Gynecomastia Beverly Hills

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Description

Gynecomastia is the growth of abnormally large breasts in males, as a result of the production of excess breast tissue, not excess fat tissue.  For that reason, this condition cannot be alleviated through diet and exercise alone. According to the American Society of Plastic Surgeons (ASPS), gynecomastia accounts for more than 65 percent of all male breast disorders.  Although not considered a serious medical problem, gynecomastia can be emotionally painful and potentially embarrassing for men of all ages. Fortunately, advances in surgical technology have enabled men to take back control of their aesthetic appearance, and to correct the condition of enlarged breasts through surgery. Male breast reduction surgery is the fifth most common plastic surgery procedure performed on men in the United States, and can be a lift-altering and confidence-inspiring surgery. At Gabbay Plastic Surgery, located in Beverly Hills, CA, Dr. Joubin Gabbay M.D. is highly experienced performing male breast reduction surgery as a permanent solution for the condition of gynecomastia, and will work tirelessly to ensure that your male breast reduction goals are brought to fruition.

Options

Dr. Gabbay understands that all patients have very specific and unique surgical needs and goals, and will specifically tailor your male breast reduction surgery to fulfill your aesthetic objectives.  During your comprehensive initial consultation, Dr. Gabbay will discuss all of the gynecomastia surgical options, and recommend the procedural techniques he feels are best suited to your particular case.

There are numerous physical and emotional benefits to having a successful male breast reduction surgery, including a firmer, flatter, and more contoured chest, and increased levels of self-confidence and self-esteem. Your surgical results will be permanent, barring substantial post-surgical weight gain, which can create a gynecomastia-like effect.  Dr. Gabbay is an expert in the surgical treatment of gynecomastia, and has helped many male patients suffering from gynecomastia. If you have any questions about gynecomastia treatment, please contact Gabbay Plastic Surgery today. We look forward to speaking with you and to setting up your complimentary, initial consultation with Dr. Gabbay.

What is A Normal Breast Size?

The breast mass that provides responsible for the contour of a man’s chest consists of a combination of fat, skin, muscle, and stromal (glandular) tissue. The shape and proportions of the male breast gland may vary between breasts, and gynecomastia (male breast enlargement) is a condition where enlargement of one or both breasts may reach abnormally large proportions. Although proper exercise and diet can improve the muscular tone of the chest, they cannot reduce the amount of glandular tissue in the breasts, and therefore, cannot change the condition of gynecomastia. An exception to this rule is the condition of pseudo-gynecomastia, where male breasts increase in size in conjunction with weight gain. In this case, the breast enlargement results from excess fatty tissue, not excess glandular tissue, and the condition may be corrected through weight loss.

Some studies have indicated that hormonal imbalances are one of the primary causes of gynecomastia, and that low testosterone or high estrogen levels may lead to the development of “female-like” breast tissue or gynecomastia.  This may happen in young men undergoing puberty. Among older men, testosterone levels naturally decrease with age, which can also lead to gynecomastia. 

Certain drugs and medications can also contribute to the condition of enlarged breasts in men:

  • Anti-androgens used to treat prostate enlargement or cancer
  • AIDS medications
  • Anti-anxiety medications
  • Tricyclic antidepressants
  • Antibiotics
  • Ulcer medications
  • Cancer treatments
  • Heart medications
  • Medications containing estrogen
  • Alcohol
  • Marijuana
  • Anabolic steroids
  • Amphetamines
  • Heroin
  • Chemotherapeutic agents such as: alkylating agents, vincristine, methotrexate, nitrosoureas, cisplatin, and imatinib
  • Ketaconazole
  • Spironolactone
  • Finasteride and dutasteride
  • Flutamide
  • Cimetidine
  • Isoniazid
  • Digoxin
  • Medications that block estrogen: tamoxifen, raloxifene and clomiphene
  • Medications that decrease estrogen production: aromatase inhibitors such as testolactone and anastrazole

The following illnesses may also lead to gynecomastia:

  • Cancer
  • Kidney failure
  • Liver failure and cirrhosis
  • Malnutrition (may cause testosterone levels to drop while estrogen levels remain constant, creating a hormonal imbalance)
  • HIV/AIDS
  • Diabetes
  • Hypogonadism, Klinefelter Syndrome or pituitary insufficiency
  • Tumors of the testes, adrenal glands, or pituitary gland
  • Hyperthyroidism

Anatomy of The Male Breast

Anatomically, the adult breast sits atop the pectoralis muscle (the chest muscle) on top of the ribcage, and the breast tissue extends from side-to-side (horizontally) from the edge of the sternum (flat bone in the middle of the chest) out to the mid-axillary line or the center of the axilla (under arm).  A thin layer of connective tissue (fascia) encircles the breast tissue, and the deep layer fascia sits on top of the pectoralis muscle, while the superficial layer sits under the skin. The skin covering the breast consists of sweat glands and hair follicles, and the blood supply from the breast comes primarily from the internal mammary artery, which runs underneath the main breast tissue. The blood supply provides nutrients such as oxygen to the breast tissue, and the lymphatic vessels of the breast flow in the opposite direction of the blood supply and drain into the lymph nodes.

The structure of the male breast is similar to that of the female breast, other than the fact that the male breast tissue lacks the specialized lobules required for milk production.

The anatomy of male breast includes:

  • Nipple—The nipple can lie flat or protrude from the areola
  • Areola—The pigmented area around the nipple
  • Fat—Excess fatty tissue may give the appearance of gynecomastia
  • Gland—Tissue located just behind the nipple and areola

Indications

Men of any age with enlarged breasts can consider gynecomastia surgery, as long as their breast development has stabilized, and they have realistic expectations about what the procedure can and cannot accomplish.  A candidate for gynecomastia must be healthy emotionally as well as physically, and the procedure may be discouraged if a patient is overweight, because the surgery is most successful for men with firm, elastic skin that will reshape to the body’s new contours.

Evaluation

During your initial consultation at Gabbay Plastic Surgery, Dr. Gabbay will determine if you are a good candidate for a male breast reduction. Your evaluation will entail a detailed medical history including any previous conditions and surgeries that you may have had. Dr. Gabbay will inquire about the medications you are currently taking including, your alcohol consumption, any use of marijuana or anabolic steroids, and whether you smoke or not.

Dr. Gabbay will examine your chest and check for any physical causes of your gynecomastia, such as impaired liver function or testicular tumors.  If a medical problem is a suspected cause, you will be referred to an appropriate specialist, because your health and safety is of utmost importance, and additional evaluations may be necessary before proceeding with breast reduction surgery.  If it is determined that you are a candidate for gynecomastia, Dr. Gabbay will educate you about the procedure and explain its limitations and risks.  In some cases (as in puberty related gynecomastia), Dr. Gabbay will recommend a course of watchful waiting to see if the condition improves on its own.  Based on factors including your quality of skin tone and the composition of your breast tissue, Dr. Gabbay will then design a customized treatment plan to fulfill your aesthetic goals.

Option Details

In some cases, specifically those where excess fat is the major cause of gynecomastia, liposuction alone may be able reduce the breast volume. However, for many gynecomastia patients, excision or surgical removal of tissue and skin is required to achieve the desired results.  The incision methods will vary depending on the amount of tissue that has to be removed, and whether or not the nipple will need to be repositioned as well.  In some cases, the incision will encircle the nipple (allowing for the reduction of enlarged nipples). Dr. Gabbay understands that the breast gland and fat components differ greatly between each patient, and in some cases he will use a combination of excision and liposuction techniques to achieve the best outcome.

Procedure Details

Male breast reduction surgery typically takes 1-2 hours, and can be performed as an outpatient procedure using deep “twilight” sedation or general anesthesia (meaning you will be unaware and comfortable during your procedure).

Depending on your individual circumstances, the most common treatment for gynecomastia is liposuction combined with surgical gland excision. During this procedure, the incision is made either on the edge of the nipple (areola) or in the underarm area.  Dr. Gabbay will then remove the persistent, excess glandular tissue, fat, and skin from around the pigmented area surrounding the areola, and from the sides and bottom of the breast.  For patients with an excessive skin envelope or poor skin quality, a direct excision of the extra skin may be necessary, and would require larger incisions and more visible scars.

If liposuction is used to remove excess fat, a slim, hollow tube (cannula) attached to a vacuum pump will be inserted directly through the existing incisions and then utilized to suction out any excess fat. For liposuction-only breast reduction, Dr. Gabbay will make a half-inch incision around the edge of the areola or in the underarm area.  After your surgery, a small drain may be inserted through a separate incision to remove excess fluids. Your incisions will be covered with a dressing, and your chest will be wrapped to keep the skin firmly in place.

Recovery

After your male breast reduction surgery, you may experience mild to moderate discomfort, which can be alleviated with pain medication. You will feel tired and sore for the first 48-72 hours, and any swelling or bruising will subside over the next few weeks.  You will be given a compression garment that will help your chest to heal properly, and you should avoid reaching or lifting of any kind for at least one week. Full physical recovery may take up to six weeks and you should avoid direct exposure to the sun during this time, as this may cause permanent irregular pigmentation of your scars.  During your postoperative visits, Dr. Gabbay will review your progress, including your incision care, and will address any concerns or questions you may have about your recovery.

Any with any surgical procedure, certain risks or complications are involved and may include:

  • Infection
  • Adverse reaction to the anesthesia
  • Bleeding
  • Loss of sensation at the incision site
  • Fluid accumulation
  • Bruising
  • Swelling
  • Skin damage
  • Pigment changes

Frequently Asked Questions (FAQs)

What is gynecomastia?

Gynecomastia is a medical term that originates from the Greek words for “women-like” breasts and this condition affects over 50 percent of the male population in one or both breasts.

What causes gynecomastia?

The primary cause of gynecomastia is largely hormonal, as it usually starts to appear at puberty when hormone levels surge from the onset of physical maturity.  Testosterone develops male characteristics while estrogen brings on female traits, and low testosterone or high estrogen levels in males can cause the development of female-like breast tissue, or gynecomastia.  Although certain drugs such as anabolic steroids, medications containing estrogen, alcohol, marijuana, and certain medical conditions including cancer, impaired liver function, or thyroid issues may cause or contribute to enlarged male breasts: it is widely accepted that a large percentage of gynecomastia cases derive from hormonal issues or in some cases unknown sources.

How is breast reduction surgery performed?

During breast reduction surgery, an incision is made either on the edge of the nipple (areola) or in the underarm area allowing Dr. Gabbay to remove the excess glandular tissue, fat and skin from around the pigmented area surrounding the areola and from the sides and bottom of the breast.  Major reductions that involve the removal of a significant amount of tissue and skin, may require larger incisions and more visible scars.  Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions.

What is pseudogynecomastia?

Pseudogynecomastia makes the male breasts abnormally large, but it is not true gynecomastia. This is a condition in which fatty tissue is responsible for the enlargement seen mainly in men who have had significant weight gain, and it can be reversed with weight loss, if the skin has not been overly stretched.

What is scarring like from gynecomastia surgery?

There will be scarring around the nipple of the breast (areola) from this procedure, but any scars will fade over a period of time and become less visible.

Who is a good candidate for gynecomastia surgery?

Men of any age who are physically healthy and emotionally stable, are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours, and in some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.

What are the benefits of male breast reduction surgery?

The results of gynecomastia surgery are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest with little downtime enabling most patients to return to work within one week, unless strenuous activities are involved.

How long does male breast reduction take to perform?

The procedure for male breast reduction takes 1-2 hours, depending on the amount of glandular tissue, fat, and excess skin that needs to be removed.  Gynecomastia is typically performed on an outpatient basis using general or local anesthesia.

Is there any non-surgical treatment for gynecomastia?

Although you can read about easy, non-surgical cures in the news and advertisements, and there is considerable ongoing research aimed at finding a way to reverse it without surgery, no effective medical treatment exists at this time.

Can Liposuction be used alone for male breast reduction?

Male breast reduction surgery may be performed with liposuction, but in most cases it is not an adequate technique when used alone.   Removing the fat around the gland only can create an unnatural bulb, causing a “re-do” surgery in the future.

Will the entire gland be removed during the surgery?

Male breast reduction surgery for gynecomastia is a cosmetic procedure, and in most cases only enough gland is removed to create a flat, contoured chest. In extreme cases, sometimes excess has to be removed and this will be discussed and determined during your consultation with Dr. Gabbay.

Is male breast reduction surgery painful?

Pain tolerance is different for every patient, but generally gynecomastia reduction surgery is not particularly painful, and most men find they only need pain pills for 2-3 days.

Will the nipple sensation be lost after breast reduction surgery?

With any breast surgery, it is always possible to have a change in nipple sensation, and some patients report changes in sensation, while others do not experience any change at all.

What are the risks or complications from male reduction surgery?

Although rare, surgery complications can occur and include bleeding, infection, bruising, swelling, temporary numbness, lack of sensation, postoperative asymmetry, pigment changes, and fluid accumulation.