Each case of gynecomastia is unique, while most men have what is considered “true gynecomastia” there are some men with a milder form which offers some options. Men that have “true gynecomastia” usually require both liposuction of fat and surgical excision of the breast gland. This is generally a three to four hour surgical procedure and requires the placing of drains which stay in place for about four days.
Men who have what is referred to as puffy nipples and/or a smaller breast mound of an A or B cup and have good quality skin could potentially be candidates for a less invasive surgery that I refer to as the “light pull through procedure”. It is not a new procedure it has been around for almost twenty years, but it has been perfected through the years with outstanding results.
This procedure differs with traditional gynecomastia surgery in that an endoscope is used. An endoscope is an instrument that is inserted into the body through a small incision of about two to three millimeters at the lateral edge of the areola. The endoscope allows the surgeon to see inside the body via optical fibers that send a picture to a computer monitor. First, fat is removed by liposuction with a cannula through the same small incision. Then, through the same incision the connecting fibers are freed up with a medical instrument that resembles a pickle fork, allowing the glandular tissue to be pulled gently through the incision thus the name “light pull through procedure”.
For my traditional gynecomastia patients, a three millimeter incision is made in the arm pit to remove fat from the chest by liposuction. Then I make an incision around the lower half of the areola to have access to breast tissue for excision. With the incision around the areola where the skin color naturally changes, the scar heals very nicely and usually is not detectable. Once fat and tissue have been removed from the chest a pocket of space is left where fluid can collect, this is referred to as a seroma, different than a hematoma which is a collection of blood from a small artery or vein. To prevent the accumulation of fluid in the pocket I use drains. The drains create a negative pressure encouraging the cavity to close down. In addition, I have my patients wear a compression vest for six weeks. There are several reasons for the vest, for one thing it helps close the pocket of space, reduces swelling and helps the skin to retract.
Contrary to a popular belief that liposuction alone may reduce the male breast, removal of breast tissue is also necessary for a well sculpted outcome. Whether it is by the traditional surgical excision or for those with a minor case who are treated by the “light pull through procedure”, breast tissue must be excised as it is too dense to be removed through the cannula by liposuction. The exception to this would be the patient that has what is known as pseudogynecomastia (which is caused by fat alone).
Since the “light pull through procedure” is so much less invasive, my patients do not require drains. In addition to not needing drains, the other advantages are; the surgical time is less and the recovery time is faster, and with the smaller incision the resulting scar heals to almost invisible.