Gynecomastia is a medical term that comes from the Greek words for “women-like breasts.” Though this oddly named condition is rarely talked about, it is actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.
For men who feel self-conscious about their appearance, breast-reduction surgery (also known as subcutaneous mastectomy) can help. The procedure removes fat and/or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer and better contoured.
Left: Many men have gynecomastia — enlarged, female-like breasts–causes by excess glandular tissue or fat (or both).
Right: Glandular tissue must be cut out, usually through a small incision near the edge of the areola.
Left: Fatty tissue can be removed by liposuction. A small, hollow tube is inserted through a tiny incision, leaving a nearly imperceptible scar.
Right: Following surgery for gynecomastia, the patient has a more masculine chest contour.
If the enlarged breast consists of mostly fatty tissue, an excellent option is liposuction. This can be done by using small incisions for the introduction of a cannula to do the suctioning.
If the enlarged breast consists mostly of glandular tissue, which is more fibrous and solid than fat, excision of the gland is needed, because liposuction cannot be used for this. The surgical approach to the enlarged gland is through an incision that follows the lower border of the areola, generally from 3 o’clock to 9 o”clock.
Most men have a combination of fat and gland, and often both approaches are used. In this situation, liposuction is generally done first, and the breast is only opened if too much tissue still remains after liposuction.
Male breast reduction refers both to the use of liposuction and/or excision of the gland. Liposuction is the easier and less expensive approach because it can be performed in about one hour. Excision of the breast gland often takes 2 to 3 hours. Infrequently, only one breast is involved with gynecomastia.
During your consultation, the breasts are examined to determine the proportion of fat to gland. Often it is difficult to know ahead of time the amount of fat versus gland because gland is mixed in with fat, and the entire breast feels uniform on examination. Therefore, both options of liposuction and subcutaneous mastectomy are presented to the patient, with the understanding that the amount of surgery needed will be determined during the operation.
An additional challenge to gynecomastia surgery is the emotional overlay that is present for most men. Because gynecomastia is a source of considerable embarrassment for many men, patients often insist on being as flat as possible. This is difficult for the surgeon for a number of reasons. Most men have some breast development and excessive flatness does not look natural. In addition, most men have fat below the collarbone and to the sides of the breasts.
Excessive removal of the breast will cause this area to be “collapsed” (depressed) in contrast to the surrounding tissue. Further, the skin of the breast has been stretched out, and may not contract adequately after the surgery causing some degree of breast hang, often associated with inversion of the nipple and areola. Therefore, the surgeon tries to create a balance of removing the proper amount of tissue that will not create a secondary deformity, yet enough removal of breast tissue to satisfy the patient. It is very important for the patient to understand these challenges in performing male breast reduction to avoid unrealistic expectations and disappointment with the surgical outcome. We often see our patients 2-3 times to be sure the patient understands how the surgical challenges may differ from their expectations.