This is an obvious concern for most patients – what are the results after gynecomastia treatment. In describing treatment outcomes, I always say that gynecomastia is like a sandwich: the bread slices are the skin on the top and the muscle below, and the gynecomastia is the meat in between. Successful treatment of gynecomastia means removing as much of the meat as possible and contouring the appropriate Zones of the chest, leaving a nice smooth layer of normal fatty tissue so that the chest looks masculine and angular.
The final result is most affected by the following three key factors:
- The amount of tissue removed.
- The amount of tissue that remains.
- The underlying anatomy of your pectoral muscle and ribs below
If your surgeon doesn’t remove enough tissue you simply won’t see much of a difference. If too much tissue is removed, it could look over done and the skin could collapse. If your pectoral muscle is round and big, that is what you will see after treatment. In many cases, patients don’t even know what their natural chest looks like because they have had gynecomastia since puberty.
Significant secondary factors that can influence your result are:
- The quality of your skin.
- Ptosis (sagging) of the chest area.
- Tubular-shaped breasts with large areolas.
- How your body heals in response to surgery.
Skin quality is everything. Good quality skin has a thick dermal layer and good elasticity, meaning skin retracts easily when stretched like a rubber band. After removal of gynecomastia tissue, quality skin retracts nicely and molds to the shape of your muscle and ribs. Poor skin quality and elasticity results in a saggy chest. This is most commonly found in patients who have experienced large weight change. Some patients simply have less elastic skin because of their genetics.
Patients with tubular breast condition have narrow, pointed breasts and enlarged areolas that are dome-shaped because of tissue herniation into the areola. It’s certainly an unusual sight, and can be a huge source of discomfort or embarrassment.
How a patient heals after treatment is also very important in determining the final result. Uneventful healing means everything proceeds in the desired manner without any drama. Issues like hematoma (blood collection), seroma (fluid collection) and hard healing can mar the results, causing lumps and bumps and persistent fullness of the chest because of scar tissue build up. Hard healers are patients who are prone to aggressive scarring, which can cause contour irregularities and induration (hardening of the tissues) that can last for many months.
The Austin Gynecomastia Center Zone Classification System is designed to ensure appropriate treatment to all the areas of the chest as an aesthetic unit so the results are natural, balanced and truly flattering. For example, treatment of Zone 1 only (up front and the area that has the actual gynecomastia tissue) without addressing fullness under the arms and in the lateral chest areas (Zones 2 and 3) will result in an unbalanced odd appearance that isn’t flattering.
For many gynecomastia patients, having chest fullness for 20 years and obsessing about it affects one’s perception of normalcy. It takes time to adjust to the “new you,” as your brain programs itself to accept the new appearance as something that fits your body image and ideal. Body Dysmorphia Disorder (BDD) is a mental illness in which patients are obsessively focused on a perceived flaw in appearance. Patients with BDD may never fully accept their result and may continue to obsess about some perceived imperfection.
Barring an unsatisfactory result, it’s important to own your result fully. Appropriate treatment will provide you with a new contour without the puffy nipples and the female-looking chest. You should recognize that your gynecomastia is gone and your chest is now normal in appearance, looking just the way it should, based on your anatomy.
So there you have it. After decades of working with gynecomastia patients, this is my understanding of how things appear after treatment and the issues involved in the healing process, both physically and mentally.