Gynecomastia Surgery (Male breast reduction) consists of contouring of fat and removal of breast glandular tissue. The minimal incision technique for gynecomastia symptoms is the most common procedure to remove man boobs.
Minimally Invasive Gynecomastia Surgery — Breast Gland Excision with Liposuction (Male Breast Reduction Surgery)
Gynecomastia surgery is male breast reduction surgery, which involves the excision of the breast glands combined with liposuction of the chest. This surgical approach removes the glandular tissue and contours the chest area into a masculine-looking, sculpted chest. The minimal incision technique successfully treats 80% of men with gynecomastia symptoms.
The key to an optimal surgical outcome is the degree of skin contraction. The process of skin contraction is similar to a rubber band. The newer the rubber band, the better the snap-back. The older the rubber band, the more relaxed it becomes. The aging process naturally breaks down the collagen and elastin fibers that give skin elasticity and the ability to contract. In general, younger patients will experience skin contraction, while older patients may require more extensive procedures to facilitate skin removal. Dr Delgado has extensive experience to determine your “snap back test” to ensure the success of your surgery.
Various factors can impair skin quality and, as a result, surgical outcome, include:
- Photoaging or sun damage
- Massive weight loss
- Genetics and ethnicity
- Stretch marks
“John’s Story “ — Follow Miguel Delgado, M.D., into the operating room to see how he performs the standard male breast reduction surgery — breast gland excision with liposuction.
Male breast reduction using the standard gynecomastia treatment technique is suitable for most individuals with grade 1 or 2 gynecomastia symptoms. In specific cases of grade 3 symptoms, the standard technique can also produce successful results. The majority of surgery for male breast reduction is performed under light general anesthesia. However, some surgeons will perform the procedure under local anesthesia, with or without Twilight (IV) sedation. Dr. Delgado prefers light general anesthesia as it gives total control during surgery, and keeps the patient comfortable to avoid excess bleeding and provide the highest possible optimal results.
Dr. Delgado performs a pre-op two weeks prior to the surgery to review the goals of his patients and discuss the procedure and operative plan. This means on the day of surgery, there is no stress and all Dr. Delgado needs to do is make anatomical markings on the patient, prior to the patient going to the operating room. Once the patient is safely under general anesthesia, a local anesthetic (lidocaine) solution and a bleeding reduction agent (epinephrine) are injected to inflate the surgical site.
In most cases, liposuction is performed through a small incision in the armpit, breast fold, or areola to reduce the fat content and sculpt the chest. Once the liposuction is complete, a Webster incision is made on the bottom half of the areola, and the skin is elevated. The glandular and fat tissue is carefully removed in small pieces until a masculine contour is achieved. The internal cavity is prepared for closure by establishing hemostasis (which controls bleeding), and the pocket is washed with sterile fluid to prevent infection. Drainage tubes are placed on each side, and the incision is sutured closed. Once the surgery is complete, foam and a specialized compression garment are placed around the chest. This specialized garment, designed by Dr. Delgado, is a customized vest shaped to the male physique to optimize the perfect compression and control bleeding.
The “pull-through” gynecomastia surgery technique is a minimally invasive procedure, usually recommended for men with Grade 1 and, on occasion, Grade 2 gynecomastia symptoms. This technique requires an even smaller incision than the standard minimally invasive gynecomastia technique.
The “pull-through technique” requires just a tiny 5 mm incision made at the lower edge of the areola. Liposuction contours the fat and blends in the shape surrounding the area. The nipple area is separated from the underlying breast tissue. A unique instrument is used to pull the breast tissue out of the incision. Additional sculpting with liposuction and scissor dissection completes the ” pull-through technique.” The closure and post-op dressing is the same as the standard procedure.
Gynecomastia Surgery Treatment with Excess Skin
Generally, men with Grade 3 or Grade 4 gynecomastia symptoms have a significant amount of excess skin. This is challenging to treat because of limits with the degree of natural skin contraction.
If loose skin is left following liposuction and surgical removal of the glandular tissue, then surgical removal of the skin is necessary. Longer incisions are needed. However, every effort will be made to keep incisions to a minimum.
Two-stage Procedure for Removing Excess Skin
The two-stage procedure is an advanced surgical technique for men with mild to moderate skin laxity. The first procedure performed is standard minimally invasive male breast reduction surgery. The second stage is a periareolar lift performed under a local anesthetic between four and six months after the initial procedure. This allows the blood supply to re-establish to the nipple-areola complex. Skin reduction begins with an incision around the entire areola, followed by a second larger circle incision. The skin and tissue between the circles form a donut shape and are removed. The gap is then meticulously closed with a permanent suture and the patient is fitted with a compression garment.
One-minute video of periareolar lift.
Pre-op reads Adolescent hypogonadism
Four years after surgery with hormone therapy and a healthy lifestyle
Double Incision Mastectomy for Severe Gynecomastia
Double incision mastectomy includes a free nipple graft and is suitable for some grade 3 and all grade 4 gynecomastia symptoms. Patients can have a breast size of C, D, or higher. Men with excess skin are typically overweight or have lost a significant amount of weight. The incision is located in the breast fold and extends toward the armpit. The incision length depends on how far the redundant tissue extends toward the back.
Surgical markings are drawn in the standing position to determine the size of the incision. The infusion solution is injected once the patient is fully under general anesthetic, then the nipple-areola complex (NAC) is completely removed and resized to the size of a nickel. Incisions are made, and glandular and fatty tissue is removed in the sitting position to take into account the effect of gravity on the tissue before removal. This allows an accurate assessment, to ensure the proper amount of glandular tissue and skin is removed for a tight and contoured chest. The nipple-areola complex (NAC) is reattached to create a masculine-looking chest that looks aesthetically correct. A compression vest is placed around the chest, which completes the operation.
The advantage of this technique is that removing excess skin provides the patient with a tightly contoured chest. Although the incisions are longer, and nipples will only have a deep touch sensation, this procedure has an extremely high patient satisfaction rate.
Double incision Mastectomy with a free nipple graft — Follow leading gynecomastia surgeon Dr. Miguel Delgado into the operating room to see how he performs mastectomy surgery on a gynecomastia patient. The patient, a bodybuilder, has developed excess breast tissue due to years of steroid use.
Liposuction for Gynecomastia
In general, male breast reduction surgery is a straightforward surgical procedure. The key is to employ an approach that results in the best outcome and liposuction alone is not the answer.
True gynecomastia symptoms are caused by fat and breast glandular tissue. Although modern liposuction instruments may be designed to break down and suction away the glandular tissue, this is not the correct treatment for gynecomastia. When liposuction is used with no other surgical technique, the contours of the chest will often appear unbalanced. Consequently, it is the number one reason for gynecomastia revision surgery.
Patients with pseudogynecomastia can experience all grades of gynecomastia. Typically, this is a result of an increase in overall body weight, Liposuction can be effective for grade 1 and grade 2 gynecomastia, however grade 3 and grade 4 will require liposuction and excision of excess skin.
Male breast reduction surgery is the most efficient and effective treatment for gynecomastia. The various surgical techniques available to address the four grades of male breast enlargement, can quickly restore your confidence and leave you feeling self-assured to have intimate relationships.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
Dr. Delgado is a world-renowned Board-Certified Plastic Surgeon, a member of the American Society of Plastic Surgeons, and a recognized expert in the field of gynecomastia surgical procedures. In 1986, Dr. Delgado founded Gynecomastia.org — the largest international forum providing unprecedented resources about gynecomastia treatments and surgical options.
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The content on Gynecomastia.org is for educational purposes only. It is not intended as medical advice. It does not replace the need to meet with a physician who will accurately diagnose your condition and suggest treatment options.