Before And After Photos
This man had a history of previous liposuction to treat idiopathic gynecomastia (unknown cause). This was done elsewhere. He complained to me of fullness on both sides of his chest. On my examination, I can easily appreciate dense, rubbery tissue beneath each areola. I suggested removal of the tissue through an incision around the areola.
He is seen here about two years after gynecomastia surgery. You can also see the mass that I removed from his chest. This was breast tissue and some scar tissue. He showed up in the office after two years wanting to know if the small wave of skin on the lateral side of his areola on the right side was normal. He noticed this when he flexed his muscle. I told him it was. In fact, I have photos of him flexing before and after the surgery and it’s the same.
Lessons to learn:
- You have to be careful when you have gynecomastia treated with liposuction alone. This is a very helpful procedure and the benefits are real, BUT, after it heals up and the swelling goes away patients often can appreciate fullness under their areolas as there is some gland present or, even if there is little to no gland, the fibrous network that is intertwined with the fat remains and often condenses under the areola and presents as fullness (puffy nipples). Liposuction removes the fat, but not gland and fibrous tissue.
- I often use a two pronged attack against gynecomastia – contour the fat with liposuction and removed the gland/fibrous tissue with direct excision or the cartilage shaver.
- Recurrence of gynecomastia is rare. I have seen one case from my own hands recently. I went back and removed a significant amount of glandular tissue that “grew” over two years’ time. This man probably had very sensitive hormone receptors on the small amount of gland that I sometimes leave under the areola for support. If this is completely removed, the areola can cave in a bit. I use my “turnover” flap to provide fullness under the areola if I plan to remove all the gland under the areola.
- This patient works out a lot and stares at himself in the mirror. Some men are really not sure what is normal and what isn’t when they have dealt with gynecomastia. He simply needed to hear it from me that everything is normal. It’s important to understand and accept a simple fact of reality when considering gynecomastia; when tissue is removed on the chest, the area will appear different (that is why we are doing it to begin with!) Since gynecomastia patients may be a bit off with their analysis of “normal” in many cases, there is an adjustment period to the new you. Embrace it.
- Would you rather have all the glandular tissue removed with the chance of a minor depression or would you prefer that tissue is left so the contour is without a minor depression? What if you can feel this tissue six months later after the swelling is resolved? Most patients would rather have their cake and eat it too. Therefore, I try to remove all the gland and leave the contour as even as possible. This is the “artwork” associated with gynecomastia surgery.