Man Boobs Surgery
Men with true gynecomastia will find the only permanent solution to their man boobs will be male breast reduction surgery. Depending on the type of man boobs will determine the best surgical approach. Men with mild to moderate gynecomastia may be candidates for the “light pull-through procedure” that is minimally invasive and performed with a small incision and a fast recovery. For men with severe gynecomastia, a two-stage procedure may be required. Pseudo-gynecomastia, where there is no breast tissue involved, may be performed with liposuction alone, or in some cases, a non-invasive an office procedure called “CoolSculpting” can give excellent results.
Puffy nipples are caused by breast tissue that is centered under the nipple areola-complex pushing the areola out and making them look “puffy.” This condition usually develops as boys go through puberty. Puffy nipples generally only last a few months but could be up to 2 years. However, a small percentage of these boys will find that their moobs have become permanent as they become adults. This devastating condition at a time when boys are developing can be very traumatic. If the condition is causing extreme psychological stress for the boy, many parents will opt for surgical solutions. As adults, many men will opt for surgical resolution. Depending on the severity of their moobs, these boys and men may be candidates for the “light pull-through procedure…
Men with moobs that are considered mild to moderate, and have good skin elasticity are potential candidates for the “light pull-through procedure.” With this minimally invasive procedure, a small ¼ inch incision is made at the edge of the areola. Liposuction is performed first to remove fat. After cutting connecting fibers of the breast tissue, the tissue is gently extracted with an instrument similar to a “pickle fork.” The advantages of this procedure are less surgery time, an almost imperceptible scar after healing, and usually, no drains are required.
For 75% to 80% of men with man boobs, the conventional surgery will be a combination of surgical excision of the breast tissue and liposuction. Liposuction is done first to reduce the fat in the chest; this is done through an incision next to the areola. Sometimes additional liposuction may be needed around the armpit area to achieve a smooth configuration with the chest. Next, an incision is made around the bottom half of the areola; special scissors are used to remove and shape the underlying breast tissue. During this procedure, the operating room table is elevated to 80 degrees so that the patient is almost in a sitting position. The chest can look very different when one is lying down; the goal is a natural look when standing. When surgery is completed, a drain is usually placed through a tiny incision in the armpit, for 3 or 4 days. The drain prevents a seroma or accumulation of fluids.
For men who have some redundant skin, a minor lift may be done at the time of surgery. The minor lift involves removing a crescent-shaped piece of skin just above the areola which will reduce sagging. A disadvantage of this lift is that the scar may be visible above the areola.
For men with extreme man boobs, and substantial loose skin, it may be necessary to do a secondary procedure. After healing from the original surgery, usually within 4 to 6 months, the periareolar lift, which can be done as an office procedure may be scheduled. With the periareolar lift, a donut shape of skin is excised from all around the areola and closed with purse string sutures. This incision heals very well and blends into the edge of the areola.
6 Months After 1st Stage
2 Weeks After Peri-Areolar Lift
Man boobs that are made up of fat alone and not combined with breast tissue respond very well to liposuction alone. If however, there is breast tissue present, and excision is not done, the gland will remain, and the outcome will be unsatisfactory. Many men with true gynecomastia are led to believe that liposuction alone can remove their moobs. These men end up seeking revision surgery which is now more complicated due to the scar tissue that formed after their first surgery.
There have been good results for men treated by non-invasive CoolSculpting. CoolSculpting freezes fat and the damaged fat cells are naturally sluffed off over a period of several weeks. This treatment is possible for men that have minor pseudogynecomastia only.
The main reasons for gynecomastia revision surgery are:
- Liposuction alone was performed without direct excision of the breast gland. Many surgeons attempt to reduce man boobs with just liposuction. There are many types of sharp cannulas that are designed to cut through the fibrous tissue; however, this rarely gets satisfactory results as it leaves too much tissue behind. Delicate sculpting of the chest is less precise, and the areola does not heal as well.
- Over resection, is where too much tissue and/or fat were removed leaving a “crater deformity.” When too much tissue and fat have been removed, the correction involves a fat flap, or fat transfer, that can be performed once the patient has healed from the first procedure.
- Under resection, is where not enough fat and/or tissue were removed. Under resection is one of the most common reasons for gynecomastia revision surgery. Many surgeons are concerned about removing too much tissue and causing a “crater deformity,” and so they err on the conservative side leaving the patient with unsatisfactory results.
Revision surgery takes the expertise of a gynecomastia specialist. Secondary surgery is much more complicated than the first procedure as now there is scar tissue that has formed making correction more complex. In addition, the skin will have less ability to contract.