Men with gynecomastia have an increase in glandular breast tissue resulting in overdeveloped or enlarged breasts. You may have gynecomastia if you feel rubbery, firm tissue under your areola or firm tissue that extends to the outer part of your chest.
Gynecomastia is a common condition that affects up to two-thirds of adolescent males as a result of hormone imbalance during puberty. In most teens, the excess tissue resolves naturally over time. In approximately 1 out of 4 men the excess tissue persists, resulting in features such as a puffy nipple, a breast mound, or other unfavorable contours.
The most common cause of gynecomastia in adults is hormone imbalance and occurs in 25% of men over 50 years of age. Excess breast tissue can also result as a side effect of certain drugs and medical conditions.
The Best Candidates
- Have enlargement of one or both breasts
- Are self-conscious about the condition
- Are motivated to improve your appearance through surgery
- Are at a stable, healthy weight
- Are not taking blood thinner medications or using nicotine products
The Surgical Options
There are several ways to approach excess male breast tissue but the most common ways involve direct excision of the tissue and liposuction. If you have excess tissue and skin you may require skin excision in addition to surgical reduction of the breast tissue.
Male breast reduction surgery is most often performed under general anesthesia to offer maximum comfort and ensure safety. The surgery usually takes 1-2 hours depending on your degree of gynecomastia and individual surgical plan. Your Restore SD surgeon will carefully mark the areas of excess tissue and planned incisions prior to surgery.
At Restore SD Plastic Surgery we utilize the SAFELipoTM technique to safely and consistently offer optimal results. The procedure starts with PAL® (power assisted liposuction). PAL® uses small vibrating cannulas (hollow metal tubes) to assist in loosening and suctioning the unwanted fat cells. PAL® decreases surgeon fatigue and improves surgical precision as well as reduces tissue trauma. Your Restore SD surgeon will begin with small incisions on the chest to infuse saline fluid containing lidocaine (for numbing the area) and epinephrine (to decrease bleeding) in the chest area and using PAL®, remove the unwanted excess tissue. Next, a small incision is extended around the bottom edge of the areola to remove the excess glandular tissue. Glandular tissue feels firm or rubbery – differing from fatty tissue – therefore direct excision in conjunction with PAL® is the most effective treatment to achieve optimal results. In certain cases skin excision is performed – the type of incision and technique uses is tailored to your individual appearance and desired outcome.
Once the tissue is removed and an optimal chest contour is achieved, the incisions are closed with absorbable sutures. Most patients do not require drain placement. Surgical dressings are applied and a compression vest is placed to ensure that swelling is minimized and a smooth contour is maintained.
Gynecomastia is an outpatient surgery, so once you have recovered from anesthesia you are able to go home with a responsible adult. You should arrange to have a friend or loved one stay with you for the next one to two days. Some surgical pain is expected and is treated with pain medications. Most patients will not have drains to care for. While you will be able to shower the next day, you should refrain from soaking in a tub or swimming for 2 weeks. You will be able to engage in normal daily activities such as eating and walking after 24 hours but intense physical activity should be avoided for 4-6 weeks. You will wear the compression vest for 4-6 weeks after surgery. Most patients return to work after 1-2 weeks. During the recovery period, you will have follow up with your Restore SD surgeon and will be guided back to your usual activities. Most complications occur from getting too active too early, so select a surgical date that allows an appropriate amount of time to heal and gradually return to your more vigorous activities.
Commonly Combined Procedures
Gynecomastia surgery can be combined with other aesthetic procedures, most commonly liposuction. SAFELipoTM of stubborn fat around the waist can easily and safely addressed during the same procedure.
- What happens at my gynecomastia (male breast reduction) consultation?
When you arrive at Restore SD Plastic Surgery to discuss a male breast reduction surgery, your Restore SD surgeon will perform a detailed examination as well as review your medical history and any medications you are taking. At your consultation, you will have photos taken with our Vectra 3D imaging system and discuss treatment areas and options while viewing your photos series. With our state of the art Canfield software, potential surgical results can be viewed and adjustments can be made, helping you to visualize possible outcomes.
- Why should I choose Restore SD Plastic Surgery for my male breast reduction surgery?
The surgeons at Restore SD Plastic Surgery have over a decade of experience with cosmetic and reconstructive surgery. In addition to being fully credentialed, we take the time to listen to your goals and partner with you to develop the best and safest surgical plan that will optimize your results and leave you looking and feeling your best.
- How do I choose a surgeon?
It is important to ask if your surgeon is Board Certified by the American Board of Plastic Surgery. As Board Certified plastic surgeons at Restore SD, we have years of training and expertise in breast surgery that cannot be imitated by short courses and alternative certifications. Ensure that your surgeon is proficient in breast surgery and male breast reduction surgery in particular. The American Board of Plastic Surgery is one of 23 members of the American Board of Medical Specialties. These specialties represent the traditional core of fully trained specialists. Alternative boards have cropped up over the last several years to try to lend legitimacy to incompletely trained or poorly trained practitioners. Accept nothing less than a surgeon certified by the American Board of Plastic Surgery who preferably is a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS).
- What about my nipples? Are they removed? Will I have sensation after male breast reduction?
Nipples are important! They are not removed in most (99%) of male breast reduction surgeries that we perform although that is a common question. When you wake up from surgery, although you will have some post-operative discomfort most men don’t feel sensation in their chest skin or nipples. Over the next few weeks to months, sensation to the skin and nipple areolar complex returns. Some men can have permanently decreased nipple sensation after surgery.
- How long do the results of male breast reduction surgery last?
Breast volume does not usually change unless there are significant fluctuations in weight or use of medications that can promote male breast enlargement. In general, most men enjoy the benefits of male breast reduction surgery for many years. Some may want a small cosmetic touch up down the road and some may never require or want any other male breast surgery.
- How much time off work should I take after male breast reduction surgery?
Depending on your profession and extent of surgery, you should expect to take 1-2 weeks off from work. You will not be able to drive while taking narcotic pain medication. You will need a ride home after having general anesthesia and have a friend or family member stay with you for the first night and a day or two if possible.
- How do I minimize post-operative scarring after male breast reduction surgery?
Unfortunately, scarless surgery does not yet exist. Your Restore SD surgeons will educate you about scar management postoperatively. A surgical scar will take 9-12 months to fully mature. Your scar will go through changes during the healing process and your Restore SD team will help you manage this part of your recovery. This can consist of sun avoidance, scar massage, scar cream, and fractionated laser treatments.
- What should I do to prepare for male breast reduction surgery?
If you have close friends or relatives who have had male breast reduction surgery – start there! A personal story of their journey may guide you to questions to ask your surgeon and having someone with a shared experience is invaluable. Educate yourself by reading our procedure page and viewing our educational videos. Other sources of information include RealSelf and WebMd. Remember to wear a button down front opening shirt on the day of surgery so that your post-operative experience does not include wrestling a shirt over your head!
- I am a smoker – can I have male breast reduction surgery?
At Restore SD Plastic surgery, we want to deliver safe, consistent, and reproducible results. Smoking tobacco or using any nicotine products has adverse effects on wound healing. Your risk of nipple loss, infection, and prolonged incision healing are much higher if you use nicotine. We recommend a nicotine free period of 8 weeks prior to surgery and have an easy urinary nicotine test that we can do in the office to help you on your journey to a safe and gratifying surgical experience with us.
- I have Diabetes – what do I need to know about male breast reduction surgery?
If you have diabetes it is important to work with your medical team to keep an ideal HbA1C. Diabetes can increase your risk for prolonged wound healing and certain types of infections. Surgery can be safely performed but requires a coordinated effort from patients, surgeons, and medical doctors to attain outstanding results. There are some instances where your Restore SD surgeon may want to postpone surgery until your diabetes is under better control.
- How soon can I travel after having male breast reduction surgery?
Having surgery means a commitment to an appropriate recovery. We recommend scheduling your surgery at a time that allows enough time to recover and gradually return to your normal activities. Flying, driving long distances, or leaving the immediate area are not recommended until you have been cleared by your surgeon. If you have specific travel needs or require advice for emergency travel soon after a procedure, please let us know and we will be glad to discuss the details with you.
- Do I have gynecomastia if I only have puffy nipples?
If you have nipples that stay large and “puffy” you may have gynecomastia. This is usually seen in very lean patients. When you have mostly muscle and very little body fat but still have gynecomastia, it can appear as a small amount of breast tissue behind the nipple areola complex. This makes them look puffy. Conservative surgery to remove most of this abnormal tissue can restore your appearance to a normal, flattened look.
- Can my large areolas be treated?
Yes. Although not very common, if your areola (the pigmented area around the nipple) is larger than normal (3-3.5cm in men) the excess can be removed surgically.
- Is there a pill I can take instead of surgery?
Some clinics offer tamoxifen (Nolvadex) or raloxifene (Evista) as a treatment therapy. These medications block the effects of estrogen and can help somewhat in certain patients who have had gynecomastia for less than a year. It has been proven most helpful as a preventative measure in patients undergoing treatment for prostate cancer, who are at high risk for developing gynecomastia as a side effect of their treatment. At Restore SD Plastic Surgery our experience is consistent with the research which is to say that pill therapy is an incomplete and ineffective treatment for most patients and surgery remains the gold standard for correction.
- When can I work out again after surgery?
It is important to remain pretty relaxed for the first 2 weeks after surgery. Your activities should be limited to usual daily activities. After that, increasing your activity slowly is acceptable, but lifting anything heavier than 10 pounds is off-limits until approximately 4-6 weeks after surgery to ensure you heal properly and without complications. Your Restore SD plastic surgeon will continue to follow-up with you regularly post operatively to ensure you are able to return to working out as soon as it is safe.