Male breast reduction surgery is the contouring of fat and breast gland excision for a person diagnosed with Gynecomastia or Man-boobs. The minimal incision is at the bottom half of the areola, but more severe cases may involve skin removal.
Breast Gland Excision with Liposuction – The Standard Male Breast Reduction Surgery
The most successful treatment for gynecomastia is male breast reduction surgery, which is excision of the breast gland with liposuction of the chest. This treatment is a successful approach to remove the glandular tissue and contour the chest area into an artistically sculpted chest. This surgical approach has successfully treated 80% of men who had gynecomastia surgery.
The key to an optimal surgical outcome is skin contraction, which facilitates better skin contour of the surgical site. 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 skin contraction occurs in the collagen and elastin fibers in the skin. These fibers naturally breakdown as we age. Therefore, younger patients regularly experience consistent contour of the skin after surgery, while older patients may have less efficient shape after surgery.
These are some of the conditions that can impair skin quality and, as a result, surgical outcome.
· Photo-aging or sun damage
· Massive weight loss
· Genetics and ethnicity
· Stretch marks
“John’s Story “– Follow leading gynecomastia surgeon Miguel Delgado, M.D. into the operating room to see how he performs the standard male breast reduction surgery -Breast gland excision with liposuction.
The best patients for a male breast reduction standard technique are individuals who are grade 1 or 2. However, grade 3 candidates often have reliably successful results as well. Male breast reduction surgery, in most cases, will be performed under general anesthesia. However, some surgeons will perform the procedure under local anesthesia or IV sedation.
The day of surgery begins with a comprehensive pre-operative appointment with your surgeon. At this time, the surgeon will mark the chest with his/her surgical markings. The anatomical markings must be done with the patient in a standing position because when lying flat, the breast looks different. Once the patient is safely under general anesthesia, a solution containing a local anesthetic (lidocaine) and a bleeding reduction agent (epinephrine) is injected to inflate the surgical site.
In most cases, liposuction is performed through an inconspicuous puncture in the armpit, breast fold, or areola.
Liposuction is used to reduce the fat content of the chest to blend in with the surrounding tissue. Once the liposuction is complete, a Webster incision is made on the inferior half of the areola, and skin elevation begins from the areola and expands broadly. The gland and fat tissue are removed in pieces through the small incision until a masculine contour is achieved. The internal cavity is prepared for closure by establishing hemostasis (which controls bleeding) and then washing the pocket with sterile fluid. Drainage tubes are placed on each side, and the incision is sutured closed. Lastly, foam and a compression garment are wrapped around the chest.
The pull-through technique is a minimally invasive procedure usually recommended for men with a Grade 1 and sometimes Grade 2 gynecomastia. The advantage of this less invasive procedure is minimal incision.
The “pull-through technique” begins with a 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 for the standard procedure.
One minute video of pull-through technique.
intra-operative view”pulling out gland
Gynecomastia Treatment with Excess Skin
Generally, men with Grade 3 or Grade 4 gynecomastia have a significant amount of excess skin. These patients are often the most challenging to treat because the degree of skin contraction achieved is reduced.
If skin redundancy is an issue, treatment will involve the surgical removal of the skin. Longer incisions are inevitable, yet every effort will be made to keep incisions to a minimum. A seasoned surgeon will be able to give you an accurate prediction of your outcome.
Two-stage Procedure for Minimal Skin Redundancy
The two-stage procedure is an ideal procedure for men with mild to moderate skin laxity. The first of the two-stage process is the standard male breast reduction surgery. Stage two is performed 4 to 6 months after the blood supply has re-established itself to the nipple-areola complex. This second stage is called a peri-areola lift. This skin reduction begins with an incision around the entire areola, followed by a second larger circle incision. The tissue between the incisions is in the shape of a doughnut. This tissue is removed. The larger outer circle of skin is stringed closed to the smaller circle with a permanent suture. A meticulous closure is done, and the patient is fitted with a compression garment. Another advantage of this technique is that it is performed under local anesthesia.
One minute video of peri-areola lift.
Pre-op reads Adolescent hypogonadism
Four years after surgery with hormone therapy and healthy life-style
Double Incision Mastectomy for Severe Gynecomastia
Double incision mastectomy, including a free nipple graft, is for some grade 3, and all grade 4 patients. Patients can have a breast size of C, D, or higher. Men with excess skin are typically obese or have lost a significant amount of weight. Some have benefitted from a gastric bypass procedure.
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. It is crucial to have a smooth transition from the chest toward the posterior aspect of the armpit.
The surgical markings are drawn in the standing position. This position will determine the length of the incision. Once general anesthesia is safely given, the infusion solution is injected. The incision is made, and the tissue is dissected off the underlying muscle. The table is raised to the sitting position. The plastic surgeon can see the effects of gravity and, therefore, can resect the proper amount of skin for a tight and contoured chest. The nipple-areola complex (NAC) is completely removed at the beginning of the procedure. It is resized to the size of a nickel. The position of the NAC is critical to obtain a masculine chest that is well balanced and looks aesthetically correct. A compression vest is placed around the chest, and this completes the operation.
The advantage of this technique is the patient will have a tightly contoured chest. These patients are some of the most satisfied in my experience. The disadvantage is the incision, and the nipple will have only a deep touch sensation.
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 body builder, has developed excess breast tissue due to years of steroid use.
Liposuction Only as a Treatment 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 has a breast gland component that is quite dense and highly resistant to removal by liposuction alone. While the sharp liposuction instruments manufactured today are designed to break down the breast gland and suction away the breast tissue, this is not the correct treatment for gynecomastia. It is the number one reason for gynecomastia revision surgery.
On the other hand, liposuction can be a very successful treatment for patients with pseudogynecomastia. Typically, this is a patient who has experienced an increase in the male breast volume as a result of overall bodyweight gain.
Male breast reduction surgery is the treatment for gynecomastia. There are a variety of surgical techniques to address the four grades of male breast enlargement. This surgery provides men with a very consistent level of patient satisfaction. The results restore men’s and boys’ confidence. Taking off your shirt and strolling down the beach or swimming with your kids is now a reality.
Power-assisted liposuction and the pull-through technique for gynecomastia: F Lista, J Ahmad – Plastic and reconstructive surgery, 2008
Management of Gynecomastia in Patients : Annals of Plastic Surgery: May 2017 – Volume 78 – Issue 5 – p 492-496
Anabolic-androgenic Steroid Use Among Gynecomastia Patients Annals of Plastic Surgery: September 2019 – Volume 83 – Issue 3 – p 258-263
Surgical treatment of primary gynecomastia in children and adolescents: Pediatric Surgery International volume 30, pages641–647(2014)– journals.lww.com
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