Gynecomastia, aka ‘man boobs’ as it is frequently called by patients seeking treatment options, is the presence of breast tissue in men. It is very common and we treat many patients for gynecomastia. Men with gynecomastia can be very self-conscious about their chest contour and it can poorly impact confidence. It can become especially bothersome in warmer weather months when men go shirtless and/or wear thin shirts, as it becomes more difficult to conceal under layers of clothing. The good news is gynecomastia is treatable with surgery and patients are generally very happy with results.
Gynecomastia is a proliferation of breast tissue, including ducts and glands, and usually presents itself as a firm mass (ie something like a grape or flattened golf ball size). It is usually confined to the area just deep to the areola, and can often be tender or painful. Gynecomastia needs to be differentiated from pseudo gynecomastia, which commonly exists in combination with gynecomastia, but can also exist as the sole diagnosis. Pseudogynecomastia is more diffuse or generalized excess fatty tissue affecting the male chest wall, but does not technically consist of breast glandular tissue.
This distinction is important to make because the appropriate surgical procedure depends on the presence of either diagnosis or a combination of both diagnoses. Pseudogynecomastia responds well to liposuction of the chest wall, whereas gynecomastia is more resistant to liposuction and more often requires direct excision of the glandular tissue.
The other major consideration when evaluating a patient with gynecomastia is whether there is associated excess skin of the chest wall. If there is excess skin, or there will be excess skin after removal of larger amounts of underlying breast or fatty tissue, skin excision will likely be required.
Thus, the best surgical treatment of gynecomastia depends on the presence of firm nodular component, diffuse fatty component, or both, and any presence of excess skin. When discussing surgical treatment with patients, probably the most common question is, ‘what will the scars look like?’
If a patient only has pseudo gynecomastia and minimal to no excess skin, often liposuction alone is a very good treatment option, and can be done through several small (<1 cm) incisions, which are very inconspicuous after healing. If a patient has gynecomastia with only firm, subareolar masses, minimal excess generalized fat, and little to no excess skin, then direct excision alone is the best option, usually accomplished with a semicircular incision around the areola (occasionally with a short transverse extension to one side or the other). This incision also is relatively inconspicuous as it is placed at the color transition between the darker areola skin and the chest wall skin. In patients who have both generalized chest wall fat and a firm glandular component, a combination of liposuction and direct excision is used.
When there is excess skin that needs to be addressed, the incision will be longer to allow for removal of skin, and is usually placed below the areola, transversely, along the lower border of the pectoralis major muscle. This incision is a little more noticeable, but patients are generally very happy to trade in the improvement in chest contour for the scar.
Recovery from gynecomastia surgery depends on the exact surgical procedure that is performed, but in general most patients are back to their usual activities within a week. Heavy lifting or more strenuous activities are usually delayed for four to eight weeks, again, depending on the exact surgical procedure performed. In most cases, a compressive vest garment will be recommended for one to two months post-op, and if there is a large skin excision involved, drainage tubes may be used for one to two weeks.
TAKING THE NEXT STEP
Visit our Body Contouring page for more information from our surgeons. We’re here to help when you’re ready. Rest assured, our plastic surgeons have performed hundreds of male body contouring surgeries and respect your privacy. In your initial consultation, our physicians will help you to feel at ease and confident in your decision. Request a complimentary cosmetic consultation online or call (402) 307-6902 or (800) 331-5001 today.
References: ‘Gynecomastia.’ George Ansstas, MD. Medscape: https://emedicine.medscape.com/article/120858-overview. George Griffing, MD ed. Apr 26, 2020.