider me a good candidate for this procedure?
- What will I need to do in order to ensure I get the best possible end result?
- How will you be approaching the procedure?
- Will you be using a specific surgical technique?
- Where will I be undergoing the procedure?
- How long do you think the estimated recovery period will be for me?
- What are the risks and complications associated with this procedure?
- Will I need help performing daily activities following the surgery?
- What are common complications and how are they handled?
- What are my options if I am dissatisfied with the outcome.?
- May I see a few relevant before-and-after photos from patients you have operated?
- What type of result can I realistically expect?
- What should I do to prepare for the surgery?
- Will I need to take any prescription medication afterwards?
- Will I have dressings/bandages after surgery? How long will I need them?
- Are there any stitches that will need to be removed?
- How long do I need to refrain from strenuous activity and exercise?
- How often will I need to come back for follow-ups?
Are There Any Risks with Gynecomastia Surgery?
Gynecomastia surgery is generally quite safe, but there are possible risks as with any other medical procedure. Your baseline health and physical condition may affect these risks. Ultimately, an analysis of risks versus benefits will inform each patient’s unique decision whether to pursue surgery. Here is a partial list of risks a gynecomastia surgery patient may encounter:
- Prominent scarring
- Seroma (fluid collection)
- Changes in nipple sensation
- Nipple inversion
- Skin wrinkling or dimpling
- Incomplete result
- Damage to underlying tissue including bone, muscle or nerves
- Chronic pain
- DVT/blood clots
Dr. Donaldson will explain these risks and go into further detail if certain risks seem more likely than others in your particular case.
About the Gynecomastia Procedure
Gynecomastia surgery contours the chest and reduces the male breast size. The technique depends upon the degree of severity. For grade I, Dr. Donaldson often prefers making a small incision under local anesthesia and directly removing the glandular tissue from behind the nipple without the patient needing to be asleep.
For grade II and III, Dr. Donaldson usually uses a combination of VASER, liposuction and direct excision of glandular tissue with a short-scar, minimally-invasive approach under general anesthesia. VASER applies ultrasound waves to the breast tissue to help emulsify the fat and break up fibrous attachments. Liposuction involves a ¼ inch incision through which a thin, hollow tube (cannula) is attached to a vacuum and used to extract the fat. If stubborn, firm glandular tissue still needs to be removed, then a ½ or 1 inch incision is made at the lower border of the darker areolar skin. Grade III skin will often shrink down over time to match the flattened chest contour.
Grade IV gynecomastia requires a more invasive approach. VASER and liposuction may still be used first, but longer incisions are ultimately required to remove the large amount of glandular tissue, fat and skin. The incisions often wrap around the areolar border in a complete circle, and sometimes also form a vertical line down the chest and/or a horizontal line across the entire lower chest. The longer scars serve to tighten the skin and eliminate folding, wrinkling or hanging skin that would otherwise be left behind.
Can other operations be performed at the same time?
Many other cosmetic procedures can be combined with gynecomastia treatment while the patient is asleep. Specific to the chest, areolar reduction and nipple reduction may be performed. The former procedure downsizes the diameter of the dark areolar skin; the latter reduces the size and projection of the actual nipple itself. Other common additions include liposuction, tummy tuck, brachioplasty and blepharoplasty.
What Will Recovery Be Like From Gynecomastia Surgery?
Following male breast reduction surgery, the incisions are closed with dissolvable sutures and a final layer of surgical-grade glue provides a sterile barrier. Light dressings are supported with an elastic bandage or customized compression garment. Temporary fluid drains are usually not necessary except in grade 4 conditions. You will be prescribed medication to relieve pain and prevent infection, and homeopathic remedies help minimize bruising and swelling.
Dr. Donaldson’s staff will walk you through the steps of caring for the surgical site and minimizing scars. Follow-up visits within a week, a month and several months later will help ensure optimal healing. You will have detailed instructions for wound care, and will be well-apprised of warning signs and what to watch for as you make progress at home. Most patients take anywhere from three days to a week away from work and other responsibilities. Strenuous exercise should be avoided for four to six weeks.
Why Should You Choose Dr. Donaldson for Gynecomastia Surgery?
A successful gynecomastia result is more likely when performed by a highly-regarded, board-certified plastic surgeon. Dr. Donaldson has a thriving gynecomastia practice that is comprised of patients who are absolutely thrilled with their results. Listen to a few of them discuss their experience in their own words:
Dr. Donaldson has the technical skills, experience and bedside manner to give you confidence as you step into the operating room. He is board certified by the American Board of Plastic Surgery, and serves as an Active Member of both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Dr. Donaldson is fellowship-trained, and has written professional articles and book chapters, presented to his peers at national and international meetings, and taught numerous residents and medical students. Many people in Columbus, Ohio recognize Dr. Donaldson from his appearances on the television news networks, where he continually serves as a media expert on an array of plastic surgery topics. He has received many honorary designations, including America’s Top Plastic Surgeons, America’s Most Compassionate Doctors, Patients’ Choice Award, Columbus Forty-under-40 and Columbus Fast-Fifty.
Schedule a Gynecomastia Surgery Consultation
Take the first step by scheduling your consultation today and learning how you can improve your appearance through gynecomastia surgery. Columbus, Ohio residents rely on Dr. Donaldson at Donaldson Plastic Surgery. Call us now at 614-442-7610 or fill out the contact information on this page to schedule your personal consultation and learn more about whether this procedure is right for you.