Gynecomastia

Male Breast Reduction

Gynecomastia is a medical term that comes from the Greek words for "women-like breasts." Though this oddly named condition is rarely talked about, it's actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast over development, there is no known cause in the vast majority of cases.

Dr. Jeffrey Kenkel is a *Board-certified plastic surgeon specializing in cosmetic surgery. He is Chairman of the Department of Plastic Surgery and Director of the Clinical Center for Cosmetic Laser Treatment at UT Southwestern Medical Center at Dallas.

* Board-certified by the American Board of Plastic Surgery

Am I a good candidate for the surgery?

Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours. Surgery may be discouraged for obese men or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcoholic 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 an option.

What should I expect from my consultation?

The initial consultation with Dr. Kenkel is very important. He will need a complete medical history, so check your own records ahead of time and be ready to provide this information.

During the consultation, Dr. Kenkel will examine your breasts and check for causes of the gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. If a medical problem is the suspected cause, you'll be referred to an appropriate specialist. Dr. Kenkel may, in extreme cases, recommend a mammogram or chest x-ray. This will not only rule out the very small possibility of breast cancer, but will reveal the breast's composition. Once Dr. Kenkel knows how much fat and glandular tissue is contained within the breasts, he can choose a surgical approach to best suit your needs.

How is the surgery performed?

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out, with a scalpel. The excision may be performed alone or in conjunction with liposuction. In a typical procedure, an incision is made in an inconspicuous location — either on the edge of the areola, the dark skin that surrounds the nipple, or in the under arm area. Working through the incision, Dr. Kenkel cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars.

If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions. If your gynecomastia consists of primarily excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than half an inch in length, is made around the edge of the areola or may be placed in the underarm area. A slim hollow tube called a cannula that is attached to a vacuum pump is then inserted into the incision. Using strong, deliberate strokes, the surgeon moves the cannula through the layers beneath the skin, breaking up the fat and suctioning it out.

What happens the day of surgery?

Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself takes 1 to 2 hours to complete. However, more extensive procedures may take longer. Correction of enlarged male breasts is performed under general anesthesia. You will sleep through the entire operation.

Be sure to arrange for someone to drive you home from the hospital and stay with you to assist you in and out of bed the first couple of days while at home. The "Patient Care" link provided will give you instructions to prepare for surgery, including guidelines on eating, drinking and smoking. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery.

What is the recovery like?

Whether you've had excision with a scalpel or liposuction, you will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by Dr. Kenkel. In any case, you should arrange to have someone drive you home after surgery and to help you out for a day or two, if needed. You'll be swollen and bruised for a while. In fact, you may wonder if there's been any improvement at all. To help reduce swelling, you'll probably be instructed to wear an elastic pressure garment continuously for a week or two, and for a few weeks longer at night. Although the worst of your swelling will dissipate in the first few weeks, it may be three months or more before the final results of your surgery are apparent. In the meantime, it is important to begin getting back to normal. You'll be encouraged to begin walking around on the day of surgery, and can return to work when you feel well enough, which could be as early as a day or two after surgery. Any sutures will generally be removed about 1 to 2 weeks following the procedure.

What should I know about my results?

Whenever surgery is performed on your body, a scar will result. The scars for this procedure are around your areola. They will fade with time and barely be visible.

The procedure may also result in permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue. The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.

How many visits do I have after surgery?

If drains are used, you will return within 1 to 2 days following surgery. Then you will return in 7 to 10 days following surgery for suture removal. During your postoperative visits, Dr. Kenkel will discuss further postoperative activity and concerns you may have. Following this visit, you will return in approximately 3 weeks, 6 weeks, 3 months, 6 months and 1 year. If you have questions or concerns during your recovery or need additional information at a later time, you can always contact Dr. Kenkel.

How much does the surgery cost?

At the time of your initial consultation, you will be quoted a price that will include Dr.Kenkel's fee as well as hospital and anesthesia fees. Fees are due at least three weeks prior to your surgery. Checks, money orders, cash and credit cards may be used for payment. A $500.00 deposit will reserve a specific time and date for our surgery.