Gynecomastia means enlargement of the male breast. The definition has nothing to do with what causes the enlargement or what tissue it is composed of. It is most common around puberty and can involve one or both sides. Most commonly the enlargement is centralized in the breast but occasionally it is not. It is present to some degree in about a third of the male population. The majority of cases are physiological or drug induced. Drug induced gynecomastia just requires cessation of the causative drug. If the gynecomastia is resistant to treatment or is the adolescent type but persistent surgery is required.

The type of surgery depends on the type of tissue contributing to the breast enlargement.

• glandular: requires surgical removal of glandular tissue
• fatty-glandular: requires surgical removal of glandular tissue with or without removal of adjacent fat to give the best overall shape
• simple fatty: requires diet/exercise for weight loss, possibly removal of the fat

Health insurance coverage for the procedure is highly variable. Some plans cover removal of the gland but not liposuction of the fat provided the problem does not resolve after stopping medications that can cause gynecomastia. In California state law mandates coverage if there is severe right vs. left asymmetry or alot of excess skin i.e. a visible abnormality easily seen by the average person and recognized as such.

This 29 year old, 5'9", 186 lb. patient had liposuction, direct excision of the gland tissue and 2cm elevation of the nipple-areola (crescent mastopexy) for his fatty-glandular gynecomastia. 250cc of liposuction fluid was injected into each side of the chest. 300cc was liposuctioned from the left and and 250cc from the right. Some of the excess tissue was gland and that cannot be removed by liposuction so it was removed by direct excision. In order to achieve a natural look after surgery and a happy patient the surgeon must evaluate the skin, fat and gland contributions before surgery. In this case the excess skin was addressed by the simple removal of a 2cm high crescent of skin above the nipple-areola. The after photo is 6 weeks after surgery and there is still some residual swelling in the lower half of the chest.

This patient had gynecomastia after massive weight loss.

Gynecomastia surgery can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.