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Gynecomastia Surgery

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Treating gynecomastia is possible and does require surgery. The surgery is referred to as male breast reduction and it is a procedure that Dr. Neavin performs regularly. At Artisan of Beauty, the technique and care that you receive are unparalleled. Dr. Neavin is one of the top rated gynecomastia surgeons in Los Angeles and specializes in treating gynecomastia through plastic surgery. And, he has a great deal of experience to guarantee you the best gynecomastia surgery results.

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While Dr. Neavin is world renown for his amazing results he is able to provide; he’s also one of the top surgeons for male surgery. Plastic surgery for men in Los Angeles & Beverly Hills has always been popular, and each year, the number of men who undergo surgery to enhance their appearance rises. Plenty of men feel self-conscious about their bodies and desire surgery to increase confidence in their image.

What is Gynecomastia?

Gynecomastia literally translates into “feminine breasts”. It may make a man feel terribly self-conscious about their appearance. It may interfere with intimacy or even manifest as avoidance behavior among peers. Gynecomastia, or enlarged male breast, is a common condition that may impair one’s ability to feel masculine.

Symptoms

When men have gynecomastia, the excess fat and tissue present detract from a sculpted chest and make the chest appear breast-like. While gynecomastia poses no physical health risk by itself, make no mistake – enlarged breasts can dramatically affect self-esteem.

Men seldom discuss their insecurities of their breasts with wives, family, or friends, and are more hesitant to see a doctor for such insecurities. If you suffer having gynecomastia, you may recognize such insecurities. You may be hesitant to be shirtless in public or fear to wear certain t-shirts that can expose your underlying breasts. You also may not feel entirely comfortable discussing your embarrassment with friends or family members. However, men with enlarged breasts is not uncommon and the feeling of embarrassment occurs very frequently in the adult population. You are not alone. In fact, studies have demonstrated that 30-60% of all men have enlarged breast size to some degree.

How Do Men Develop Gynecomastia?

Many causes of enlarged breasts in men are unknown. This is termed idiopathic gynecomastia. It may also be caused by imbalances of testosterone to estrogen marked by an increase in estrogen production, a decrease in androgen production, or a combination of this imbalance. Over representation of estrogen can result in fat deposition or gland development in greater than usual quantity in the breasts. When this happens in puberty, there can be an increase in the development of glandular breast tissue in the teenager. It may even spontaneously regress after puberty ends. In fact, up to two thirds of pubertal gynecomastia cases resolve within a couple of years of onset without medical treatment. In the large majority of cases, enlarged breasts exist since puberty

Tumors: Located in the brain, testicles, or adrenal glands. Specifically, Sertoli cell tumors, Leydig cell tumors, and cCG-secreting choriocarcinoma.
Steroids Induced Gynecomastia (and testosterone therapy)
Smoking marijuana (controversial etiology)
Excessive alcohol consumption can also cause gynecomastia
Renal Failure and Hyperthyroidism
Prescription Drugs
Liver Disease
Certain Herbs

The Components of Gynecomastia

The ideal male chest is typically flat and firm with very little projection from the nipple. Ideally, the pectoralis major muscle lateral and inferior border can be seen. Although weight may determine the size of the breasts, it doesn’t always contribute to excess fat and skin on the chest specifically. Thin men may have large breasts. And heavy men may possess no true signs. Male breasts may consist of any combination of excess fat, skin, or glandular tissue. With gynecomastia, the chest will appear overly abundant ranging from puffiness behind the nipple to total loss of muscle definition. One or both breasts will contain fat, glandular tissue or excess skin that make the breasts protrude from or sag away from the chest wall. In milder cases, it may be isolated behind the areola, or nipples may swell. In severe cases, the male chest can look very much like woman’s breasts.

Types of Gynecomastia

In simplest terms, gynecomstia is measured in 4 grades. Grade 1 is mild and Grade 4 is severe. Male breasts can be composed of fat, glandular, and skin elements. Pseudo-gynecomastia refers to a condition where the male breast is enlarged due to fat, not gland. This distinction is important only because it may guide the treatment. If the breast is truly just fat, liposuction alone can reduce it adequately. Once there is glandular elements present, glandular resection must be performed to reshape the chest. Liposuction will not remove glandular tissue. When we discuss gynecomastia surgery, the enlargement of the breasts is just one reason to seek treatment from a plastic surgeon. What determines whether or not on has gynecomastia really relies on the history, the presentation, and where the breasts sit on the bell curve for men. Your level of gynecomastia will determine what kind of surgery you will need. There are no reliable blood tests to determine if one has gynecomastia or to what extent their breast development is abnormal. In an attempt to apply order to diagnoses, a classification system has been developed by the American Society of Plastic Surgeons to help diagnosis and develop consistent treatment algorithms. This system employs 4 grades

Gynecomastia Grade Scale

Grade 1: A localized breast tissue growth behind the areola. This Grade is commonly seen in the athletic body. Anabolic steroids may contribute to this condition, which will require surgery to correct.

Grade 2: Moderate breast enlargement that exceed the areola boundaries

Grade 3: Moderate breast enlargement that exceed the areola boundaries with skin redundancy

Grade 4: Marked breast enlargement with skin redundancy and feminization of the breast

Male Breast Reduction Details

The key to successful gynecomastia surgery is for the gyneocmastia surgeon to customize the procedure specifically to one’s chest. As mentioned, male breast enlargement can range from mild to severe, and may include any number of tissue abnormalities such as gland, skin, and fat. The tissues playing a role in the misshaped breast must be addressed appropriately for optimal correction.

Liposuction alone will correct the deformity. However, in truth this is rarely the scenario. Most of the time when excess fat on the breast is present, there is also glandular overgrowth. A common mistake inexperienced surgeons make is assuming that that liposuction alone will reduce the breast adequately. What often occurs is a rather good volume decompression with residual firmness or swelling behind the areola. A subsequent glandular excision is required to create a flat chest. Below are markings for a mild case of gynecomastia.  As you can see, the surgery must extend beyond the gland to achieve the best possible results.

In either case, the procedure starts with the injection of local anesthesia and large volumes of tumescence, which is a combination of salt water, lidocaine, and epinephrine. Sodium bicarbonate may also be added to reduce some of the discomfort with injection when performed under local anesthesia. If liposuction alone is performed, two access sites will be incised, each approximately one centimeter in length. The location of these incisions will be placed on the border of the areola to help camouflage the scar, and the lateral chest wall. With two access points for liposuction, a more uniform result can be achieved. Liposuction will performed from deeper to more superficial using both access sites for crosshatching. The breast, as well as the lateral, superior,and inferior chest walls will be contoured to blend the tissue reduction and aid in skin tightening.

At the completion of liposuction, the incisions are closed with a single stitch.  Often, the incision around the areola is extended from approximately three o’clock to nine o’clock to perform gland excision under direct vision.  Glandular tissue will be excised carefully, as too much reduction of tissue can lead to deformities which are very difficult to correct. It is far more preferred to leave too much than to remove too much. Small, secondary gland reductions can be performed quite easily in the office under local anesthesia if necessary down the road. Adding volume to a deformity is much more complex with less predictable outcomes. In many cases with glandular excision, drains will be placed temporarily. Drains can be easily concealed under clothes. They generally remain for a few days and are painlessly removed in the office. The purpose of drains is to reduce fluid accumulation within the dead space from tissue excision. Fluid that is not drained can prolong swelling and lead to the formation of a seroma, a fluid collection that may need to be drained in the office. Undrained seromas may become infected or harden resulting in an irregularity of the chest wall.

Recovery from Male Breast Reduction

Gynecomastia surgery is outpatient surgery meaning patients can go home the same day after surgery. Following your gyno procedure, the downtime will be proportional to the extent of surgery, with cases involving skin excision being the longest course. Generally speaking, one can return to a desk job within three to five days. Strenuous exercise should be avoided for three weeks post surgery. Vitally important is the use of a compression vest. A vest should be worn for a minimum of 4 weeks post gynecomastia surgery to allow the tissues to tighten and reduce potential space for fluid collection. Vests can be worn under normal clothes. Patients may remove the vests for showering, but should wear the vests all other times.

What is the average cost of Male Breast Reduction in Los Angeles

There are a number of factors that determine the cost of the surgery. During your consultation, Dr. Neavin will go through what may or may not need to be done in order to achieve the best results. At your consultation, you will be given the cost of the surgery. In most cases, the cost of the surgery is in the average of $10,500 – $13,000.

Schedule Your Consultation

If you would like to find out whether male breast reduction surgery is right for you, contact Artisan of Beauty© by calling 310-858-8811 or texting 323-975-1287 and schedule a complimentary consultation with board certified surgeon Dr. Neavin at his Los Angeles location.

FAQ

What is gynecomastia?

Gynecomastia is the growth of abnormally large breasts in males, due to the excess growth of breast tissue. Often, fatty tissue accompanies gynecomastia. It is important to note that every man has breast tissue, so its presence is not abnormal or pathological. However, it is the amount of breast tissue that is considered when evaluating normal versus abnormal.
Gynecomastia is NOT cancer. Gynecomastia is the most common reason for a medical evaluation of the male breast.
Medical treatment of gynecomastia that has persisted beyond a year is often ineffective and surgical removal of the excess tissue is usually required. However, medications such as aromatase inhibitors have been found to be effective in some cases. Aromatase inhibitors are more likely to prevent progression of the condition rather than cause regression.

What are the classifications of gynecomastia?

Several classification systems have been adopted to describe the degree of gynecomastia. All of them focus on skin and the subcutaneous tissue (fat and breast tissue below the skin).
Grade I: Minor enlargement, no skin excess
Grade II: Moderate enlargement, no skin excess
Grade III: Moderate enlargement, skin excess
Grade IV: Marked enlargement, skin excess
The classification system is often utilized to guide treatments. As a rule, the higher the grade, the bigger the surgery when diet, exercise and medications don’t work.

What are the treatments for gynecomastia?

In mild cases of gynecomastia, diet, exercise, and observation are often employed first. While medications are available, they are rarely used. Their benefit is traditionally minimal. Selective estrogen receptor modulators such as tamoxifen may be beneficial in the treatment of gynecomastia but are not approved by the Food and Drug Administration for use in this condition. Aromatase inhibitors such as testolactone have been approved for the treatment of gynecomastia in children and adolescents. Tamoxifen may be used for painful gynecomastia in adults.
Often, surgery is necessary to correct the gynecomastia. Depending on the degree of development and skin excess, surgery may involve any combination of liposuction, breast excision, and skin excision.
Most cases of gynecomastia are managed with aggressive liposuction in combination with glandular excision. Rarely is it necessary to excise skin. In the cases where skin is excised, it is often in the background of massive weight loss. In this particular population, the gynecomastia is mainly a skin issue, not true breast development.
In patients with very good skin elasticity (generally, the younger the patient, the more elasticity), even cases with skin redundancy may be able to avoid skin excision (which requires more incisions and larger scars). The skin in men with good elasticity has the propensity to contract and tighten over the course of weeks to months.
The goal for liposuction in gynecomastia is to remove the fat in the breast and blend that contour into the chest to provide a natural, smooth looking result. This requires one or two small incisions for the liposuction cannula. The incisions are placed in areas that are well hidden, such as in the armpit.
Liposuciton does NOT remove breast tissue. This is important to understand. If there is true breast enlargement and not just fat, glandular excision is required in addition to the liposuction. In MOST cases, this is the rule. Men who have large breasts typically have both fat AND breast tissue. This is in contrast to the massive weight loss person who has mainly a skin issue.

Where are the incisions in gynecomastia surgery?

The liposuction incisions, which are about 1 cm, are hidden under the arm or breast fold. The most common incision to excise breast tissue is the 3 to 9 o’clock incision around the areola (green). Here, the incision is camouflaged well between the border of lighter skin and areaola.
In cases where skin needs to be excised, incisions may need to be placed completely around the areola and/or fold of the breast (white and red, respectively). There is no need to have a vertical scar on the male chest in nearly all cases (as opposed to the incision pattern we see for female breast reduction). The vertical scar in women is a result of excising skin to project the breast. In men, we want to reduce breast projection.

What is the downtime for gynecomastia?

Gynecomastia surgery is a surface operation. All of the surgery is focused above the muscles and bones. Thus, downtime is minimal. One should take it easy for at least one week. While daily activities such as walking, and driving (once off narcotics) are usually fine, there is still room for complications. If heart rate or blood pressure increase from strenuous exercise, bleeding can develop. Not life-threatening bleeding, but the complication still requires aspiration in the office or operating room. More common than bleeding is seroma and scar tethering, where the areola adheres onto the muscle.

What are the complications of gynecomastia surgery?

Seroma is the accumulation of fluid under the skin. Often, seromas will reabsorb, but when they don’t, aspiration is generally performed in our office. Under local anesthesia, a small needle is placed under the skin and into the pocket of fluid so it can be removed. This is why drains are usually placed during surgery. Drains collect the fluid that would normally accumulate. The drains that are placed are usually removed in the office within a week following surgery. This is an easy, painless process that takes just a couple of minutes to complete.
Scar tethering is when the areola tissue adheres to the muscle during healing and creates a slight depression. This is generally not obvious and often gets better with time. To improve or correct this if it is visible, steroid injections or fat grafting in the office can be performed.
The complete healing process for gynecomastia surgery ranges from weeks to months. A tight vest will be worn for four weeks. This allows the tissues to heal and contract uniformly and helps prevent seroma formation. It may take six weeks or more for the skin to tighten. If skin fails to tighten , small skin excision can be performed in the office under local anesthesia. However, this is rare.

Does insurance cover gynecomastia surgery?

Because gynecomastia is not considered a signficant medical condition, health insurance will not cover the surgery. If the gynecomastia is excessively large, or if the loose skin is causing recurrent rashes, insurance MAY cover the surgery. However, covering the surgery often means coverage for just a portion of the costs. Most offices will not try to obtain authorization for the surgery because authorization doesn’t mean a reimbursement for the procedure.
Gynecomastia is a difficult condition that can lead to substantial loss of self-esteem. If you are struggling with this problem, help is available. Contact Artisan of Beauty Plastic Surgery today at 310‑858‑8811 to find out if gynecomastia surgery is the right choice for you.