January 25, 2011
While most Plastic Surgery practices have traditionally been focused on women, many are seeing a growing male population. And while there are many reasons why men seek Cosmetic Surgery, one of the more popular procedures is to address Gynecomastia, or “male breast development”.
For many men, simply taking off their shirt is an embarrassing event and so men with Gynecomastia often not only avoid other people when they are changing but they also may actually end up avoiding the activities they would love to participate in such as swimming or heading to the water, simply because they don’t want others to see their chest.
So what exactly is Gynecomastia? The term derives from the Greek stems “gyne” meaning woman and “mastos” meaning breast. And while it most commonly develops during puberty, there are cases that have been seen in the elderly, although this is less common. And although there are more worrisome reasons for its development (such as pituitary and testicular tumors), the most common reason is an imbalance in sex hormones or the tissue responsiveness to them.
To accurately assess the cause, a thorough medical history must be taken and a physical examination performed. For most patients seeking cosmetic surgery to address this, many of them have already undergone extensive testing by their primary physicians prior to seeking treatment. Once they reach a Plastic Surgeon, the question is then what can actually be done and what results can be expected.
To properly treat Gynecomastia, three main tissue types must be evaluated: skin, fat, and the glandular tissue itself. For the most subtle forms of Gynecomastia where “puffy nipples” are the main complaint, simple removal of breast tissue under the areola can often provide very dramatic improvement with scars that are almost completely imperceptible over time. From those patients with fatty tissue contributing to breast prominence, liposuction is often performed initially to contour the chest wall followed by direct excision of the remaining breast tissue. If excessive, loose skin is a problem then a skin removal procedure may need to be combined either at the time of the initial surgery or down the road once swelling has resolved. In most cases, unless there is a tremendous amount of loose skin, most Plastic Surgeons will wait until the swelling has improved to gauge the amount of skin shrinkage that occurs. In a majority of cases, patients will rather accept a little loose skin than the incisions and scarring associated with the actual skin removal.
For the typical patient in my practice, I favor a two step approach. First, I begin with a very small (1.5-2.0 mm) incision on the lateral chest wall in an extension of the breast fold through which I perform VASER ultrasonic liposuction. The goal here is to not only remove excess fat and contour the chest wall but also use the ultrasonic energy to encourage even greater skin tightening. From here, I then do something very unique. I use a curved arthroscopic shaver (the same device used to remove damaged cartilage from knees, etc.) to gently and smoothly remove breast tissue from beneath the breast mound. Since adding this approach, I have virtually eliminated an incision directly on the breast itself and am having significantly greater control over shaping in the operating room and am seeing even better results and happier patients.
Foam padding is applied to the chest wall immediately following surgery and the chest is snugly wrapped with an ACE wrap to provide even circumferential compression. Dressings are then removed 24 hours later and replaced with a compression vest which is then worn for about six weeks. Patients can shower the day after surgery and return to normal activities within 2-3 days following their procedure. Most gradually return to exercise within 3-4 weeks after surgery and describe the discomfort as very tolerable.
The biggest limitation in treating Gynecomastia is not the actual procedures currently available but, instead, a real lack of education as to what can actually be done. Many men simply do not realize that there are excellent options for addressing this condition and so they never seek treatment. Of those that do, they are truly some of my happiest clients!
If you have symptoms of Gynecomastia or know someone that does, we encourage you to call our Denver Cosmetic Surgery office for more information. We look forward to hearing from you!
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