GYNECOMASTIA, THE CONDITION OF OVERDEVELOPED OR ENLARGED BREASTS, IS COMMON IN MEN OF ANY AGE. It may be the result of hormonal changes, heredity, disease, or the use of certain drugs. Gynecomastia can be more than a physical problem - it can cause emotional discomfort and impair an adolescent or adult male's self-confidence. Some men may avoid certain physical activities and intimacy simply to hide their condition.

If you have gynecomastia, breast reduction surgery may be right for you. In general, gynecomastia can be surgically treated by removing excess fat, glandular tissue and/or skin. The result is a better proportioned, more masculine contoured upper body and the freedom and self-confidence to lead an active life.

This brochure presents an overview of breast reduction for men. The best way to learn how correction of gynecomastia can help fulfill your personal goals is a consultation with a plastic surgeon certified by The American Board of Plastic Surgery® or The Royal College of Physician and Surgeons of Canada®.

What gynecomastia?

Gynecomastia is the condition of enlarged or over-developed breasts that are disproportionate to a man's body. Plastic surgery to improve gynecomastia is technically called reduction mammaplasty, and reduces breast size, flattening and enhancing the chest contours. In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases, the position and size of the areola can be surgically improved and excess skin may need to be reduced.

Gynecomastia can develop as a result of hormone changes in adolescence or later in life, or due to heredity, certain illnesses, or the use of certain prescription medications. It can also develop as a result of excessive alcohol consumption, cigarette and other tobacco use, marijuana use, and the use of anabolic steroids. Enlarged breasts in obese men are generally not categorized as gynecomastia, but more often are due to being overweight. Gynecomastia is characterized in the breast by:

• Excess localized fat
• Excess glandular tissue development
• A combination of both excess fat and glandular tissue

In addition, gynecomastia may present unilaterally (one breast) or bilaterally (both breasts). In some cases, correction of gynecomastia may be considered a reconstructive procedure, and therefore may be eligible for insurance coverage. Reconstructive cases are generally determined on a case-by-case basis; pre-certification is always required for insurance coverage. The American Society of Plastic Surgeons has published a position paper for physicians and insurers defining the recommended criteria for reconstructive cases of gynecomastia. Ask your physician for a copy of this document to submit to your insurer.

Breast reduction surgery can be performed at any age; however, it is best performed when a male's overall physical growth is fully complete. Adolescents may benefit from surgery, although secondary procedures may be needed in the future should breast development continue.

In general, good candidates for breast reduction are men of relatively normal weight whose breast development has stabilized. Prior to surgery, a complete medical history and physical exam including diagnostic testing is recommended to try to determine the underlying cause of gynecomastia. This may include diagnostic testing of your endocrine function. Surgical correction of gynecomastia is best performed on:

• Men whose condition cannot be corrected through alternative medical treatments
• Healthy individuals who do not have a life-threatening illness or medical conditions
that can impair healing
• Non-smokers and non-drug users
• Individuals with a positive outlook and specific goals in mind for improving
the physical symptoms of gynecomastia and the appearance of chest contours

Where do I begin?

A consultation with your plastic surgeon is the first step to learn how correction of gynecomastia can improve the appearance of your upper body and produce a more masculine chest contour. A consultation is designed to fully educate you about breast reduction in a non-pressured environment and will include:

• A discussion of your goals and an evaluation of your individual case
• Options available to correct gynecomastia
• Likely outcomes of breast reduction and any risks associated with the procedure
• The prescribed course of treatment recommended by your plastic surgeon

Your plastic surgeon will also answer your questions.

Evaluation

Overall health and personal outlook can greatly impact the outcome of surgery to correct gynecomastia. These will be carefully evaluated in consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction require that you:

• Honestly share your expectations
• Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
• Commit to precisely following all of your plastic surgeon's instructions

Safety

By making the decision to consult with a board-certified plastic surgeon and following all the instructions given, you are taking an important step in helping to ensure your safety..

Your plastic surgeon is certified by The American Board of Plastic Surgery® or The Royal College of Physicians and Surgeons of Canada®. This certification designates surgeons who are specifically trained in plastic surgery of the face and entire body.

Correction of my gynecomastia

The factors considered to determine the plastic surgery techniques appropriate to correct your gynecomastia include:

• Cause of gynecomastia
• Degree of excess breast tissue and correction necessary
• Composition of the excess breast tissue: fat, glandular tissue and skin
• Age and overall health
• Recommendations of your plastic surgeon

In cases where gynecomastia is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions. The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction. There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.

Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision is also necessary if the areola will be reduced, or the nipple repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference.

If gynecomastia is primarily caused by excess fat deposits,
treatment may be achieved using liposuction techniques alone.
Through small incisions at the perimeter of the areola, in the
natural contours of the chest, or in the axilla (the underarm area),
a cannula is inserted to loosen and suction excess fat deposits.

Gynecomastia may also be treated by excision: the
surgical removal of excess glandular breast tissue, fat and skin.
Incision patterns and locations vary. Commonly incisions
are in a concentric pattern around the areola or in the
natural contours of the breast. Excision techniques
and a concentric pattern are used where an enlarged
areola will be reduced and/or repositioned.

In some cases, gynecomastia inay be treated with both
liposuction and excision. Any surgical treatment to
correct gynecomastia will require incisions.
While most incision lines are concealed within natural
contours, some may be visible and are a necessary
result of breast reduction surgery. However, most
men feel that achieving a more masculine chest
contour is the most important result of the
surgical correction of gynecomastia.

Preparing for surgery

Your plastic surgeon will carefully explain the procedure that will be used to correct your gynecomastia. Prior to surgery, you will be given specific instructions that may include:

• Pre-surgical considerations, diagnostic testing and medications
• Day of surgery instructions and medications
• Specific information related to the use of anesthesia
• Postoperative care and follow-up

In addition, you will be asked to sign consent forms to assure your plastic surgeon that you fully understand the procedure you will undergo and the risks and potential complications.

Possible risks of breast reduction include blood pooling beneath the skin (hematoma), blood clots, and infection or poor healing at the incision site. Changes in nipple or breast sensation are usually temporary; however it is possible that the loss of sensation may be permanent. Smokers are at increased risk for poor wound healing and are advised to stop smoking for several weeks before and after surgery. If liposuction techniques are used, additional risks include uneven contours, rippling or loose skin, irregular pigmentation, excessive fluid loss or fluid accumulation. All surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent.

It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether excitement for the anticipated outcomes or preoperative stress. Discuss these feelings with your plastic surgeon.

What to expect

Surgery to correct gynecomastia may be performed on an outpatient basis, in an office-based or ambulatory surgical facility, or a hospital setting. It may be performed under general anesthesia or local anesthesia with sedation. These decisions will be based on the requirements of your specific procedure and considerations of patient and surgeon preference. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

Following surgery

Once your procedure is completed, dressings or bandages will be applied to your incisions and an elastic bandage or support garment may be used to minimize swelling and support the new chest contour as it heals. A small, thin tube may be temporarily placed under the skin to drain any excess blood that may collect. Before being released, you and an accompanying family member, friend or caregiver will be given specific instructions that may include:

• How to care for the surgical site and drains
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to follow-up with your plastic surgeon

Progress and healing

Initial healing will include swelling and discomfort at the incision sites. Discomfort is common and can be controlled with medication. Wearing the elastic bandage around the clock may be recommended for the first few days or weeks. It is important to keep the incision sites clean.

You will be instructed to engage in light activity as soon as possible to minimize the potential for blood clots and other complications. Follow all instructions carefully; this is essential to the success of your outcome. A return to light activity is possible as soon as you feel ready, usually within a few days of surgery.

If sutures are used, they will be removed within 5 to 10 days following surgery. You will likely be ready to return to work and more normal activity at this time, as long as you do not engage in any heavy lifting or vigorous exercise.

Healing will continue for several weeks as swelling resolves and your new chest contour settles. The scars created by any incisions will continue to refine and fade, however they are permanent. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.

Results and outlook

The final results of breast reduction in men are permanent in many cases. However, if gynecomastia resulted from the use of certain prescription medications, steroids or marijuana, you must be fully free from these substances in order to maintain your results.

All scars are permanent, even though some scars may be concealed in the natural contours of the breast. The resulting scars to correct your gynecomastia are a necessary tradeoff for your masculine chest contour. Your improved upper body will likely enhance your self-image and confidence, whether in a shirt and tie, a t-shirt, or baring your chest at the beach.

Your surgeon, your choice

Choosing to have cosmetic or reconstructive plastic surgery is an important decision; so is selecting a plastic surgeon. Consider these important guidelines:

BOARD CERTIFICATION - Not all physicians who perform plastic surgery or who use the title plastic surgeon are board certified in plastic surgery.

The American Board of Plastic Surgery® (ABPS) and The Royal College of Physicians and Surgeons of Canada®. certify physicians in plastic surgery of the face and entire body. To be certified by either board, a plastic surgeon must:
• Graduate from an accredited medical school
• Complete a minimum of five years of surgical training following medical school, including an accredited plastic surgery residency program
• Pass comprehensive written and oral exams

PRIVILEGES - Your surgeon should have operating privileges at an accredited, local hospital for the same procedure you plan to have performed - even if that surgeon suggests your procedure be performed in an accredited office-based surgical facility or at an ambulatory surgery center.


This educational brochure is designed to supplement a personal consultation with a plastic surgeon certified by The American Board of Plastic Surgery® or by The Royal College of Physicians and Surgeons of Canada®. Plastic surgeons with this certification have completed extensive surgical training and rigorous examinations in plastic surgery; this uniquely qualifies them to perform cosmetic and reconstructive procedures of the face and entire body.

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