Gynecomastia Surgery

Abstract

Adolescent gynecomastia can severely affect self-esteem. The cause is usually idiopathic. Anabolic steroids or dietary supplements are commonly implicated in bodybuilders. Gynecomastia can start with puberty, resolving on its own in most cases, or develop in older men as the balance of circulating testosterone and estrogens shifts toward estrogens.

Ultrasound or power-assisted liposuction is advantageous in removing fatty tissue from the breast. Many men having liposuction of the abdomen and flanks will also have the chest treated simultaneously. These patients may be satisfied with an improvement, if not correction, of their gynecomastia.

A combination of liposuction and direct excision is widely applicable. The traditional approach is periareolar because the scar is usually inconspicuous. A pad of breast tissue is preserved directly under the nipple/areola to prevent a depression deformity. Young men who have dense breast tissue or adolescent obesity, patients who present specifically for treatment of gynecomastia rather than an adjunct procedure done at the time of liposuction of the trunk, and bodybuilders are best served with a one-stage combination of liposuction and direct excision.

In cases of severe skin laxity (e.g., after massive weight loss), skin resection may be unavoidable. Nipple grafts are debilitating to this unique body part, and correct nipple siting can be a challenge. Just as in female breast reduction, nipples are best maintained on well-vascularized pedicles. This procedure is done no differently from a vertical breast reduction in a woman except that maximum breast tissue is removed.

Hematomas do occur. Over-resection is a common error, and can leave an unnatural saucer-like contour deformity. Fat injection may be used to treat contour depressions.