Male Breast Reduction for Gynecomastia

Male Breast Reduction for Gynecomastia (Enlarged Male Breasts)

Enlarged breasts in men (gynecomastia) is more common than most people realize. It can be mild or severe, ranging from slightly enlarged and puffy nipples to large feminine looking breast masses on the chest. This can create social embarrassment and impact self-esteem and confidence at any age.

Some men with gynecomastia feel significant emotional distress and avoid physical activity and intimacy. They may also feel uncomfortable removing their shirts in front of other people and avoid places like the gym, pool, or beach. This can limit their ability to enjoy social activities and recreational opportunities and ultimately prevent them from living life to the fullest.

Treatments for enlarged breasts in men include medications and weight loss, but these are not always effective. Fortunately, male breast reduction surgery is an option to help men achieve a more masculine chest contour and appearance.

Male breast reduction, also known as gynecomastia surgery, entails a range of surgical techniques. When looking for a surgeon, it is important to choose one who has training and vast experience in aesthetic plastic surgery for the chest area.

Dr. Ginger Xu is a Board-certified plastic surgeon who has helped many people align the appearance of their chests and bodies with their own personal goals. Dr. Xu received specialty training in aesthetic plastic surgery at Harvard. She is now based in the San Francisco Bay area.

Dr. Xu embraces the responsibility of transforming her patients’ appearance to reflect their inner values and sense of self. She seeks to create natural results and give men the emotional relief and comfort of having physical features ultimately aligning with their sense of masculinity.

What Is Gynecomastia?

Gynecomastia refers to an enlargement of breast tissue in men. It is a common condition affecting up to 50 percent of men. The signs of enlarged breasts can begin in adolescence, at maturity or after middle age. In adolescents, enlarged breasts sometimes resolve with time or with a course of medication.

Enlarged breasts can appear in men who have healthy body weight and in men who are overweight. In some cases, one breast can be larger than the other causing an asymmetrical appearance. Enlarged breasts in men can be made up of:

  • Excess fatty tissue
  • Excess glandular tissue
  • Excess skin

What Is the Cause of Gynecomastia?

In men with healthy body weight, gynecomastia can develop for unknown reasons or can be related to factors including:

  • An inherited predisposition
  • Use of other drugs – eg. non-prescribed steroids or cannabis overuse
  • Taking certain prescription medications – eg. those affecting testosterone levels
  • Low levels of testosterone – including during aging
  • Hormonal shifts for various reasons
  • Presence of tumors or cancers that produce hormones
  • Other medical conditions

Medical treatments used at the early stages of gynecomastia can help, but if the enlarged breasts remain stable for several years, plastic surgery is usually required.

In men who have experienced significant weight gain, excess skin and fat tissue can remain once they lose significant weight. In these cases, surgery will be needed to correct the appearance of the chest.

Can Losing Weight Help Gynecomastia?

Overweight men should try losing weight to see if the loss of fat tissue around the breast can improve the appearance of their chests. But if the enlarged breasts contain excess glandular tissue or excess skin, weight loss might not give the desired results.

Ideally, overweight men should obtain and maintain healthy body weight. Any remaining skin, fat and glandular tissue can be removed using one of the procedures described below. If you later regain weight, you might have regrowth of enlarged breasts.

You should understand that your surgeon will have to recommend a surgical approach that suits your body type. If you are overweight, you may have the risk of additional complications such as:

  • Wound-healing problems
  • Infection
  • Wound separation
  • Fat necrosis
  • “Dog ears” – skin bulges at the corners of the incisions
  • Dissatisfaction with final aesthetics
  • Deep vein thrombosis (DVTs) – blood clots
  • Pneumonia and respiratory issues after surgery
  • Changes in the appearance of the chest if you lose or gain weight after the surgery

Is There Anything I Should Do Before Considering Surgery?

Men who are concerned about the appearance of their breasts should consult with a doctor for a thorough physical examination including laboratory blood tests and testicular examination. The examination might reveal factors that can be corrected with non-surgical treatment.

Wherever possible, men should ask their doctors about adjusting prescribed medications contributing to their large breasts and/or they should stop taking other drugs which may play a role (cannabis, steroids). You should not stop taking any prescribed medication without consulting your doctor.

If non-surgical options have not helped to reduce the size of your enlarged breasts, an aesthetic plastic surgeon such as Dr. Xu can help advise you of surgical options.

A good surgeon who listens to your vision for your body and who has experience in all the chest-related techniques is best able to match their surgical approach with your goals and body type.

Am I a Good Candidate for Gynecomastia Correction Surgery?

Men who are good candidates for male breast reduction:

  • Have found non-surgical treatments did not sufficiently improve the appearance of their chest
  • Are in good physical health
  • Are close to healthy body weight – overweight men should first try to correct their gynecomastia with weight loss
  • Have stable body weight – significant changes in body weight after surgery can affect the results
  • Have mature chests – teenagers can have surgery but it is typical for gynecomastia at that age to naturally resolve due to hormonal shifts
  • Are non-smokers or have quit smoking at least six weeks before surgery
  • Are not taking medications or other drugs that could cause the growth of excess breast tissue
  • Are not happy with the appearance of their chest
  • Understand why they want to have a more masculine chest

Gynecomastia Correction Techniques

A range of procedures is available to correct enlarged male breasts by removing excess skin, fat tissue and/or glandular tissue and reshaping the contour of the chest so that it appears more masculine.

The best way to learn about which approach can help you is to schedule a consultation with Dr. Xu. During the initial consultation, Dr. Xu will listen to your goals, examine your body and recommend an approach that best meets your needs.

The limitations and benefits of different surgical procedures to correct gynecomastia are described below.

Liposuction

Liposuction for gynecomastia involves making multiple small incisions through which the surgeon can suction out the fat and breast tissue with a cannula. This can be performed using traditional liposuction methods or with ultrasound-assisted liposuction which helps break up glandular tissue. The main advantage of this method is that scarring is minimal.

Liposuction is a good approach when there is a modest amount of diffusely fatty breast tissue with no skin excess. It does not address a firm “nugget” of tissue which is sometimes found behind the nipple. It also does not reduce the size of the areolas or any of the chest skin.

Liposuction can also be used in combination with other techniques to fine-tune the appearance of the chest.

Direct Excision

Direct excision is best for men who have a firm “nugget” of gynecomastia tissue usually found behind the areola. This tissue is very dense and difficult to remove through liposuction so direct excision is required. This approach also does not remove any skin and is only appropriate for men with minimal skin excess.

The procedure involves the surgeon making an incision around the lower border of the areola to remove glandular tissue and fat. The scar is partially camouflaged along the border of the areola and nipple sensation is usually retained. This approach can be done in combination with liposuction.

Additional surgery may be needed if excess skin remains after healing or if the transition near the outer borders of the chest is not smooth.

Circumareolar Approach

The circumareolar approach is a combination of direct excision with additional skin removal around the areola. Two circular incisions are made that allow a donut-shaped piece of skin to be removed to reduce the size of the areola and any puffy appearance.

This method is derived from the “Benelli-style” technique and can also be described as a “concentric circle approach with an areola reduction.” The larger incision around the border of the areola enables better access for the surgeon to remove tissue and some excess skin.

This method allows some removal of excess skin while avoiding the larger scar across the chest seen in the more extensive procedures (see below). The final scar is around the entire circumference of the areola and is partially camouflaged by the new border of the areola. This method can be combined with liposuction.

Nipple sensation is often decreased immediately after surgery, but sensation usually returns with time. Possible issues with this technique include:

  • Skin wrinkling or bunching after areola reduction – can cause fullness rather than a smooth profile
  • Spreading or thickening of the areola scar – more likely for larger changes in areola size

Extended-Incision Approach

This approach involves an incision around the areola (circumareolar approach) plus an additional incision extending from this circle, which removes any remaining excess skin in the shape of a wedge. This results in an additional scar that appears like a dart extending from the circular scar around the areola. The design and direction of the additional incision varies by person and is customized to enable optimal tissue and skin removal depending on your individual anatomy. This is a good approach for men with a moderate amount of chest skin and tissue, who may not require the double-incision technique.

Double Incision with Possible Nipple Graft

This approach is good for men who have a larger amount of excess fat and/or glandular tissue and excess skin. Usually, the nipple is also low on the chest and needs to be moved to a higher, more natural position.

Double-incision surgery is the most powerful and reliable approach to masculinizing the chest in severe cases of gynecomastia. It gives the surgeon maximal control over reshaping the chest skin, and unlimited access to remove all the excess tissue. It consistently creates a smooth chest contour and enables optimal tightening of chest skin.

Two incisions are made: one above the areola and one along the pectoral muscle fold. All of the intervening skin and excess tissue is removed, and the incisions are brought together to create one final horizontal scar along the lower chest. The surgeon aims to position the final scar along the pectoralis muscle fold, which is a natural shadow on a masculine chest.

The repositioning of the nipple can be approached in one of two ways depending on the amount of nipple movement needed:

  • The nipple and areola remain partially attached
  • The nipple and areola are totally detached and moved as a free nipple graft

For men who need only a moderate amount of nipple repositioning, the nipple and areola remain partially attached on a small wedge of tissue containing blood vessels and nerves (dermal pedicle). The nipple-areola complex is then repositioned by bringing it through a new opening created higher up on the chest skin.

This method is more likely to retain sensation and preserve the original structure of the nipple after healing. Possible drawbacks with this method include:

  • Fullness or bulging caused by the dermal pedicle
  • Higher risk of bleeding
  • Possible partial loss of nipple tissue

For men who need a more significant amount of nipple repositioning, the nipple and areola are totally detached as a small coin of skin called a “free nipple graft” and moved to a more aesthetic location higher up on the chest. This enables both repositioning and reduction of the size of the areola to give a more masculine appearance. As the nipples are totally detached in this process, some of the disadvantages of the free nipple graft include:

  • Possible complete loss of the nipple if blood flow is not re-established
  • Possible pigment loss and mottled coloration
  • Loss of nipple sensation
  • Flattening and loss of original nipple architecture

Dr. Xu can discuss with you the possibilities of nipple and areola tattooing to help smooth out any color irregularities in a nipple graft and improve the overall appearance of the nipple and areola.

How Will I Know Which Procedure Is Right for Me?

Gynecomastia is categorized into four different grades:

  • Grade 1 – minor breast enlargement and no excess skin
  • Grade 2 – moderate breast enlargement and no excess skin
  • Grade 3 – moderate breast enlargement and excess skin
  • Grade 4 – marked breast enlargement and excess skin

The approach recommended by your surgeon will take into account:

  • The presence or absence of excess skin
  • The amount of excess tissue
  • Whether the excess tissue is fat or glandular tissue
  • Whether you want correction of enlarged or puffy areolas

The best surgical approach for each man must take into account individual goals and the degree of scarring he considers acceptable.

Dr. Xu customizes each treatment plan to best suit individual needs. Dr. Xu will assess your body type, medical history, and goals so that together you can develop the best plan to treat your gynecomastia.

Special Considerations for Gynecomastia Surgery

Does Gynecomastia Surgery Address Puffy Nipples?

Yes, your surgery can be customized to incorporate techniques that improve puffy nipples. Incisions around the areolas can be used to cinch the areola tighter and reduce size and puffiness. Tissue can also be removed from underneath the areola to reduce the projection.

Are the Results Permanent? Can Gynecomastia Return After Surgery?

The results of surgery to correct gynecomastia is permanent in the sense that the skin and tissue removed will not grow back.

However, further tissue growth and skin stretching can be caused by:

  • Weight gain
  • Certain medications
  • Other drug use – such as non-prescription steroids or cannabis
  • Hormonal changes – eg. decreasing testosterone levels during the natural aging process

The best way to maintain your results is to maintain a healthy lifestyle.

How Do I Work With My Plastic Surgeon to Decide Which Technique Is Best for Me?

You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the best results. The goal of a good surgeon should be to arm you with the knowledge to understand the factors affecting your gynecomastia.

Dr. Xu can discuss how your age, breast size, breast shape, and skin affects the choice of surgical technique and the results you can achieve.

It is important you have a realistic understanding of:

  • How your chest will look after surgery
  • Where your nipples will be positioned
  • The limitations of the surgery
  • Any short- and long-term effects such as scarring
  • Any possible complications
  • The potential need for more breast surgery

The chest is a very sensitive part of the male anatomy and men have different levels of scarring they can tolerate. Dr. Xu can explain which technique she would recommend for your situation and the level of scarring you can expect.

Techniques causing more scarring might also give you a chest shape closer to your goals. Dr. Xu can give you the information you need to weigh the benefit of a more aesthetic chest with the level of scarring.

Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired look can help her understand your needs. Your medical history is also important, including any information about other medical conditions.

Things to also discuss with Dr. Xu include:

  • Why you want the surgery
  • Your future lifestyle goals
  • What appearance you hope to achieve
  • What sort of chest shape or form you would like

What To Expect During My Consultation

Dr. Xu understands the responsibility of transforming a man’s appearance to better reflect his identity and build self-esteem. Her top priority is understanding your vision and desires.

Once Dr. Xu has examined your body, breasts, and chest, she will use her artistic sense and technical expertise to recommend an approach to your surgery that will best suit your goals.

During a consultation, Dr. Xu will explain:

  • The different types of gynecomastia surgical techniques
  • Which surgery options would best suit your needs
  • What types of incisions will be needed
  • How much scarring you can expect
  • Any need for further operations
  • Potential complications or side effects
  • How other surgeries (eg. tummy tuck, liposuction) can fulfill your vision for your body, if that is your preference
  • What to do during the recovery period

Gynecomastia Surgery and Recovery

Preparing for Gynecomastia Surgery

Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.

Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least 6 weeks prior to surgery.

You may need to get a blood test or undergo additional workup depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.

In the weeks before surgery, recommendations to help you prepare include:

  • Making sure you get enough sleep and rest
  • Eating a healthy diet with adequate protein and nutrition
  • Exercising or engaging in physical activity to strengthen your body
  • Maintaining a positive state of mind
  • Prioritizing your well-being and reducing stress levels

It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.

Recovering from Gynecomastia Surgery

The recovery time will depend on the techniques used. For example, recovery after liposuction alone will be faster than double incisions. Dr. Xu will give you specific recovery instructions that you should follow to improve healing for the best possible appearance of your chest.

After your surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:

  • The procedures used
  • Whether you had other surgeries completed at the same time – such as liposuction or post-weight-loss surgery and body contouring
  • Your age
  • Your health before the surgery

Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.

If drains are inserted, these will usually be removed after one week. Recovery can take up to six to eight weeks and you must wear a compression vest. During this time, you should avoid lifting any heavy items. Once bruising and tenderness have gone, you can return to normal light activities. Most people can return to work after two weeks, but heavy exercise should be avoided for eight weeks. Ask Dr. Xu when you can return to the full range of activities.

If you have had a combination of surgeries, Dr. Xu can advise you of any additional recovery needs.

Gynecomastia Surgery Recovery Tips

During the early stages of recovery, follow these tips to improve your results:

  • Wear your compression vest as instructed – to decrease swelling and the risk of fluid collections
  • Take pain-relieving medication as instructed
  • Use ice packs – to decrease swelling, bruising and pain
  • Do not shower or get your incisions wet – use baby wipes until the dressings are removed and you get the go-ahead from your doctor to enter the water
  • Only carry or lift very light weights and do not lift your arms over your head – especially in the early weeks after surgery
  • Avoid strenuous exercise – ask your doctor when you can return to full activity
  • Do not smoke or drink alcohol – both affect wound healing
    Do not expose scars to the sun for at least six months – the sun can cause scars to become permanently darker and more noticeable
  • Use scar treatments – ask Dr. Xu about skincare and scar treatments to use once your dressings have been removed

What Are The Possible Complications of Gynecomastia Surgery?

Your risk for complications will depend on the specific technique used and Dr. Xu will make you aware of these before you have surgery. The risk of some common complications (such as infection, bleeding, and wound separation) can be decreased by following your doctor’s post-surgery instructions.

Potential complications after surgery for gynecomastia include:

  • Bleeding or hematoma (a collection of blood)
  • Seroma (fluid collection) requiring drainage procedures later
  • Wound separation or breakdown
  • Temporary or permanent loss of nipple sensation
  • Reduced or changed nipple sensation
  • Loss of a nipple graft
  • Unfavorable scarring
  • The potential need for additional revision surgery to obtain your desired result
  • Infection
  • Chronic pain
  • Suture irritation or extrusion
  • Fat necrosis
  • Minor asymmetry