Gynecomastia Surgery :
Everything You Need To Know
Gynecomastia surgery is also known as male breast reduction surgery or male breast tissue excision. It is a procedure for men who have over-developed or enlarged breasts. For that reason, male breast reduction surgery is done to reduce the appearance of unusually large male breasts. This type of procedure is normally performed on an outpatient basis for cosmetic reasons.
The Gynecomastia procedure normally involves the excision of glandular tissue with or without liposuction to remove excess fatty tissue when present.
What is Gynecomastia?
Gynecomastia (also referred to as “man boobs” or “male breasts”) is a condition that is much more common than the average person would believe. Gynecomastia causes the breast area to swell to a larger than normal size and can happen in both boys and men. Though it is more common in teenage boys throughout puberty, it is a condition that can also affect adult men (and in fact, is a growing concern for such men).
I see a lot of confusion from patients around exactly what is Gynecomastia, and what isn’t. If you’ve ever wondered whether you have Gynecomastia or if it’s just fat, I’ve written a short article on the topic to enlighten you.
What causes Gynecomastia?
Gynecomastia is predominantly a result of hormonal changes in the body that lead to an imbalance between testosterone and estrogen, though recent research has suggested that the condition may also be genetic which explains why it seems to develop at any age regardless of hormones.
There are several causes of Gynecomastia. For example, Gynecomastia is commonly seen in puberty. During puberty, male hormones naturally spike and find themselves out of balance. Typically this isn’t a major issue, as a young male reaches the end of puberty his hormones balance themselves out and Gynecomastia can disappear by itself.
In some instances, gynecomastia can be a secondary effect of abnormal hormonal changes due to unrelated disease processes. For example, gynecomastia may be seen in people who suffer from testicular cancer, liver disease, or renal failure – in some instances, these diseases may cause abnormal hormonal levels, which lead to gynecomastia as a secondary effect. Additionally, gynecomastia is commonly seen in men with obesity. This is primarily due to the fact that fat releases estrogen, and in an obese state, estrogen levels may become significantly elevated, which leads to the development of gynecomastia.
Lastly, other hormonal causes of Gynecomastia include taking supplements and medications. Examples include anabolic steroids, smoking marijuana, prostate cancer medications, and even some natural ingredients such as lavender and tea tree.
The five main causes of Gynecomastia are discussed in greater depth in my article, check it out if you want to find out all there is to know about the latest research into the cause of this condition.
Symptoms of Gynecomastia
Although the most obvious sign, which is clearly visible to the eyes, in a patient suffering from Gynecomastia is the enlarging of the male breast to an unusual size. However, there are many other symptoms associated with this disorder that may be experienced by the patient. These include:
- The breast tissue may feel irregular to the touch, with the nipple having a rubbery texture.
- The patient may experience pain on touching the enlarged breast or its nipple.
- In the boys around the age of puberty, breast buds may be felt in one or both the breast and can last up to 2 years.
It is important to talk about these symptoms, because the patient may often confuse Gynecomastia with several other related disorders affecting the male breast, and untimely treatment of which can prove significantly harmful for the patient. This includes:
- Cancer of the Breast: This may affect only one breast and unlike Gynecomastia the breast will not have a hard consistency.
- Breast Abscess: This may be associated with fever and chills and the affected breast may have swelled with a reddish tinge and very hot to touch.
Grades of Gynecomastia
Gynecomastia is classified into four types, based on the severity of the condition. We term them as Grade 1 – 4, though medically they’re referred to as below:
Grade I: Small enlargement with no loose skin
Grade II (A): Moderate enlargement with no loose skin
Grade II (B): Moderate enlargement with extra skin
Grade III: Marked enlargement with extra skin
Grade IV: Marked enlargement with substantial skin excess
In moderate to severe cases, Gynecomastia surgery is a good option for improving the shape of the chest. Generally, Grade 1 Gynecomastia will not require surgery, and in most cases neither will Grade 2. That being said, if for cosmetic reasons you wish to remove even mild Gynecomastia, surgery is an option. When we reach Grade 3 and 4 is where surgery is recommended for the vast majority of patients.
If you’re wondering what grade your Gynecomastia is, check out my in-depth look at the 4 Grades in this article, where I go through a deeper analysis of what each type looks like, and how to identify which one you are suffering from.
Treating Gynecomastia without Surgery
Like any other disease, before starting the treatment of gynecomastia, the possible cause should first be discovered, and by treating this cause, the entire disorder may be treated without any prolonged medical or surgical intervention. However, if gynecomastia is very recently discovered or no treatable cause of the disorder could be pinpointed, then medical intervention may be carried out in the hopes to treat and reverse the symptoms of gynecomastia. This medical intervention can be of three types, depending on the classes of treatment regimen given to the patient.
Androgens include Testosterone, Dihydrotestosterone, and Danazol as a part of the treatment regimen for Gynecomastia.
- Testosterone is a naturally produced hormone, which was given in the past to treat gynecomastia, however, recent studies have revealed that it may actually cause the disorder as one of its side effects.
- Dihydrotestosterone is a non-aromatizable androgen and can be used for the treatment of long-standing gynecomastia which is usually associated with puberty
- Danazol is a weak acting androgen that has also been successfully used for its effect against gynecomastia due to its ability to inhibit the serum gonadotropin levels. The dose usually given to patients is 200mg twice a day.
The class of Anti-Estrogens that can be used for the treatment of gynecomastia includes Clomiphene and Tamoxifen.
- Clomiphene acts as a weak estrogen along with an anti-estrogen at a dose of 100mg/day and has shown a 64% response rate on its regular use. Since lower doses of this drug have not shown any positive effects on the treatment of gynecomastia, it is recommended that one should consume high doses as prescribed by a doctor, to get the desired results..
- Tamoxifen is purely an anti-estrogen drug that is often prescribed for the treatment of gynecomastia due to its inhibitory action on the estrogen production, in turn, causing a significant reduction in breast size of the patients.
The Aromatase Inhibitors which are usually included in the treatment of gynecomastia include Letrozole and Anastrozole.
- Letrozole is a comparatively new aromatase inhibitor that may potentially be used for the treatment of gynecomastia, however, due to insufficient evidence, the exact effect and mechanism of action of this drug is not known.
- Anastrozole is similar to Letsrozole in that it is also a recently discovered type of aromatase inhibitor and inhibits the secretion of aromatase which are associated with the growth of the mammary gland growth in males.
Gynecomastia Surgery recovery
Recovery time for gynecomastia surgery depends on the procedures performed. For example, if you only require removal of glandular tissue, most regular activities may be resumed the day after surgery, On the other hand, if you require removal of glandular breast tissue with liposuction, downtime may be more significant.
In the latter case, strenuous activity should be restricted for up to a month. During recovery, you will wear a compression garment to help reduce swelling, which I advise to be worn consistently for the first month after surgery. Most bruising and swelling caused by gynecomastia surgery normally disappears within two weeks, but can in some cases take up to 4 months. In terms of lasting scarring following surgery, Incisions are, for the most part, small and well hidden, leaving very minimal lasting scars. It’s always good to understand what happens when your chest is healing from gynecomastia surgery, and the scarring you may experience.
Getting back to work and normal life after gynecomastia surgery is always front of mind for my patients, and I’ve written some in depth posts to help educate on such topics. Have a look at this article if you’d like to read more about my top 3 tips for speeding up your recovery. As for getting back to work, like I mention above, this will depend on your specific surgery and situation. This blog post explains the process of after-surgery recovery and returning to work in much greater depth.
Am I a Candidate for Gynecomastia Surgery?
If you are an adult male who suffers from excess breast tissue or fatty enlargement of the breasts, you may be considered a candidate for gynecomastia surgery.
To break it into more specific terms, gynecomastia surgery may be right for you if one or several of the following apply:
- You experience pain or discomfort in your breast/ behind the nipple or are bothered by the feeling that your breasts have grown
- You feel the changes of gynecomastia surgery would increase positive body confidence and improve your mental health
- Your condition has not been successfully treated through alternative medical means
- You are a healthy man and don’t suffer from a life-threatening illness or medical condition
- You are not a heavy smoker, and you do not take recreational drugs
- You are a fully grown adult, with full breast development
- You understand the expected results and can take a positive but realistic view of what your breast area will look like after
- You are a teenager/ adolescent and understand that while you will benefit from surgery, a second procedure may be needed in the future should the condition return
If the above sounds like you, then it’s worth considering gynecomastia surgery. Male breast reduction is a common treatment, safe, and relatively quick to perform and recover from. The body confidence increase I witness with my gynecomastia patients is always heartwarming to see. A full list of the benefits is detailed below.
Benefits of Gynecomastia Surgery
Although we often link the word surgery with pain, bloodshed, and terror, it is actually one of the quickest treatment forms to return a body part back to its normal anatomic shape. This is why surgery is often considered for the treatment of gynecomastia, in order to remove the excess breast tissue in males and return their chest to the shape and size it used to be earlier in life. There are many other advantages associated with gynecomastia surgery, for example:
The Cosmetics Benefit
Gynecomastia surgery allows a man to get a flat and muscular chest as it allows the removal of fat deposits from the breast region. It may not only help return the appearance of the male breast to its original form but also a better version of it, providing a very evident cosmetic advantage.
Self Esteem Boost
Having excess fatty tissues in the male breast can make it look very similar to that of females and in turn, make the individual a potential target of bullying. If this is not treated soon enough, it may significantly affect the conscience and self-esteem of a person – potentially leading to self-imposed isolation. Hence by restoring the male breast to its natural state, gynecomastia surgery very often allows a man to regain his self-esteem and confidence.
Quicker Treatment Approach
Gynecomastia surgery is a quicker treatment approach for restoring the male breast form as compared to medical intervention which may take years and even after that the original form may not be completely restored. With the advent of newer pain-free surgical options like single incision endoscopic surgeries, the recovery time may also be reduced.
Risks of Gynecomastia Surgery
Gynecomastia surgery carries a very low risk. For example, infection and bleeding occur less than 1% of the time. Some men may experience size asymmetries between the two breasts, although this happens extremely rarely with experienced surgeons.
One thing you must consider is that removal of breast tissue alone may leave depressions or dents in the chest, which is expected and normal with gynecomastia surgeries where there is an abundance of excess male breast tissue. Because of this, liposuction can be done at the same time to minimize and often times completely eradiate dents and soft-tissue depressions. For a deeper look at the potential risks and side effects of gynecomastia surgery, check out the article I’ve linked to.
Lastly, while there are no serious long term side effects associated with gynecomastia surgery (except increased self-confidence!) you should minimize sun exposure to the chest area for at least six months following your procedure to prevent darkening of the skin or hyperpigmentation.
The Surgery Walkthrough
Depending on the cause and appearance of the male breast, the Gynecomastia surgery may include various procedures.
- Gland Removal: This procedure involves the placement of an incision on the lower side of the areola and involves the removal of glandular tissue in order to reduce the size of the breast.
- Vaser-Assisted Liposuction: In a lot of patients, gynecomastia is purely a fatty issue, meaning that the glandular tissue is not the source of breast enlargement, but rather, excess chest fat is. In these cases the solution is purely to do liposuction. This procedure involves the placement of a small incision of 2-3 mm in the chest skin and is conducted to remove the excess fatty tissues around the breast to reduce their size. The use of Vaser ( or ultrasound ) is used in conjunction with the liposuction because it creates superior soft-tissue and skin tightening following the liposuction. Additionally, Vaser is very useful in ironing out the dents or depressions which may be left after removing the breast tissue.
- Gland Removal with Vaser-Assisted Liposuction: : In some patients, there is a need to remove both glandular tissue as well as fatty tissue from the chest. In these clinical scenarios, the glandular tissue is primarily removed, and then liposuction is performed in the chest region to create a revitalized and more youthful chest contour.
- Skin Removal: : Depending on the amount of excess skin, which can be significant in patients with Grade IV gynecomastia, the procedure of removing excess skin may involve the placement of an incision around the entire areola to remove the excess skin that is left after the removal of the glandular and fatty tissues. If the breast is sagging and requires a lift, some patients may even require “anchor scar” incisions much like are performed in breast lift surgery ( aka mastopexy ) for women in order to attain optimal aesthetic results.
How long do the results of Gynecomastia Surgery last ?
Forever ! ( When performed by an experienced gynecomastia surgeon ).
Gynecomastia surgery generally produces permanent results, assuming the procedure is successful in removing all of the glandular breast tissue. In rare cases, gynecomastia may recur but this does not relate to the surgery itself. In these cases, it’s usually an external factor that causes the condition to return, such as an adolescent male whose breasts had not fully developed before the initial surgery, or in someone who gains an inordinate amount of weight, resulting in increase in fatty breast tissue.
Here’s a helpful article explaining when and how Gynecomastia can grow back
Cost for Gynecomastia Surgery
Before considering the cost of Gynecomastia surgery, it’s important to break down exactly what goes into the procedure as a whole.
As with any surgery, your provider will have to factor several variables into the price, including:
- Surgery center costs
- Anesthesiologist fees
- Surgeon’s fee
- Pre-consultation, labs, ECGs, and other medical tests
- Post-surgery treatment, garments and aftercare
- Prescriptions for medication
In terms of the surgeon’s fee, the average cost for gynecomastia surgery in the United States is just under $4,200 (taken from 2019 statistics: American Society of Plastic Surgeons). It is important to note that this price doesn’t include the variables such as anesthesia, rental of facilities, medication, and more. It’s always recommended to discuss this in-depth with your specialist plastic surgeon.
Moreover, the surgeon’s fee for gynecomastia surgery will vary depending on their level of experience. With plastic surgery, you truly do want to pay for the experience, which is why doctors with 15 + years under their belt tend to cost more than a relative newcomer to the field.
Male breast reduction is a serious consideration, and the aesthetics of your body will be altered permanently, so you’ll want to ensure everything goes smoothly. It’s one surgery where the price should not be the #1 factor in your mind. Having a Board Certified Plastic Surgeon with hundreds of successful procedures under their belt is the ideal scenario.
The price will also vary depending on the complexity of your particular case. More invasive treatments such as glandular removal with Vaser-assisted liposuction will generally carry a higher cost than a simple incision and removal of fat.
Finally, the location should also be factored into the cost of any surgery. The best surgeons in the world congregate in certain areas (for the US that is typically Los Angeles, New York, and Miami). To get the best, you should expect to pay above the average national cost. After all, you’ll want above average results!
For financing the surgery, you should check with your insurer; however, most health insurance plans do not cover male breast reduction or its complications. Many plastic surgeons (including here at GVMD) offer patient financing plans, so be sure to ask.