The ideal gynecomastia surgery techniques (male breast reduction) will depend on the underlying cause of the woman-like breasts. It is important to note that some patients will need an excision-based approach, others will benefit more from liposuction, or even a combination of these two.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says a good number of patients can benefit from excision-based surgery combined with liposuction. With this approach, he can remove the excess tissue, which is mostly behind the nipple area, and then further sculpt the breast (or even the surrounding area) by removing the excess fat.
Dr. Smiley prefers microcannula liposuction technique when dealing with the very dense or fibrous fat found in the male breasts. This involves the use of thin hollowed tube (less than 2.5 mm) to sculpt the breast and/ or its adjacent area by removing some of the excess fat.
Some patients can also benefit from liposuction of the flanks (in addition to the adjacent area of the breasts) so they will not deviate from the more masculine-looking chest.
While liposuction can serve as a stand-alone procedure, only patients with pseudo gynecomastia (the enlargement is only caused by the excess fat, as opposed to the excess breast tissue) can benefit from it.
Male breast liposuction typically uses 1-2 small incisions that are placed near the armpit and/or at the border of the areola for optimal scar concealment.
Patients with “real” gynecomastia (puffy nipple area due to the excess tissue) can only achieve good results from excision-based surgery. Oftentimes, it involves a small incision placed precisely at the lower border of the areola so when the scar heals it is almost invisible.
However, patients with substantial enlargement and/or significant amount of redundant skin—which typically happens after massive weight loss—will need a more extensive excision-based surgery, which of course results in additional scarring.
For patients who need substantial correction, they may have to accept the appearance of breast fold scar or even a vertical scar from the areola down to the breast crease. This rather extensive technique is reserved for massive weight loss patients.
- Two-staged gynecomastia surgery techniques
Some patients can benefit from a two-staged gynecomastia surgery. This is particularly true for young men (they typically have good skin shrinkage) who want to try first liposuction and wait a few months to decide if they need an excision-based surgery.
Some moderately overweight men and massive weight loss patients could also benefit from a two-staged gynecomastia surgery.
For a small subset of patients, male breast reduction by liposuction is enough to deliver good results. However, the right candidates should have good skin shrinkage and have no excess tissue, which can be diagnosed on physical exam and possibly some type of imaging test such as MRI, chest X-ray, and breast ultrasound.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says male breast reduction by liposuction involves unique challenges, which must be recognized beforehand to achieve good results from the surgery.
Before and After Photos
The male breast contains highly fibrous fat, meaning it has more connective tissue. For this reason, the use of larger cannulas or flexible hollowed tubes for suctioning the fats is not advisable.
Microcannulas are the right choice when treating highly fibrous fats because of their narrow body (outside diameter is typically less than 2.5 mm) that allows them to easily penetrate the tissue.
Inadvertent over correction can be problematic due to skin irregularities, collapsed areola, and other types of deformity. For this reason, the use of microcannula becomes more important than ever when the surgery involves a highly sensitive area like the male breast.
The goal of liposuction is to remove just the right amount fat to eliminate the appearance of “fullness” without causing the internal structures to collapse. Simply put, there should be sufficient fat beneath the skin after surgery to achieve smooth results and to avoid a gamut of complications.
It is also important to move the microcannula at correct speed to prevent inadvertently removing too much fat in one area. For this reason, a prudent patient will only choose a board-certified plastic surgeon who performs male breast reduction by liposuction on a regular basis.
- Issues involving skin shrinkage
To achieve smooth results, the patient must have good skin shrinkage, allowing it to shrink-wrap around the new contour. As a result, older people (aged 55 and above) and massive weight loss patients are in general not good candidates for a liposuction-only approach.
As with any body contouring surgery, liposuction is only reserved for patients of normal, healthy weight. Any attempt to perform the surgery on someone who is significantly overweight or obese can lead to poor cosmetic results and an increased risk of complications.
There are several factors influencing male breast reduction surgery cost; these include the surgical maneuvers (excision-based techniques, liposuction, or both), clinic location, surgeon’s fee, among others.
Sometimes, insurance coverage for male breast reduction is possible provided that the abnormal enlargement of the breasts, a condition referred to as gynecomastia, poses serious health problems. A good example is a tumor developing alongside with the tissue.
Another situation that makes insurance coverage possible is that gynecomastia comes with extreme pain and discomfort.
Meanwhile, health insurance issuers rarely recognize psychological and emotional benefits as valid reasons for coverage. Simply put, the patient must provide sufficient evidence that his condition poses a serious medical condition.
Because most patients seeking for male breast reduction do not qualify for insurance coverage, they must be in good financial position prior to the operation. The consensus is to have available funds at least twice the actual cost of the surgery as a way to prepare for “unexpected” events like a longer than usual recovery and the need for some type of revision.
In Beverly Hills plastic surgery, the average male breast reduction surgery cost involving excision-based techniques (i.e., removing the excess glandular tissue and possibly some skin and fat) is between $5,000 and $7,000.
For liposuction-alone surgery, which is only reserved for patients with a condition called fake or pseudo gynecomastia, the average cost is between $3,000 and $5,000.
But sometimes, the excess fat extends far into the armpit area, which of course also requires this treatment to achieve smooth results, thus increasing the cost.
Pseudo gynecomastia means the underlying problem is the excess fat. However, the vast majority of male breast enlargements are caused by too much tissue, which is typically removed by creating a U-shaped incision precisely at the lower border of the areola.
While it may be tempting to choose a surgeon offering the lowest price, it is important to note that using this as a benchmark could preclude one from selecting a qualified doctor.
Qualified doctors, i.e., board-certified plastic surgeons who perform the surgery on a regular basis, will not lower the price too drastically because of the cost involving accredited surgical facility and anesthesiologist (and other licensed professionals and staff).
A surgery that is priced way too low can be interpreted as a sign of desperation, i.e., to compensate for the surgeon’s lack of training and experience and attract “less” prudent patients. Also, this could be a sign that a doctor has compromised patient safety, such as performing the surgery at a non-accredited facility.
Despite the proliferation of high-tech devices and new surgical techniques in male breast reduction surgery, the truth is the skills and experience of your gynecomastia surgeon will remain the most influential factor determining the results.
To help you select the “right” gynecomastia surgeon, experts at California Surgical Institute have provided a list of qualifications he must possess.
Board certifications from “recognized” accrediting agencies (i.e., The American Board of Plastic Surgery and The American Society of Plastic Surgeons) will ensure that your plastic surgeon has specific and relevant training that would help him deliver cosmetically pleasing results and minimize risk of complications.
- Male breast reduction is your surgeon’s “staple” procedure.
Take note that plastic surgery is a very broad practice; hence, board certifications should not only be your main criteria. Bear in mind that your surgeon’s experience will also determine the results of your male breast reduction surgery.
Ideally, your gynecomastia surgeon should be performing over a hundred male breast reduction surgeries every year.
Male breast reduction or any type of body contouring plastic surgery is a combination of art and science. The goal is to produce results that adhere to the beauty ideals with the use of a highly customized surgical method.
- He has good bedside manner.
Aside from doctor’s clinical skills and experience, the success of any plastic surgery also lies in good rapport with his patients. It is important that he listens to your input and goals and allays your concerns as well by carefully explaining his contingency plan should complications occur.
Meanwhile, stay away from surgeons who ask no or very little input from you. There should always be a mutual respect and trust between a doctor and his patient to make the relationship work.
- You feel that your safety is his utmost priority.
Choose a gynecomastia surgeon who only performs his surgery at an accredited surgical facility staffed by trained and licensed nurses and anesthesiologists (and other medical providers).
Also, a prudent surgeon will always demand a lengthy consultation to know the details of your medical history (including the use of drugs), and a medical/physical exam to identify any risk factor prior to surgery.
Don’t be slighted when your surgeon refuses to perform surgery unless your medical condition is well under control. In fact, this is a sign that he truly cares about your safety.
Pain after male breast reduction surgery is typically mild and would last just a few days since it does not involve vital nerves and muscles. In general, the surgeon just removes some excess breast tissue with the use of a U-shaped incision precisely at the border of the lower areola.
For most patients, routine oral narcotics or Tylenol are enough to provide comfort. Meanwhile, it is important to avoid aspirin and ibuprofen medications particularly in the first few days after surgery because they could increase bleeding or lead to poor healing.
Photo Credit: everydayplus at FreeDigitalPhotos. net
Simply put, severe pain after male breast reduction is very rare except when the patient develops hematoma (firm clotted blood beneath the skin or inside a cavity) or other healing problems.
While pain is typically just minimal or moderate, many surgeons in Inland Empire plastic surgery would still like to give their patients more options when it comes to pain control management.
One of the options (aside from oral painkillers) is to use pain pumps, which are small balloon-like devices with catheters that slowly deliver numbing drugs directly to the incision site, without affecting the rest of the body and its normal functions.
With pain pumps, the patients can avoid or at least minimize their use of oral painkillers and ultimately avoid their side effects such as nausea, lethargy, vomiting, and constipation. While these are not mandatory, they may like the convenience it provides during the initial healing stage.
The effects of pain pumps can last between three and five days.
Instead of actual pain, a good number of patients describe the initial healing as feeling sore.
To prevent healing problems and persistent swelling, it is important to avoid strenuous activities (particularly exercises that involve the chest muscle) and heavy lifting for at least three weeks. The goal is to keep one’s heart rate and blood pressure at a normal resting state.
Male breast reduction by liposuction and excision can produce good results—i.e., more masculine chest appearance. Leading Los Angeles plastic surgeon Dr. Tarick Smiley has demonstrated this approach in his recent Snapchat video.
The patient shown in the video had gynecomastia, a condition in which the male breasts are unusually large due to the excess glandular tissue and possibly some extra fat.
It is important to note that pseudo or fake gynecosmatia is caused by excess fat alone, thereby a liposuction-alone procedure is enough to produce good results. However, only a small subset of patients can benefit from such approach.
In the video, Dr. Smiley started the procedure with liposuction to remove the excess fat. A very thin hollowed steel tube attached to a vacuum pump was used to eliminate the fatty tissues.
While today’s liposuction comes in many techniques, Dr. Smiley said that tumescent method is particularly ideal because it minimizes bleeding and make the extraction process quicker and gentler. This procedure involves injecting the fatty area with a solution (a concoction of saline, local anesthesia, and epinephrine) to make the fat cells swell up.
And with fats all swollen up, they are easier and quicker to suction out.
After removing the excess fat, Dr. Smiley followed the procedure with breast tissue excision. He created a U-shaped incision along the lower border of the areola for optimal scar concealment.
For the vast majority of patients, the U-shaped scar exactly within the light-dark junction skin fades to the point that is very difficult to detect even by the patients themselves.
Aside from overlarge male breasts, the patient shown in the video also had visible asymmetry due to the left side appearing ”fuller” than the other. For this reason, Dr. Smiley said he removed more glandular tissue on the larger side.
Male breast reduction by liposuction and excision, as suggested by Dr. Smiley, is more about leaving behind enough tissue, as opposed to aggressive removal of fat and glandular tissue, to produce smooth results and to preserve the natural valleys and contours of the chest.
Over-correction or over-resection of tissue and/or fat, meanwhile, can lead to sunken areola deformity and other reminders of plastic surgery, said the renowned plastic surgeon.