Male Breast Reduction (Gynecomastia)

MALE BREAST REDUCTION (GYNECOMASTIA)

Surgery performed by Dr. Elswick

Gynecomastia comes from the Greek word for “women-like” breasts and is a medical term for enlarged breast in males. Although it is not widely heard of it is very common.  It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.

For men who feel self-conscious about their appearance, male breast reduction surgery can help improve their self image. The procedure removes fat and/or glandular tissue from the breasts, and in extreme cases removes excess skin, which results in a chest that is flatter, firmer, and better contoured.  Dr. Elswick is highly qualified and experienced in body contouring. She uses a unique, minimally invasive technique that she learned while training at the Mayo Clinic to remove both types of tissue.  This technique minimizes scarring and allows you to achieve natural results that enhance your appearance and self-confidence.  She is one of a few doctors nationwide that uses this technique for Gynecomastia surgery.

THE BEST CANDIDATES FOR MALE BREAST REDUCTION

Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age whose breast size has been stable for a year.  If you are experiencing changes, you may need to be evaluated by an endocrinologist prior to having surgery.  Surgery may be discouraged for obese men or for overweight men who have not first attempted to correct the gynecomastia with exercise or weight loss. Also, individuals who drink alcohol beverages in excess or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered.  Very rarely, cancer can be a cause of gynecomastia (either of the breast itself or testicular cancer that secretes hormones causing breast growth).  If you have concerning factors for cancer, you may be referred for additional evaluation prior to surgery.

PLANNING YOUR SURGERY

The initial consultation is very important. Dr. Elswick will complete a medical history, examine your chest, and check for causes of the gynecomastia, such as impaired liver function, use of certain medications known to cause gynecomastia, or drug use. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist.  She may also recommend a mammogram or breast x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast composition.

PREPARING FOR YOUR SURGERY

You should be at your goal weight prior to surgery.  It is important to maintain a healthy diet prior to your surgery to optimize the healing capabilities of your body.  Our qualified staff will give you specific instructions to prepare for the procedure, including guidelines on diet and medications.  Patients using tobacco or other nicotine-containing products must stop at least four weeks before and after surgery. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.

WHERE YOUR SURGERY WILL BE PERFORMED

Your surgery can be performed at Columbia Surgery Center (our private outpatient surgical suite adjacent to our office) or at one of the local hospitals.  Dr. Elswick has privileges at William Beaumont Hospital of Troy, William Beaumont Hospital of Royal Oak, and McLaren Macomb Hospital. Gynecomastia surgery is usually an outpatient procedure.

TYPES OF ANESTHESIA

Gynecomastia surgery is usually performed under general anesthetic but in some cases it can be performed under local anesthesia with sedation.

THE SURGERY

There are many different techniques for gynecomastia surgery.  The best option for treatment is individualized based on a patient’s physical exam.  Glandular (breast) tissue must be cut out because liposuction will not be able to remove this firm, rubbery tissue.  Fatty tissue can be removed by liposuction or by excision (cutting it out).  If you have a lot of extra skin or poor skin elasticity, some of the skin may need to be directly excised.  The amount of glandular tissue, fatty tissue, and quality/amount of skin determine what surgical technique will be best for you.

If you have predominantly fatty tissue and good skin quality, liposuction alone is an excellent option for treatment.  To access the fat, several small incisions are made surrounding the area that will be liposuctioned.  The incisions are typically about 5-7 mm in size and are hidden in normal skin creases.  A solution called tumescent is injected in the fatty deposits to help break up the fat, provide anesthetic (numbing of the area), and minimize bruising.  After the tumescent solution takes effect, the liposuction cannula is used to break up and remove the fat.  Taking the appropriate amount of fat and blending it with the surrounding tissue is extremely important. This requires not only a highly qualified surgeon but an artistic eye to ensure you end up with a nice, even contour.

If you have a mix of glandular and fatty tissue with good skin quality, Dr. Elswick uses a unique, minimally invasive technique to remove both types of tissue and is one of very few surgeons nationwide that use this technique.  The fatty tissue is removed with liposuction, as discussed above, and the glandular tissue is removed with an arthroscopic shaver.  This shaver is the same type of shaver that is used for arthroscopic, minimally invasive joint surgery.  It is shaped similar to a liposuction cannula but has a protected blade that oscillates and is able to cut through and extract the firm glandular tissue. Since the shaver is inserted through the same incisions used for liposuction, this technique minimizes scarring from the surgery compared to traditional gynecomastia surgery, where an incision was made around the areola (pigmented portion of the breast) to remove the glandular tissue  Traditional gynecomastia surgery leaves a much longer and more obvious scar compared to the minimally invasive technique.

If you have a lot of excess skin or poor skin quality, the skin will need to be removed in addition to removal of the glandular and fatty tissue.  This can be done through various techniques but may involve a combination of incisions around the areola, in the fold underneath the breast, or in a vertical line from the areola to the fold underneath the breast.

AFTER YOUR SURGERY

The incisions on the chest are usually closed with sutures under and above the skin.  The sutures under the skin are absorbed by the patient’s body and the sutures above the skin are removed one week after surgery.  Dressings typically consist of gauze, large cotton pads, a large foam pad, and a compression garment.  The compression garment should be worn for 4-6 weeks.  Mild to moderate discomfort and pain is to be expected after surgery, which will usually subside in the first few days to weeks after your surgery. You will likely to feel tired and sore for 1-2 weeks after surgery.  Most of your discomfort can be controlled by medication prescribed by your doctor in addition to taking regular Tylenol.

Bruising and swelling is expected after surgery.  Generally the major bruising and swelling subsides 1-2 weeks after surgery.  However, the final result of your surgery will not be evident until 6 months after surgery.  Slight numbness in the surgical area is common and typically resolves over a few months.

You should not participate in any strenuous exercise, heavy lifting, or repetitive upper extremity activities for 4-6 weeks after surgery.  Strenuous exercise includes any activities where your heart rate exceeds 100 beats per minute.    You should not lift anything heavier than 10 pounds (about a gallon of milk).  It is ok to type and work at a computer.  You can slowly work back into your normal activities at 4 weeks post-operatively and should be back to your normal self at 6-8 weeks post-operatively.

When you can return to work depends on how you are healing post-operatively and what you do for work.  Patients with sedentary jobs can return to work as early as 1-2 weeks post-operatively.  If you do a lot of lifting or repetitive arm motions, you will require six weeks off or modified duties at work.

YOUR NEW LOOK

Gynecomastia surgery gives your chest a more masculine appearance.  It will appear flatter and feel firmer. Patients have a high satisfaction rate.

RISKS ASSOCIATED WITH MALE BREAST REDUCTION

Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them.  In addition, every procedure has limitations.  An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.

Most patients who have gynecomastia surgery heal well without any complications.  Potential complications include bleeding, infection, seroma (fluid accumulation), asymmetry, contour irregularities, and numbness.  Sometimes you may require additional surgeries to address these complications.

INTERESTED IN SETTING UP A CONSULTATION? 

Are you interested in finding out if you are a candidate for minimally invasive or traditional gynecomastia surgery?

Call today to set up your consultation with Dr. Elswick. 248.524.0620