This is a case of a young man who presented to my office for help with gynecomastia that he says he has suffered with since puberty. On a scale of 1-10, where 10 was the worst, he says he has a “13”! He has a history of anxiety and depression and the condition runs in his family. With all that he has to deal with, his gynecomastia doesn’t help at all.
On examination, he indeed has the round appearance of breasts, also known as gynecomastia, and a clear candidate for gynecomastia surgery. He is about 10 pounds overweight, is relatively muscular and in good shape. He has well localized, dense tissue palpable in an elliptical shape at the level of his nipple-areola complexes. He does not have “puffy” nipples as some men do. He has very significant thoracic (rib cage) asymmetries on examination (his ribs project more on one side of his chest than the other).
He is seen here about nine months from gynecomastia treatment with surgical removal of the tissue alone through an incision along the lower half of his areola. No liposuction was performed. About 85 grams of dense breast tissue was removed from each side – essentially a mastectomy was performed (breast removal).
He says he is very happy with his results. He says it now is a 3 out of 10 on the “gynecomastia scale”. He is able to appreciate his chest wall and rib asymmetries now that this tissue has been removed.
Aggressive treatment of gynecomastia so that all of the tissue is removed can result in significant flattening of the chest area. Although this is perfectly ok for some patients, others may find this concerning. For this reason, it’s important for a patient to express to there surgeon that they will accept that some fullness will remain after surgery so that the outcome appears more natural. This is an important point to consider because some patients “want it all gone” while others want a more contoured or conservative approach, with results that more closely approach “normal”. The big problem with many gynecomastia patients is that many don’t know what is “normal”. Finding the right balance in the individual patient is my overriding goal.
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