Male breast reduction and tummy tuck performed at the same time offers advantages such as lower cost compared to having them separately. Furthermore, not everyone has the luxury to have two recovery periods.
Dr. Tarick Smiley, one of the leading Beverly Hills plastic surgeons, says that patient safety is the most important aspect of multiple-surgeries operations. Theoretically, the longer operative time under general anesthesia and the more incisions and cutting are made, the higher the risk of complication is.
The first and most critical step to make combo surgery reasonably safe is to conduct strict patient selection. In this respect, Dr. Smiley requires all his patients to pass lab screening to ensure that they can handle the “rigors” of any operation.
Lab screening typically includes blood work and EKG and cardiopulmonary tests.
After passing lab screening, the patients are instructed to “prepare” weeks or even months prior to surgery. The idea is to help them achieve their optimal health through superb diet and regular exercise.
Preparation for surgery also involves complete cessation from tobacco and smoking cessation products and discontinuation of all drugs and supplements with blood thinning properties. For clarity, Dr. Smiley provides his patients written materials that let them know all the things and activities they need to avoid before surgery and afterwards.
To further ensure patient safety, Dr. Smiley says in his recent Snapchat post that he only works with a board-certified anesthesiologist who requires a separate lab screening. Also, this specialist monitors the patient’s vital signs at the time of surgery.
Moreover, all efforts are made to complete the surgery in less than six hours to control the amount of surgical trauma and bleeding.
While combo procedures have a perceived higher risk of complications, Dr. Smiley says having separate surgeries also has problems—e.g., multiple recovery periods, higher cost, and “multiple” risks.
Because bleeding has a large effect on the recovery period and the risk of complications, Dr. Smiley uses different modalities to reduce blood loss. For instance, he injects epinephrine before making incisions.
Epinephrine is a drug that constricts the blood vessels, ultimately reducing the amount of bleeding. Furthermore, it “spreads” the effects of local anesthesia and so the patients rely less on oral narcotics to control their postop discomfort.
Male breast reduction preparation aims to ward off infection or any other types of complications, and to help patients achieve the best results possible, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Male breast reduction, or medically referred to as gynecomastia surgery, usually involves a small U-shaped incision at the lower border of the areola to remove the excess breast tissue, ultimately correcting the appearance of woman-like breasts. Occasionally, it is combined with liposuction.
Liposuction uses a few small puncture wounds where a flexible tube (cannula) is moved back and forth to remove the “unwanted” fat. These round incisions heal and fade into almost invisible scars.
Anytime the skin is cut open there is always a risk of infection and wound healing problems. For this reason, Dr. Smiley requires all his patients to undergo lab screening to ensure that they are healthy enough for the surgery and can handle the ensuing recovery.
Should lab screening show any medical condition (anemia, bleeding disorder, hypertension, etc.) known to impede healing, Dr. Smiley says he will not proceed with the surgery unless it becomes well under control by diet, change in lifestyle, weight management, and/or medications.
Patients who pass their lab screening are then instructed to “prepare” for the surgery. Dr. Smiley recommends complete discontinuation of smoking and smoking cessation products, and aspirin and other drugs and supplements with blood thinning properties.
For clarity, Dr. Smiley provides his patients written instructions of things and activities they have to avoid two weeks before and after surgery.
But sometimes, male breast reduction preparation can take more than two weeks. For instance, patients who are markedly overweight are generally instructed to shed the extra pounds first before they undergo the knife. The idea is to allow the skin to snap back to the best of its ability, making it much easier to achieve a tighter, more masculine breast appearance.
Nonetheless, some patients who are slightly or even moderately overweight may proceed with the surgery provided that they are healthy and are happy with their weight or are not expecting to lose significant amount of body mass, says Dr. Smiley.
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.