Gynecomastia: Plastic Surgery for Large Male Breast Correction

Gynecomastia can occur due to hormonal imbalance, with higher estrogen levels compared to the levels of testosterone in men. There are plenty of diseases and drugs that may cause gynecomastia. It may occur as side effects of some drugs, birth defects, obesity, excess alcohol intake, anabolic steroids, sagging skin due to weight loss, liver diseases, radiation effects, testicular problems amongst many others. A thorough hormonal and medical check-up is recommended in all cases to unveil underlying diseases or hormonal abnormalities.

Gynecomastia and male breast cancer have a strong association between them but do not have a cause-effect relationship. By itself, Gynecomastia is benign and does not cause cancer. For example, men with 'Klinefelter Syndrome' who have testicular failure after puberty, develop gynecomastia and have a 60 times higher risk to develop male breast cancer. Breast cancer occurs in male-to-female transgender individuals who undergo testes removal and high-dose estrogen injections. High risk of gynecomastia and male breast cancer also co-exist with high estrogen levels in men.

No. Gynecomastia consists of breast tissue directly under the nipple-areola complex, spreading outwards over the chest. While spreading, the breast gland joins and blends with fatty tissue all around it. The interlocking of fat and breast causes these two structures to blend together without any well-defined capsule or wall-like structure. They grow together and nourish each other. The presence of breast tissue leads to more fat deposition around it in the chest. With time, these fatty tissues get converted to breast tissues and increase breast gland volume. This cycle continues leading to an ever-increasing male breast volume over the years.

Men and young adults suffering from gynecomastia struggle both physically and emotionally. Most are ashamed of themselves and feel that 'they are less of a man'. They cannot wear body-hugging shirts or t-shirts or tight garments. They are reluctant to remove their shirts in public, go for a swim, participate in sports, or work-outs at the gym. While growing up, many become the butt of jokes of their colleagues, facing taunts, bullying, and physical abuse. Often it is associated with continuous embarrassment and severe emotional distress. Psychological depression occurs in many people, more so in sensitive boys and young men.

A male breast can be 'small', presenting as a small accumulation of excess breast tissue underneath the nipple-areola complex, also found as 'puffy nipples'. A male breast can be 'large', with full-scale development of breast tissues and surrounding large amounts of fat, appearing as a large pendulous feminine breast. They can also present as just about anything in between these two extremes. To help in surgical decision-making, a classification divides gynecomastia into three types, depending on whether the nipple-areola complex is above, at, or below the level of the inferior mammary fold (it is the line where breast tissues meet the chest wall).

Different options are available for gynecomastia surgery or male breast reduction. (1) Gynecomastia excision surgery alone. (2) Liposuction of chest wall alone. (3) Combination of Liposuction & Excision of gynecomastia. (4) Minimally Invasive Combination of Liposuction and Key-Hole Male Breast Reduction. (5) Large Male Breast Reduction with skin excision and bigger scars. (6) Full-fledged Male Breast Reduction with a method similar to reducing feminine breasts. The final treatment plan depends upon what you 'have', what is 'possible' for what you have, and what you ultimately 'want'. Each type of male breast reduction surgery has its own risks and benefits.

A good candidate for gynecomastia correction surgery or male breast reduction has the following attributes: (1) Men and young adults suffering from enlarged breast tissues with discomfort and pain. (2) Embarrassed and suffer severe emotional distress, feeling 'less of a man' due to this problem. (3) Otherwise in good physical and mental health with no major medical problems. (4) Tried to resolve his problem with diet and exercise, but did not succeed. (5) Has a realistic and reasonable expectations of outcome after a good consultation.

You will need to take the following precautions for achieving better results during your surgery:

(1) Blood-thinning medicines like aspirin, aspirin-like drugs, anti-inflammatory drugs, pain killers need to be stopped at least 2 weeks before surgery. (2) Smoking should be stopped 2 weeks before and 1 week after surgery. (3) Alcohol consumption has to stop at least 3 days, and preferably 1 week prior to surgery. (4) Herbal medicines, green tea, ginseng are also blood thinners and need to be stopped about 2 weeks before surgery.

Male breast reduction or gynecomastia surgery can be performed under local anesthesia with oral sedation, intravenous 'twilight' anesthesia, or general anesthesia. For limited gynecomastia excision, local anesthesia with oral sedation is usually sufficient. For large male breast reduction surgery for feminine like breasts, general anesthesia may be preferable. For almost all other cases, Dr. Srinjoy Saha prefers intravenous 'twilight' anesthesia. It is a sophisticated newer type of anesthesia that is most commonly performed. In this type, you will be sleeping gently deeply, and comfortably, with eyes closed, without pain, and without awareness of your surroundings or passage of time. You will be awake immediately after your surgery is over, without grogginess, nausea, hangover, or sore throat, but refreshed and alert.

Minimally invasive gynecomastia correction surgery is being increasingly demanded by young men presenting with their gynecomastia problems. It is a sophisticated modification of different techniques that have been proven to reduce male breasts without leaving any visible scars and a flat chest in a vast majority of patients. In this surgery, 'tumescent' fluid is prepared in normal saline by adding adrenaline (to reduce bleeding), lignocaine (to numb the area), and other medicines. It is injected in a special way into the chest region to make the breast glands and fatty tissues soft and easy to remove. Next, liposuction is performed through very small cuts (about 3 - 4 mm) in hidden areas of the chest and armpits. Dr. Srinjoy Saha uses fine specialized instruments for performing liposuction with the best results, wherein fat and some breast tissues are dissected and removed. Residual solid breast tissue directly underneath the nipple-areola complex is removed surgically. Peri-areolar incision is extended ever so slightly, to insert fine scissors and diathermy probe to dissect and remove remaining breast tissue under vision, directly and entirely. Adequate care is taken to prevent the formation of a 'crater' underneath the nipple-areola complex. Finally, the wound is closed with dissolvable sutures and taped from the outside. Drains are used only in very rare circumstances. Removed breast tissue is sent for histopathological examination or biopsy to confirm the presence or absence of gynecomastia, cancerous changes, or any other diseases.

In most cases, immediately after completion of male breast reduction or gynecomastia surgery, the chest looks trim, chiseled, and contoured. Any swelling usually disappears within a few days revealing the contour of the underlying pectoral muscles. Areolar diameter shrinks with time. Skin tightens gradually. Minimally invasive male breast reduction surgery achieves all these 'best possible result' changes through hidden small scars. This process has immensely helped many people desiring changes and deliverance from the misery of gynecomastia. It enables them to look forward to life anew with hope.

Immediately after surgery, there may be temporary swelling, bruising, and less-sensation in the nipple and lower chest areas. All of these go down in the next few days. Pain and discomfort in the chest disappear usually within the next 2 - 4 days and are adequately controlled with routine pain killers. Most are able to return to normal office work or school within 3 - 4 days. Compression garments need to be worn under clothes for about a month. Light exercises start after about 2 weeks. Heavy exercises and sports are usually recommended after 6 weeks. Complete healing occurs gradually and may take anywhere between 3 - 6 months.

Everything that is removed during your male breast reduction surgery is permanent. Breast gland and fatty tissues removed during surgery disappear from treated chest areas forever. If you gain some weight after surgery, fatty deposition generally happens in other parts of the body, where there are more fat cells. If you gain a lot of weight, some amount of that fat gain will be visible in the thin fat layer that remains after surgery on the chest wall, in accordance with fatty layer increase all over your body. However, it will never be as prominent or protuberant as it was with gynecomastia. Most importantly, once removed, breast tissues do not recur in the chest areas in men.

Impressive improvements in your chest contours are seen immediately following the surgery. They continue to evolve over the next six months, resulting in enviable chiseled chest contours, and something you can be proud of. Male breast reduction or gynecomastia surgery is extremely effective and has the best-proven track record of excellent patient satisfaction. The onus of maintaining all this good work finally lies with you. Eating a healthy balanced nutritious diet according to the prepared chart is a must. Adequate exercises every day, both stretch and strength, are helpful. Habit-forming drugs, alcohol abuse, smoking, and overeating need to be avoided at all costs.

Yes, of course! Revision male breast reduction or gynecomastia surgery is common, and many men come to Dr. Srinjoy Saha to achieve their dream chest contour after being disappointed by earlier surgery elsewhere.

Revisions are usually required for the following problems: (1) Irregular contours over the chest wall and around the nipple-areola complex. (2) Crater deformity underneath the nipple-areola complex. (3) Nipple problems - scars, loss of nipples. (4) Scars - visible, large, ugly looking scars over chest and nipples. (5) Skin laxity - chest skin not being tight and contoured enough. (6) Persistent pain following surgery. (7) Persistent numbness or loss of sensation following surgery.

Each case is individualized and treatment options would be outlined to you for your specific presenting problem. The most acceptable revision procedure for you would be performed to obtain the best results in your revision male breast reduction. Please note that while the best possible surgery can be performed, it will be impossible to guarantee the exact results afterward. To a significant extent, the results depend upon your body's response and we need to stay humble and hopeful.