Gynecomastia

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Gynecomastia Newport Beach

Gynecomastia is the medical term for male breast enlargement (from the latin gyno, meaning “female,” and mastia, meaning “breast”). This condition is extremely common, particularly among men of certain ethnicities (Middle Eastern, Hispanic, African-American, South Asian, and Pacific Islanders, for example), and also in men who are overweight or obese. There is somewhat of a distinction between the fatty enlargement of the male breast that happens with weight gain and medical gynecomastia, which involves at least some overgrowth of the actual breast gland tissue (usually in addition to added fat in the breast). The end result, though, whatever the cause of the gynecomastia, is often social embarrassment, which can be extreme and isolating in certain circumstances for some patients, especially those with significant breast enlargement and overhang. Some of these very afflicted men have to wear bras and other supportive garments. Other patients are bothered more by the inability to wear certain clothing and change their wardrobes to be able to conceal the breast mounds.

There is a solution to this!

Gynecomastia can be treated by surgical male breast reduction and liposuction techniques, which help address both the overgrowth of breast gland tissue and fatty replacement in the breast. Sometimes liposuction (usually using Vaser ultrasound technique) alone can improve the gynecomastia in milder cases. Other patients need a combination of direct removal of the more fibrous breast gland tissue combined with liposuction for the fat tissues, in order to have a smoother result.

Before considering you a candidate for gynecomastia surgery, Dr. Sayed will perform a detailed medical history and physical exam to try to identify if there is a medical cause of the gynecomastia, which may require further workup or nonsurgical treatment of the underlying condition. While in general, gynecomastia can result from changes in the balance between testosterone and estrogens, there are some common causes of gynecomastia we like to rule out before performing surgery. These include:

  • Steroid use, whether for bodybuilding or medical indication
  • A history of pituitary gland dysfunction or tumors, which might secrete hormones like Prolactin, which cause breast enlargement
  • Problems with the adrenal glands and testosterone production
  • Masses in the breast, including rare incidence of male breast cancer

Once you are determined to be a candidate, Dr. Sayed will put together a plan for reduction of the gynecomastia which may include Vaser liposuction, direct excision (removal) of the breast gland tissue, use of postoperative drains and garments, and a return to exercise regimen to help add muscle definition to the chest.

Gynecomastia 101

Gynecomastia management starts with a history and physical exam, followed usually by some lab testing. A mammogram may be ordered if there is a significant family history of breast cancer. Dr. Sayed will assess the degree of breast fat and gland enlargement, the overhang of the breast (if any), and the skin elasticity or looseness. These factors help determine which surgical approach or incisions are required. There is a grading system based on how much overhang there is and the degree of enlargement.

The male gynecomastia procedure can range from liposuction done through an incision around part of the nipple-areola complex, along with a few small inconspicuous puncture sites near the side of the breast, to a full, inverted-T “anchor” pattern of incisions in patients with more severe enlargement of overhang. At right is an example of an approach to the breast that combines removal of tissue, lifting of the nipple, and correction of overhang.

The most common approach in men with mild to moderate gynecomastia is a semicircular periareolar incision (similar to the nipple approach to breast implant placement in women), with direct removal of tissue supplemented by Vaser-assisted liposuction.

Gynecomastia Surgery FAQ’s

1. How do I know if I am a candidate for gynecomastia surgery?

Some of our selection criteria to include you as a gynecomastia surgery candidate include:​​

  • Excess breast weight/volume, overhang, bulging or other cosmetic concerns in the male breast
  • No medically treatable underlying cause based on evaluation and workup
  • General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions
  • No masses on breast examination – if you have a significant family history of breast cancer we may request a preoperative mammogram
  • Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
  • Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
  • Reasonable expectations of how much correction is possible with specific techniques

2. How long does gynecomastia surgery usually take?

Most gynecomastia surgical reduction procedures are about 2.5 hours in duration, depending on the incision approach, size of the breasts, degree of asymmetry, and other considerations. Mild cases treated by liposuction alone may take less than 2 hours.

3. What is recovery from gynecomastia surgery like?

Most gynecomastia reduction procedures are performed on an outpatient basis in a AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation. Patients usually spend up to a couple hours in the postoperative suite before being discharged in the care of a companion, family member or friend. Dr. Sayed gives a 24 hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.

Early postop recovery findings can include bruising and swelling, mild discomfort, fluid collections, numbness or diminished sensation in nipples, and some mental adjustment to the process of healing which most patients undergo. Most patients are advised to take a few days out of social circulation and we’d prefer that you not drive yourself in the first 10 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable but there may be a few that need to be removed at around 14 to 21 days postop. Occasionally, a patient may have a small fluid collection called a seroma in one or both breasts that may need a minor drainage procedure in the office to help resolve.

We ask that you abstain from exercise for 2 weeks and then return to light fitness routines after that. You will be asked to wear a surgical garment (like a compressive shirt) for several weeks, and it will be easiest for you if you wear button-down shirts (as opposed to polos or T-shirts you have to pull over your head) in the beginning. Dr. Sayed and his team provide close postop care in the office and with our remote engagement tools. You will be asked to take some supplement medications to aid in your recovery, which may include medications for pain, bruising, swelling, and dietary optimization.

4. How long do gynecomastia reduction results usually last?

Most male gynecomastia reduction patients have a long-lasting (several years to permanent) result, especially if their weight is stable and controlled. If you gain substantial weight, you may regain some fat in the breast even after extensive treatment. The glandular tissue removed does not generally return.

5. How can I prepare for my gynecomastia surgery?

  • Have a reasonable expectation of what surgery can accomplish
  • Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
  • Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
  • If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk
  • Designate a caretaker who can help you through the first 5 to 7 days after your gynecomastia reduction
  • Make plans to stay out of the gym for a couple of weeks
  • Identify whether any female relatives in your immediate family have any history of breast cancer

6. How much does a gynecomastia reduction cost in Southern California or South Florida/Miami?

We don’t like to publish pricing as it is subject to market changes and dependent on the types of procedures you consider. We do have a fee schedule available in the office after your consultation, and we can give you an estimate through virtual consultation tools available on this site like our Zwivel® page. Feel free to contact us for a pre-consultation and we are happy to provide more information. For gynecomastia patients, the main considerations are whether you need liposuction alone or in combination with direct excision, the size of the breasts and your weight (which impact how long you may be under anesthesia), and whether we need to send tissue to a pathology laboratory for testing after surgical removal.