Some patients require a two-staged male chest reduction surgery, meaning liposuction and tissue excision are performed concurrently to achieve the best results possible.
Dr. Tarick Smiley, an Inland Empire plastic surgery expert, has recently demonstrated the “combo” technique on his Snapchat.
Dr. Tarick Smiley removes the excess breast tissue that will not come out with a liposuction-alone approach.
He first started the surgery by infiltrating each breast with tumescent fluids, which provided numbing effect and caused the fat cells to expand, paving way for quicker and more accurate removal via cannula (slender steel tube attached to a vacuum pump).
Afterwards, he created a small puncture wound on each side of the chest, precisely at the edge of the lower areola to conceal any resulting scar. This incision allowed him to remove the excess fat that was mainly behind the nipple area.
However, the patient’s male breast enlargement, or medically referred to as gynecomastia, not only stemmed from the excess fat, but also from the extra tissue, which a liposuction-alone approach could not address.
“The extra glandular or breast tissue is too thick and dense. It will not come out with a liposuction cannula,” says Dr. Smiley.
Hence, after liposuction Dr. Smiley proceeded to excision-based surgery with a creation of a curved incision that was also positioned at the lower border of the areola. Using surgical scissors and other special instruments, he was able to separate the excess tissue from the skin and eventually removed it.
By removing the excess breast tissue, he further eliminated the “roundedness” or fullness of the breast as well as the prominent submammary fold.
Meanwhile, the recovery following a two-staged male chest reduction is about a week. After this period, most patients can return to work although it remains prudent to avoid heavy lifting and strenuous exercise for another 2-3 weeks to eliminate the risk of persistent swelling, bleeding, and healing problems.
The postop pain is typically minimal that most patients will only need over-the-counter pain medications such as Tylenol. However, it is the swelling that takes longer time to dissipate (up to six months).
Liposuction for male breast reduction is often inadequate because the vast majority of patients have chest enlargement caused by excess glandular tissue and not just fat, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
“The breast or glandular tissue is too fibrous that it will not come out with liposuction alone,” says Dr. Smiley in his recent Snapchat post.
Before removing the excess breast tissue, Dr. Smiley performs liposuction first to eliminate the fat.
Dr. Smiley says that liposuction uses a hollowed steel tube to suction the fat out of the treated area; however, it cannot draw out the “extremely fibrous and dense” glandular tissue, which can only be removed with a longer incision.
To allay the concern of patients regarding the appearance of scar, Dr. Smiley says the incision is “precisely made at the lower border of the areola” to hide the scar.
“The light and dark skin junction perfectly conceals the scar. After all, men like to take off their shirt without having to worry about surgical stigmata. They are simply more secretive when it comes to plastic surgery,” Dr. Smiley says.
Recently, the renowned plastic surgeon performed a combination of excision and liposuction in a male patient who has good physique due to regular exercise and superb diet. But despite his commitment to healthy lifestyle, his chest remained unusually large for a man, a condition medically referred to as gynecomastia.
A small U-shaped incision is placed at the lower border of the areola to remove the excess tissue with a cautery device.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 27,760 men with gynecomastia had male breast reduction surgery, which is traditionally performed with an excision-based technique.
However, Dr. Smiley says that a good number of men can benefit from a simultaneous liposuction, which he performed in the said patient.
Dr. Smiley started the procedure with the injection of tumescent fluids into the chest before performing liposuction to remove the excess fat. The idea, he says, is to keep bleeding to a minimum and to numb the area.
The liposuction incision was a small “puncture hole” placed at the border of the lower areola.
Afterwards, he created a curved incision also placed right at the lower border of the areola so he could remove the excess glandular tissue that was causing the “appearance of woman-like breast.” Nonetheless, he maintained the patient’s good muscle definition so his new chest would not detract from his athletic physique.
Gynecomastia surgery results should not just look “flat.” First and foremost, great surgeons know the importance of eliminating all the surgical stigmata—i.e., nipple collapse, visible scars, and asymmetry—paving way for the most natural-looking appearance of the male chest.
The surgery is reserved for men whose overdeveloped chest is caused by the excess glandular tissue, which will not come out of liposuction cannula alone. Hence, it requires an excision-based surgery to flatten out the chest appearance.
But the caveat with the excision-based approach is the risk of visible scar, which can put off men who tend to be secretive about their plastic surgery, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
In order to achieve high patient satisfaction rate, Dr. Smiley highlights the importance of hiding the scar, which is done by placing it precisely at the lower border of the areola whose texture and color makes it perfect for concealing the incision site.
Meanwhile, the pictures below show a male patient who underwent gynecomastia surgery about two months ago. It should be noted that he has spent years exercising and eating healthy, which resulted in his great physique, except his chest that remained “full” and with its nipple pointing downward.
Just two months after this patient’s gynecomastia surgery and the scar has already healed nicely.
Due to the discordant appearance between his chest and the rest of his body, he was deemed as a good candidate for gynecomastia surgery. Furthermore, his well-tested commitment to healthy lifestyle would be the key to the preservation of his results.
It should be noted that gynecomastia surgery results are almost always expected to be permanent, although large weight gain and the use of anabolic steroids or certain drugs and supplements may affect or even reverse the surgery.
During surgery, Dr. Smiley was able to remove a large chunk of excess glandular tissue, which he first separated carefully from the overlying skin. Nonetheless, he left behind enough tissue to achieve a smooth chest contour.
The surgery demands precise tissue excision because over-aggressive removal can lead to nipple collapse and contour irregularities. After all, men in general are reticent about their plastic surgery and so all efforts are made to eliminate telltale signs.
Before and After Photos.
Male breast reduction photos can shed light on the artistic and technical skills of a surgeon. Nonetheless, you should also take into account the “before” pictures, which show the patients’ starting anatomies that will always have an effect on the final results. Hence, overweight patients do not achieve the same results as men with good physique.
Sample photos depicting great results from male breast reduction.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat demonstrating a patient with gynecomastia, a condition in which his overdeveloped male breasts were caused by excess fat and glandular tissue.
Unlike fat that can be taken out with liposuction cannula, which is a hollowed steel probe attached to a vacuum pump, the glandular or breast tissue is noted for its highly fibrous nature. Thus, the patient required a concomitant excision procedure.
Microcannula is used to remove the breast fat. The tiny round incision is placed precisely at the border of the areola for optimal scar concealment.
Dr. Smiley started the surgery with liposuction that involved a small puncture wound placed at the lower border of the areola. Since the breast fat is highly fibrous, meaning it has more connective tissue and thus harder to suction out, he used a microcannula instead of a large or standard cannula.
Microcannulae have a narrower steel body (2.2 mm or less) compared to the standard cannulae and so they remove smaller bits of fat. While this could mean slightly longer surgery, it promotes more precise fat removal, leading to smoother results.
The glandular tissue is very tough that liposuction cannula cannot suction it out. Hence, excision is warranted.
However, even a microcannula could not remove the patient’s extra glandular tissue that was mainly located behind the nipple area. Hence, Dr. Smiley created a curved incision right at the border of the lower areola in order to excise a huge chunk of tissue.
To prevent nipple collapse, surface irregularities, and other telltale signs of bad plastic surgery, Dr. Smiley ensured that enough soft tissue remained after surgery.
Meanwhile, he also performed liposuction along the patient’s axilla (armpit), particularly the lateral aspect of the torso so it would not detract from the flatter, more athletic male chest.
Because all the incisions were small and were placed in inconspicuous areas—i.e., border of the areola and armpit—the patient can expect invisible scar after 6-18 months.
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.