I have been seeing more and more older male patients for ‘gynecomastia’ in the past several years. In the past, most of the males I saw with ‘chest problems’ were usually teenage boys who had the very typical adolescent form of gynecomastia. Some of these were quite small, isolated to the nipple-areola area, and others were quite large, having a B or C cup size breast equivalent to females. Surgical techniques included liposuction, open excision through the nipple, periareolar reduction methods, and rarely a more traditional form of breast reduction. These newer presentations of older gynecomastias (in reality, these are not really true gynecomastias but more accurately, pseudogynecomastias) present new challenges and require some adaptations to traditional gynecomastia approaches.

 
Some of these ‘newer’ gynecomastia are quite simple to treat. With the contemporary male model image of a very flat chest (I call it the Abercrombie Fitch look), some teenagers and men in their 20s and 30s want a small change in their chest contour by decreasing any projection of the nipple-areolar complex. Traditional liposuction, done aggressively under the nipple, works quite well for this small reduction.

The next gynecomasia problem is in the overweight patient who has a large chest and small pseudo breasts. Liposuction, with or without a superior crescent nipple lift, helps the chest contour but the nipple never really gets as high up on the chest wall as we would like. Similarly, the male who has lost a lot of weight usually due to bariatric surgery, poses a difficult problem due to the excess hanging skin. Proper nipple position can never really be obtained in these patients without a lot of undesired scarring.

Then there is the older male who has a combination of loose skin, low nipple position, and a ‘deflated’ chest appearance. Liposuction, nipple lifts, and occasionally pectoral implants can help rejuvenate the aged chest appearance. This is a problem of tissue volume loss and loose skin, the opposite of the younger gynecomastia patient.

 
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast Reduction Surgery for Gynecomastia  (Breast Enlargement in Males)

Breast reduction surgery is not just for women….although smaller in total number…..men get the procedure too! One of the most disturbing developments in a male is the development of breast mounds. This can occur during the male teenage years, when hormonal levels are changing, or when a man is older as a result of drugs, medications, or time and gravity. Rarely, although possible, is the development of breast enlargement secondary to an endocrine tumor or actual breast cancer. (about 1% of all breast cancers occur in men) Regardless of the cause, male breasts are psychologically very disturbing and often are visible through clothing. Many teenage boys, for example, will be reluctant to take a gym class or go to the pool in the summer for fear of ridicule. In older men, as popularized on the Seinfeld TV series, the concept of a ‘mansierre’ or a ‘bro’ garment is not too far fetched as the once proud chest area falls due to gravity and age.

The surgical treatment of male breast enlargement (gynecomastia) varies based on age and the type/amount of gynecomastia. In the teenage male patient, gynecomastia can be as slight as a protruding nipple area all the way up to an actual breast of a B or C cup size. We live today in an era of, what I call, the ‘Abercrombie Fitch look’, where the male teenager wants to have a smooth and very flat chest, including very little nipple projection. While most small gynecomastias resolve after a few years, if there is just a light residual nipple protrusion, the teenager wants it reduced. I have seen more and more of this over the past few years. These are simple to correct with a small incision at the bottom of the nipple and direct excision of the excess breast tissue. When the breast development is larger and the tissue is fairly soft, liposuction without the need for direct excision may be all that is needed. When the male breast is more like a female breast, however, these are the more difficult cases. The extra skin must be managed but without creating scars that run outside of the nipple. This type of ‘donut’ excision, with liposuction or direct excision, often requires several operations to get the best result. each time more skin is removed in the donut pattern until the chest area is fairly flat with the nipple in a more uplifted position. While it is possible to do these larger gynecomastias in one-stage with a large scar, all you are doing is trading off one undersired problem for another. The scarring will still have them self-conscious….and uncorrectable for a lifetime.

In older men, the gynecomastia problem is often quite different. It is more of a problem with saggy excess skin and less of a problem with a large amount of breast tissue. (sometimes) For these men, we must have a strategy to deal with the excess skin which often involves a donut excision pattern and a nipple lift, usually with liposuction to contour the chest. In some select patients, I have placed a pectoral implant with a nipple lift to provide better volume to a ‘deflated’ chest appearance. Either way, older male gynecomastia can eliminate the need for that ‘manssiere’ or the ‘bro’.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis