Gynecomastia Surgery - Male Breast Reduction - Austin Gynecomastia Center
What Is Gynecomastia?
Gynecomastia refers to the appearance of female-like breasts in a man, ranging from simply puffy nipples to full-blown breast development. Gynecomastia is caused by the proliferation of tissue usually related to an imbalance of the sex hormones estrogen and testosterone. This tissue is fat, gland and fibrous in nature. Any or all types of tissue can be found at treatment.
Gynecomastia is a benign condition that can be hereditary, though it is not related to breast cancer in any way. In a small number of patients the condition may cause pain or tenderness. The true frequency of gynecomastia is unknown, but studies estimate that gynecomastia occurs in 5-30% of all men. If we do some simple math and assume the lower end of the percentage, more than 8 million men have some form of gynecomastia in the United States, so those who suffer from this condition are certainly not alone.
The real problem associated with gynecomastia, often called gyno for short, is not just the appearance of the chest, but also the negative psychological consequences. Being a man and having the appearance of a female breast provokes confusion, anxiety, humiliation and the potential for long term psychological consequences. These include avoidance and antisocial behaviors, depression, anxiety and problems with interpersonal relationships – among many others.
Do I Have Gynecomastia?
The answer to this question is a simple visual inspection of your body. The normal male chest has a thin layer of tissue with small, flat areolas. If your chest has fullness, puffy nipples and abnormally wide areolas you most certainly have gynecomastia. It is the appearance of your chest — it looks more round and feminine than normal. Your nipples stick out particularly when wearing certain shirts. If you have any question about whether or not you have gynecomastia simply submit a Virtual Consultation from Home and I’ll get back to you in a jiffy.
How Is Gynecomastia Fixed?
Gynecomastia is fixed once and permanently by an expert surgeon who removes the offending tissue and contours the chest so that it looks masculine and sculpted. Non-surgical methods for male breast reduction will not remove your gynecomastia. The gold standard treatment for gynecomastia is a surgical procedure that typically involves the removal of tissue beneath the areola in addition to some form of liposuction. At the Austin Gynecomastia Center, the procedure takes about 60 minutes, the recovery is short (1-2 days) and pain is mild and very tolerable. The results are immediate, it does not come back and satisfaction is very high. There is no scarring.
How Much Does Gynecomastia Surgery Cost?
Who Gets Gynecomastia? What Causes It?
Men who develop gynecomastia ask Why me? Everyone wants to know how they got it and how can they get rid of it. The majority of gynecomastia patients developed the condition when they were going through puberty and it never went away (as in most young boys) or it even got bigger with time. This is callled natural or “idiopathic” gynecomastia. It’s caused by a temporary imbalance of the sex hormones during this stage of pubertal development in young boys.
The next most common cause of gynecomastia is the group of young men who have taken hormones or prohormones for body building reasons. This causes a disturbance of the hormones which can lead to the development of glandular type gynecomastia. Lastly, uncommon medical issues and medications make up the smallest category of gynecomastia patients.
No matter the cause, reducing male breasts from all types of gynecomastia is all done the SAME. Don’t spend a lot of time looking for the cause of your gynecomastia because you won’t find one. Just accept it is what it is and move on.
Does My Chest Look This Way Because It’s Just Fat? Do I Have Pseudogynecomastia?
It is very common for guys to think that they have gynecomastia because they are overweight. The extra weight they are carrying is in their chest area and that is why it looks so weird. You come across the term “pseudogynecomastia” that means “fake” gynecomastia. This is a fatty chest.
Truth be told, diet and weight loss will not make your gynecomastia go away. I wish it did. I believe the term pseudogynecomastia should not exist and I will go out on a limb and say that if a doctor truly believes that this condition exists they simply haven’t dealt with many gynecomastia patients. I have heard from thousands of men from all over the globe who have lost a ton of weight and they told me that it actually made things worse (their chest became more noticeable as a breast with weight loss).
By all means, if you are overweight and you think your condition will be better after weight loss I strongly encourage you to lose weight and see what happens. It’s always better to be at your best weight for general health reasons and the quality of your results will be better.
What Does Gynecomastia Look Like? How Do I Know If I Have Gynecomastia?
If you look at a normal male chest it is not round and nipples are small and flat. You can see the outline of the pectoralis muscle and when you flex it moves under the skin. Those patients with gynecomastia have a much different story. There is some tissue that has accumulated between the muscle and the skin. The chest starts to look more rounded and not linear. The nipples become puffy. You can feel a fair amount of tissue under the skin. You notice that you look like you have headlights when wearing tighter T shirts. You know something is going on but it creeps up on you. Subconsciously you start to shrug your shoulders forward and down because it makes your chest less noticeable. This is gynecomastia my friend. Often, what is showing is only the tip of the iceberg – there is much more tissue under the skin and muscle than what you can see.
How Is Gynecomastia Diagnosed?
Making a “diagnosis” of gynecomastia is done on visual inspection. I know it when I see it. If you are thinking you have gynecomastia, there is a 98% guarantee that you have it. No lab tests, x-rays, hormone levels or other tests are needed to make the diagnosis. There are rare cases of gynecomastia that is caused by a medical or medication issue and these are generally obvious to your doctor and additional investigation may be warranted. Remember, don’t panic if you know you have gynecomastia! It is harmless. You won’t get cancer. It’s treatable.
Why Is Gynecomastia Bad For You?
Gynecomastia is physically harmless. The problem is that it gets into your head and starts to consume your very being. My Gynecomastia Scale is my way of enhancing communication with my patients. It’s a simple scale of 1 through 10 with 1 meaning it doesn’t bother you and 10 indicating the worst situation. The goal of the male breast reduction is to fix your body and your head. True successful remedy is achieved only after you are better in the mind and the body.
What Is The Best Treatment For Gynecomastia
The gold standard cure for gynecomastia is surgery. Prescription, over the counter or internet sourced hormones and medications will not effectively treat established gynecomastia. Diet and exercise will not cure your gynecomastia because it is resistant to both. Trust me on this one my friends: you will be wasting your time and money attempting to treat your gynecomastia with non-surgical methods.
The full physical remedy of gynecomastia involves some form of liposuction and tissue removal. The liposuction is used to contour the fatty tissue while tissue removal is needed to remove the denser tissue that can’t be helped with liposuction alone. This tissue is always under the areolas and if it remains it will result in the gyno symptoms coming back.
Ultrasonic liposuction has a long history in the treatment of gynecomastia and has been shown to be of significant benefit over standard liposuction. Ultrasonic liposuction uses sound waves to dissolve the fat and works more efficiently in the removal of the fibrofatty tissue associated with most gynecomastia cases. I’ve found that the Vaser shrinks gynecomastia gland by a factor of seven! The addition of the Ultrasonic Vaser system in my practice has revolutionized male breast reduction of all types, making the procedure smoother and more predictable with less pain and a shorter recovery.
Gyno surgery is straightforward, but requires great technical skill and artistry. Every case is different to some degree, challenging your surgeon to make appropriate adjustments and modifications so that the best result is realized.
Zone 0 or “ground zero” is the area immediately behind the nipple areola complex. This is almost always glandular tissue and is responsible for the puffy chest area seen in many men. This is illustrated in my “golf ball gynecomastia” video.
Zone 1 is the anterior chest area that is usually shaped like a horizontal ellipse. This Zone includes Zone 0 and is the most commonly affected area in gynecomastia and creates the breast like appearance. It obscures or rounds off the lower pectoral muscle area that is more masculine if it is flat and linear, which is the appearance after treatment.
Zone 2 is the area lateral to the chest and under the arm. This is never actually gynecomastia tissue but it is commonly full in patients and when treated, the results are far more impressive, smooth and masculine. This can extend up to under the armpit area and is a region that I treat to remove the fullness you feel when you move your arms at your side.
Zone 3 is the area just at the apex of the fold or crease of the armpit. This can be full of fat that bulges from the lateral border of the pectoralis muscle. After treatment, the muscle is linear, well-defined and sculpted.
Zone 4 is located below the fold at the bottom of the chest and is shaped like a banana. This is seen in about 10% of cases. It may be a part of a patient’s normal anatomy, but is also often associated with being overweight.
Zones 0 and 1 have true gynecomastia tissue present. Zones 2-4 only have fat and are included in my treatment as contouring to help you obtain the best, most symmetrical, natural-looking and masculine body.
Secondary Gynecomastia Procedure
A patient who has already had gynecomastia surgery may desire additional surgical procedure to resolve problems or complications. Because of my vast experience with gynecomastia, I am frequently asked to perform secondary gynecomastia removal, which are generally more challenging and complex but certainly fixable.
The most common reason why a patient has more than one gynecomastia procedure is because there wasn’t adequate tissue removal. It’s critical that your surgeon removes the right amount of tissue so the result is optimal. This skill comes with vast experience.
My approach to a secondary case is based on the findings after an evaluation. Additional liposuction or tissue removal can often improve things significantly. Scar release techniques, skin excision, fat grafting or internal flaps can all be helpful in selected cases. Patients are often told to wait up to 2 years to heal before any additional procedures are considered. However, I have found that I can offer a second procedure after around six months when the tissues are soft with little chance for changes with additional waiting.
Non-Surgical Remedies For Gynecomastia
Non-surgical remedies of gynecomastia is almost always unsuccessful. In most cases, their gynecomastia is established and nothing can change it. The internet is loaded with non-surgical solutions to gynecomastia because there are many gynecomastia sufferers out there who want a solution to this sensitive problem that doesn’t involve a surgical procedure. There is money to be made on this vulnerable group of consumers: the market will fill you with wonderful success stories, enticing photographs, great testimonials and provide you with hope. The reality of the situation is entirely different. As I’ve learned time and time again, gynecomastia will not go away without effective surgical procedure from a qualified and experienced gynecomastia surgeon.
When Is The Best Time To Consider A Male Breast Reduction?
Gynecomastia typically results from tissue that forms at puberty and fails to go away. If it has been present for over two years and it’s still there it isn’t going anywhere without treatment. It’s always best to treat gynecomastia before it starts to do permanent damage to your psyche. The longer it persists, the more dysfunctional behaviors you will learn. Life is too short to waste living with gynecomastia. You won’t wake up one day and it will be gone. You have to take the first step to cure. The sooner the better.
Austin Gynecomastia Center Innovations
Over the years, I have developed several surgical techniques that have withstood the test of time and have helped me immensely in keeping my procedures as complication-free as possible.
Vaser Ultrasonic Liposuction
Vaser liposuction is a new tool in my arsenal to treat gyno. Vaser ultrasonic liposuction is a machine that contours fat with ultrasonic (sound) energy. This is different from standard liposuction that uses a cannula (tube) attached to a suction machine. The incision is smaller and therefore any scar will be smaller. Using the Vaser technique, it is easier for me to perform the procedure reliably and consistently. I only need a few of the many instruments required with the open technique. I no longer need my specially designed retractors. There’s less impact on the body due to the reduced physical strain. There is less pain, bruising and swelling post operatively. In fact, the Vaser ultrasonic liposuction is so powerful that I rarely use the following innovations that I developed previously, though I’m always glad to have them in my roster.
Puffy nipples are the result of excess glandular tissue beneath the nipple-areola complex. In some cases, removal of all this tissue may result in a depression, or noticeable concavity. Leaving tissue behind, however, which is not uncommon with inexperienced surgeons, often results in recurrence of gyno because remaining tissue has a tendency to “clump” as a mass. The best way to get rid of puffy nipples once and for all is to use my waffle technique to break up the “spring” in the tissue. The result is a flat and even chest area.
Removal of the glandular tissue can result in a depression or divot, while leaving the tissue behind could result in residual fullness of the areola zones or puffy nipples: either scenario can result in dissatisfaction. In order to create an even contour and to support the overlying nipple-areola complexes, I like to create internal flaps with the normal tissue. I can often rotate this tissue and suture it to other areas of normal tissue so the tissue layer is even and smooth. The whole idea is to leave an even layer of normal tissue once the unwanted tissue has been removed.
In cases where a large gland is present and removed, there is what is called “dead space” afterwards. Blood or other bodily fluids will naturally fill this space during the healing process. This accumulation of fluid can cause some post-operative complications, such as hematomas or seromas. Left around for long enough, this fluid can cause “hard healing” leading to excess scarring and, at times, contour irregularities. Drains are often helpful but don’t work as well as suture closure of this dead space. The technique of quilting sutures has been used in other areas of plastic surgery with proven success, and is equally effective in male breast reduction.
In cases when there is a large amount of gynecomastia tissue, or when there is very loose skin after notable weight loss, I may use pleating sutures to help gather and redistribute the skin during the early healing phase. This has been proven to be very effective in achieving an even contour, even in the most complicated cases. It can even elevate the nipple areola complexes to a higher, more normal location. This comes in very handy when there is significant tissue sagging not uncommonly seen in weight loss patients or overweight men. The goal of the pleating suture is to move the skin to a better location and allow it to heal down to the deeper layer so it stays put at the ideal place. This may prevent the need for later skin removal with large scars.
This refers to the surgical technique of dissecting beneath the tissue to sever the attachments to the overlying skin. This allows the skin to spread out in a larger area during the healing phase, promoting an even, wrinkle-free, crease-free contour. Think of it as spreading out excess tissue in a larger area so it is more likely to lay flat as opposed to being bunched up with creases and folds.
Gynecomastia and Bodybuilding
The gynecomastia that occurs in body builders who use steroids or pro hormones is uniquely different. These men typically have very little body fat, and their gynecomastia is mostly firm, rubbery gland that is easily felt upon examination.
Bodybuilders often display puffy nipples and an odd shape to the chest, with the nipple-areola complex looking downwards and an area of fullness along the bottom of the muscle. Needless to say, this is a very disturbing feature to men who have spent an enormous amount of time and effort working their bodies to a state of strength and muscular definition.
The physiology of the development of breasts in body builders can be complex. However, as a simple explanation, the testosterone hormones or pro hormones are partly converted to estrogen (the female sex hormone), which can cause gynecomastia in some men. Pain in the area of glandular tissue is more common in these men. Pain indicates inflammation and irritation of the adjacent nerves. The chest area can be sensitive to touch and even something rubbing on the area can be quite painful. This pain often subsides with time as the tissue “burns out” and becomes less inflamed and more fibrotic.
These men have tough, well-localized glandular tissue that must be removed in its entirety. The gland can adhere to the overlying skin and to the underlying muscle. The goal is to remove as much of the gland as possible so that recurrence is uncommon even in those who continue to use hormones or pro hormones. These cases are often more challenging, as it is more difficult to work with the tissues after you remove a firm, adherent mass. The surrounding area needs to be contoured so the result is smooth and even.
Unfortunately, I can’t speak to the drugs or drug regimens designed to prevent or treat gynecomastia that are often used amongst body builders. There are no scientific studies that approve or disapprove of these drugs, or that attest to their safety. Please use good judgment when you are dealing with the unknown. If you want the best advice, I would seek the counsel of a real doctor and not the local “go to” guy in the gym.
What Type Of Anesthesia Is Best?
Appropriate anesthesia is a compliment to any surgical procedure. Local anesthesia is best suited for only the smallest of cases, usually limited to those who have a small amount of fullness in Zone 1. Adequate contouring means reduction of tissue down to the sensitive area of the pectoralis muscle. Treatment of Zones 2 and 3 is difficult without general anesthesia because of the proximity of the Zones to the abundant nerves under the arm.
It’s important that your experience not be traumatic or barbaric. Your surgeon needs the best opportunity to perform expert contouring, which can only be achieved if you are immobile and relaxed. What’s the benefit of avoiding adequate anesthesia if your result is not good? Why not have your procedure performed without pain or anxiety, once and for all? Patients who only choose local anesthesia often tell me they probably should have chosen IV sedation or general anesthesia. Most procedures take less than an hour and a half to complete. All my anesthesia services are provided by a very experienced board certified anesthesiologist who has the same attitude as mine: we don’t fool around when it comes to your health and safety, period.
The use of any form of anesthesia beyond local requires that you have a ride home after your procedure and that you have someone stay with you for 12 hours afterwards. Many of my out of town clients bring someone along to care for them, or seek a local caregiver who can stay with them.
What Is The Recovery Like After Gynecomastia Surgery?
The recovery from gynecomastia surgery is not that interesting. Pain and discomfort is mild to moderate. On a scale of one to ten, it would be about a 5 at most. If general or IV anesthesia is used, you will feel somewhat foggy the first few hours afterwards. I offer oral pain medications that are to be used for the first 1 to 2 days. Most men take a day or two off before returning to work and other normal daily activities. Most patients return to moderate exercise after seven to ten days. Mild tightness and discomfort will persist for up to four weeks.
Compression garments should be worn for two to four weeks to control swelling, provide support and facilitate skin retraction. I encourage all my patients to massage the treated area with their hands or a roller device to soften the scar tissue and help the skin lay out nicely. This should be done several times a day for 20 minutes or more starting 3 weeks after your procedure and working it for eight weeks or more if needed.
A plastic drain may be used after surgery to collect fluid and blood that tends to accumulate in the space formerly occupied by the tissue. The drains are removed after three to five days, depending on the amount of daily fluid accumulation. Drains are infrequently used in my practice because of I use techniques and technology, like Vaser liposuction and quilting sutures, which makes drains unnecessary.
It may take several months for the swelling to subside completely and for the tissues to soften or “relax.” Four to six weeks after the procedure, maximal scar formation can result in areas of firmness beneath the skin. This is normal. Massage helps to soften the scar, and if needed, small amounts of steroids are injected to soften the scar. The final position of the scar around the areola generally heals very well and won’t be visible to others, hence the beauty of the procedure.
Results are immediate. It should not have to take “months” for the swelling to go away for you to notice an improvement. The contour will be flatter, with no puffy nipples and with good muscular definition. Fullness of the lateral chest and underarms should be improved dramatically if these areas were full before treatment.
Not much is known about the psychological recovery from gynecomastia. There is no doubt that surgery helps tremendously, but the degree to which it helps depends on the individual. Some tell me it never crosses their mind again, while others say it’s a lot better but that they are not 100% over the trauma. I take photos of the excised tissue, and allow patients the opportunity to actually feel the removed tissue as well. Why? It’s simple. I’ve learned that men who suffered from gynecomastia often need a sense of “closure” and want to know that it was real and fortunately, gone forever. I am actively researching these psychological issues in the hopes that we can provide better solutions to this invisible aspect of gynecomastia. An abstract of my ongoing study Psychosocial Correlates of Idiopathic Gynecomastia in Young Males: Preliminary Findings From a Mixed-Methods Study has been just been published in the Journal of Adolescent Health.
Potential complications can be broken up into two categories: early and late.
Early complications include hematomas or blood collection in the area immediately after surgery, usually within 24 hours. This is noticed as increased chest size accompanied by pain and bloody drainage. Although not life threatening, hematomas require removal of the collection, because blood left under the skin can form scar tissue or become infected over time. If small, the hematoma can be removed in a simple office procedure, and if large, it may require a visit to the operating room. It should be known that a surgical drain does not prevent a hematoma. Physical activity may provoke hematoma formation, which is why I recommend that patients avoid any strenuous activities for 3 days.
Late complications include seroma formation, “hard healing,” contour irregularities and infections. A seroma is a collection of watery fluid on the chest. Some men are just prone to seroma formation. I have observed that the rate of seroma formation is more frequent in those who consume a lot of fluids after their procedure. Many believe that drinking a lot of fluid will help the healing process, but this is not the case for gynecomastia recovery. Restrict your fluid intake after surgery to what is normal: 6-8 glasses of water a day. Drink if you are thirsty. If your urine is darker you can use more fluids. If it is clear you need less fluid. A small seroma the size of a walnut will generally go away by itself, but larger seromas, which can interfere with the healing process, can be removed with a small needle aspiration. Seromas can and do recur in an unpredictable manner, which may require several visits until resolved.
“Hard healing” is a term used to describe excessive and unusual healing in the area treated. This is typically seen after the sixth to eighth weeks and is recognized as firmness of the tissues and palpable masses under the skin. The most common cause of this ‘over-healing’ is a patient’s unique healing response that is more aggressive than those of most others. Hard healers will have to be patient during the healing phase as time is their friend.
Options to reduce hard healing include massage, rolling techniques, steroid injections and sometimes, additional procedures to treat the actual scarring. This is the most unpredictable aspect of gynecomastia recovery and is the reason why I am a stickler about post-operative massaging of the chest and the use of the roller and compression garments.
Contour irregularities are caused by a variety of reasons. This is often related to the quality of your skin and how your surgeon performs the procedure. Excessive tissue removal may result in a depression while inadequate removal may result in excess fullness. “Recurrence” of gynecomastia is uncommon in an expert’s hands as it is often the result of undertreatment (not removing enough tissue and leaving gland under the nipple-areola complex.) After the swelling of surgery subsides weeks later, it then appears that a mass is still there. Treatment for recurrence requires a secondary procedure to remove this residual tissue. Recurrence is most likely to occur in those who have only had liposuction to treat their gynecomastia without tissue removal.
In experienced hands, infection after a male breast reduction is uncommon, rendering post-surgery antibiotics unnecessary. Treatment of a rare infection would require a drainage procedure, antibiotics or both.
Loss of the nipple areola complex is unlikely in standard treatment, but is more common in complex cases involving skin removal and relocation of the nipple areola complexes. This procedure is typically left to the most experienced surgeons who have performed this multiple times and understand the dynamics of this procedure.
Loss of sensitivity in the nipple areola complex is common post-procedurally, but usually returns to normal after several months.
What Is The Psychology Of Gynecomastia?
The most important issue concerning gynecomastia is the lingering psychological scars from having to cope with it for many years. The stigma of having prominent breasts can lead to antisocial behavior, anxiety, self-hate, poor self-esteem, poor body image, and problems with interpersonal relationships. It’s real and I hear about it every day.
Defense mechanisms persist in men who have or had gynecomastia: wearing two shirts, taping the nipple areola complexes, being selective about what shirts to wear, not putting themselves into situations where they may have to expose their chests to others and slumping their shoulders. These are just a few behaviors adopted to avoid embarrassment. It often takes a lot of courage for these men to seek care.
The longer the condition persists without remedy, the greater the chance for psychological damage. This is the main reason I urge men to seek a male breast reduction procedure after an appropriate diagnosis has been made. I encourage all men who suffer from gynecomastia to seek evaluation as soon as possible. Put simply, if a mound in your breast area causes psychological distress, I would strongly recommend that you remove the source of distress. In my experience, the benefits far outweigh the risks of no treatment.
How Do We Evaluate An Out Of Town Patient?
Most of the men who visit the Austin Gynecomastia Center are from out of town. Yet another AGC innovation is our Virtual Consultation From Home. This allows you to show me what you have with pictures and tell me a bit about yourself and your medical history, all at no cost to you and in the privacy of your own home. Then, I will get back to you with my recommendation and an estimated fee for your procedure.
My Email Consultation is the ultimate in letting me review your case without a need to travel to Austin beforehand. Upload images of your areas of concern and I can evaluate your situation and make recommendations. It’s private, secure and free. I have been using Email for consultations for over two years now, and my patients absolutely love it.
Surgical removal of gynecomastia at the AGC is straightforward and has helped thousands from all over the world. Most cases take about an hour or so and the majority of them require anesthesia. Patients arrive the evening before their day of procedure and leave the day after their procedure. Follow up is by phone, email and Skype. In this manner, we have successfully treated hundreds of men from all over the world.
If you decide to start your journey with the AGC after your free consultation, it’s a simple trip to the great city of Austin, Texas and a brief stay for your procedure. Before you know it, you will be at home, back to your new life — a life without gynecomastia! There is no better place than the AGC to rid yourself of gynecomastia once and for all. You know you want it done, and you want it done right the first time.
The Austin Gynecomastia Center has been so successful because I am well versed in both the experiences of my patients and the art of gynecomastia surgery. Quite simply, we take great care of you. My staff of professionals all understand the unique nature of gynecomastia and they know how to make you feel comfortable and at home. You will know that you are in great hands.
Gynecomastia can often be like cancer in how it affects mentality. Patients are very anxious about their condition and all want the best result possible from the most experienced surgeon. I am truly honored and humbled to be able to practice my art on men who appreciate what I bring to the table. Beyond my technical skillset, I also have a strong desire to reduce fears and uncertainties with my personality and candor. The successful treatment of gynecomastia has been my most professionally rewarding procedure and is a constant reminder of my duty as a physician to help those in need.