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Posts Tagged ‘gynecomastia’

Plastic Surgery’s Did You Know? King Tut and Gynecomastia

Sunday, September 16th, 2012

 

The most well known or at least the most publicized ancient pharaohs of Egypt, King Tut, ruled and died early. The demise of the young pharoah has always been a mystery and much speculation has centered around his cause of death from murder to accidents. But a recent theory based on medical evidence suggests that he died from a genetic condition of temporal lobe epilepsy. Based on art and figurines of how he was depicted, King Tut is consistently shown with highly feminine features, including enlarged breasts. His enlarged breasts indicates that he suffered from gynecomastia. What is the connection between the temporal lobe of the brain and gynecomastia and other feminized features? The temporal lobe is connected to parts of the brain that are involved in the release of hormones. Epileptic seizures are known to alter the level of hormones involved in sexual development. This might well explain the development of the pharoah’s large breasts. Scans of his body showed that he died from a fracture of his leg at the time of death. People with epilepsy have a much higher incidence of dying from accidents and falls and are more likely to die young. The art of the time also depicted him with a walking stick, also suggestive of leg injuries or impairment. Further clues is that King Tut’s predecessors and relatives also had early deaths as well as similar body features, including gynecomastia.

Open Excision of Areolar Gynecomastia for the Puffy Nipple

Thursday, July 15th, 2010

Gynecomastia is defined succinctly as male breast enlargement. While this description is accurate, it is overly simplistic. Gynecomastia is a wide spectrum of male breast problems caused by the growth of excess male breast tissue. This can range from the smaller areolar gynecomastias (puffy nipple), up to a size that resembles a large droopy female breast (giant gynecomastia), to a deflated sac of skin and sagging nipple. (elder gynecomastia) The quest for younger males is a completely flat chest with no nipple protrusion.

One of the unique types of gynecomastia that is rarely discussed is that seen in the younger male which may be small but is very firm. Generally seen in men between late teens and mid-thirties, it presents as a discrete swelling under and around the nipple. It is very firm and nodular. These male patients will usually have a history of some drug use in the past, whether it be steroids, growth hormone, or other anabolic supplements. They can be patients who were treated for a medical condition in the past, such as congenital adrenal hyperplasia, or may be bodybuilders or very athletic.

In presentation, this type of gynecomastia is not large and is fairly small. The actual firm mass underlying the areola is not large and it is fairly discrete, although bothersome to the patient. Many men may not be that bothered by it but young body-conscious males are very aware of it. This is particularly relevant in today’s male culture where a very flat chest contour is desired. Even a slightly puffy nipple stands out by these standards. For bodybuilders, this nipple mass is accentuated on flexing and in certain poses.

It is important to appreciate that although this areolar mass is small, it is not able to be removed adequately by liposuction. It is tempting to do so and I have tried because it seems like it should be easy to extract. I have not been successful even with laser liposuction. (Smartlipo) It can be reduced but not flattened sufficiently to the satisfaction of these male patients.

The firm consistency of the young male areolar gynecomastia requires that it be removed by an open excision technique. Through a lower areolar incision, the mass can be easily excised in a circumferential manner around the base of the areola. The firm dense consistency of the mass can be quite surprising. While it is important to remove as much as possible, one must be careful to not remove too much, ending up after healing with a nipple indentation. Some tissue must be left on the underside of the nipple to prevent this potential complication. Depending on the size of the excision cavity, a small drain may be used for several days after surgery. If the underlying space is not too large, the ‘dead space’ can be tacked down and reduced so a drain is not necessary. The areolar incision is closed with internal dissolveable sutures and taped. A circumferential chest wrap is worn for several weeks after surgery.

Dense areolar gynecomastia is best approached by doing open excision. Liposuction is tempting but will not be successful as the consistency of the mass is too dense.  

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions About Gynecomastia Surgery

Sunday, January 3rd, 2010

1.      What is the difference between teenage and adult gynecomastia?

 

Gynecomastia, or male breast enlargement, can occur at any age. It is most commonly seen in teenage males after undergoing puberty. The breast tissue often responds by becoming larger and more noticeable. While many teen age gynecomastias do go away and the chest gets flatter again, this does not occur in all male teenagers. If the enlarged breast tissue has not gone down by age 15 or 16, it is not likely to go away. A parent should consult with their pediatrician first to be sure that there is not a treatable cause. (endocrine disorder)

 

Adult male gynecomastia is different in numerous ways. Breast masses, particularly if they are just on one side and painful, should be evaluated to rule breast cancer. (about 1% of all breast cancers do occur in men) Older men can develop gynecomastia  as a result of the medications that they take for prostate enlargement and in the treatment of some cancers. Older men also develop chest sagging or drooping as well as some breast enlargement as their testosterone levels fall.

 

2.      At what age should a teenager undergo surgery to correct their breast enlargement?

 

My personal approach is to treat the gynecomastia when it is psychologically disruptive to the teenager. I don’t think it is necessary to wait until they are 17 or 18 to see if it goes away. While age 12 or 13 is too young, if the breast enlargement has not changed by age 15 or 16, then a plastic surgery consultation is in order. If the breast enlargement is going to really go away on its own, a substantial change will be apparent by that age. From a psychological perspective, I have seen numerous teenage boys that have suffered too long and could have had surgical correction earlier. 

 

3.      Will my insurance cover the costs of gynecomastia surgery?

 

Insurance coverage for gynecomastia  requires an insurance pre-determination process. After an initial consultation, your plastic surgeon will write a letter complete with photographs to them. They will use that information to either approve or deny coverage. My experience is that the success rate for insurance coverage is in less than half of the cases. Some insurance companies even specifically exclude gynecomastia surgery from their policies. Adolescent or teenage gynecomastia has a much better success rate than that of adult men.

 

 

4.      What is the best method to treat gynecomastia, liposuction or open excision?

 

Liposuction and open excision are two methods to treat gynecomastia. Sometimes they are done alone and in others both are used in a single surgery. Which one is used will depend on the size of the gynecomastia and how firm or soft the breast tissue feels. For small breast tissue enlargement that is just around the nipple, a simple open approach with an incision around the lower half of the nipple is used to cut it out. If the gynecomastia is larger and soft, then liposuction alone may be sufficient. In gynecomastias that have sufficient size but have a harder feel under gthe nipple, then a combination of liposuction and excision is done.

 

In very large male breast enlargements (where an actual breast mound exists), another issue to consider is what to do with the extra skin. Some form of skin reduction needs to be done to lift the nipple, make it smaller, and tighten the chest skin as well. Because skin reduction causes scars, reduction of breast mound skin is usually done by keeping the incision and cut-out around the nipple. Older gynecomastia techniques used more traditional female breast reduction scars which should be avoided due to poor and very noticeable scarring.

  

5.      When can I return to exercise and working out after surgery?

 

That will depend upon what type of gynecomastia surgery one has. If liposuction alone is used, one could return to working out within 10 to 14 days. If any form of open excision  with or without skin reductio, is used, one should wait a full month after surgery before stressing the chest tissues. This will help prevent any build-up of fluids (seroma)that could occur.

 

6.      What is the difference between gynecomastia and  ‘man boobs’?

 

There is no difference. Man boobs is a slang or urban term for gynecomastia. It is used very unflatteringly across the internet with numerous so-named websites dedicated to mocking this unfortunate and embarrassing male condition.

 

7.      Will I need drains after my surgery?

 

In cases where open excision is used, yes. The drains will stay in for 3 to 5 days after surgery. When liposuction alone is used, drains are not necessary.

Dr. Barry Eppley

Indianapolis, Indiana

Common Questions about Breast And Body Contouring on Indianapolis Doc Chat Radio Show

Saturday, January 2nd, 2010

On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from noon – 1:00PM on Saturday afternoon, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Common Questions about Plastic Surgery was aired. Today’s topics covered were body plastic surgery. Using the seven most common questions that Dr. Eppley receives from his practice on breast surgery, tummy tucks, and liposuction, the show answered these questions in detail for the listeners. The following questions answered were:

 

Breast Augmentation

1. Can a woman breast-feed after breast augmentation?

2. Is it true that there is usually no loss of sense of touch of the nipples?

3. Can implants achieve some lifting of sagging breasts?

4. What about getting insurance to pay for the breast augmentation?

5. Will my breast implants feel like natural breasts?

6. What is the difference between breast implants placed under the pectoralis muscle and implants placed under it?

7. Will smoking affect my recovery?

Breast Reductions

1. Will my insurance cover the cost of breast reduction?

2. Why are some women unhappy with their breast reduction surgeries?

3. What are the different Breast Reduction Procedures and Incision Patterns?

4. How do you determine the size of the nipple/areola complex?

5. Do you prefer to use drains? If so, when will the drains be removed?

6. Will I stay overnight?

7. What type of anesthesia is used during the Breast Reduction procedure?

Gynecomastia

1. What is the difference in breast enlargement in younger vs. older men?

2. What is the best  method for treating gynecomastia?

3. Will insurance cover my gynecomastia surgery?

4. Can gynecomastia be treated by liposuction alone?

5. How long after surgery can I work out and exercise?

6. Is gynecomastia the same as ‘man boobs’?

7. Will breast enlargement recur after surgery?

Breast Lift

1. Are the results from a breast lift permanent?

2. Why would I want a breast lift?

3. What should I expect during breast lift surgery?

4. Where will the surgery most likely take place?

5. When can I return to work and strenuous activity?

6. Will I require any blood transfusions during breast lift surgery?

7. Is it possible to have my insurance cover my breast lift surgery?

 

Breast Reconstruction

1. What are the techniques of breast reconstruction?

2. What Are the Alternatives to Breast Reconstruction?

3. Can I Have Breast Reconstruction with Breast Implants?

4. When is the best time to do breast reconstruction?

5. Where are the scars after breast reconstruction?

6. Can breast cancer come back after breast reconstruction?

7. Is breast reconstruction surgery painful?

 

Tummy Tuck

1. How can one minimize the risk of complications associated with a tummy tuck?

2. How does abdominal liposuction differ from a “tummy tuck”?

3. What are the advantages of a tummy tuck (compared to liposuction)?

4. What are the disadvantages of a tummy tuck?

5. When is liposuction sufficient and when is a tummy tuck necessary?

6. If liposuction is safer, what are the reasons for doing a tummy tuck?

7. Are tummy tucks covered by insurance?

 

Liposuction

1. Who is a good candidate for liposuction surgery?

2. What Alternatives Are There to Liposuction?

3. What type of liposuction is the best?

4. What is Tumescent Liposuction?

5. How long does Liposuction surgery take?

6. What anesthesia is used with Liposuction?

7. Who is qualified to perform Liposuction?

Free Plastic Surgery consultations with Dr. Eppley can be arranged by calling his Indianapolis suburban area facilities at IU Health North or IU Health West Hospital at 317-706-4444 or sending an email inquiry to: info @eppleyplasticsurgery.com.

Man Boob (Gynecomastia) Reduction in the Young Male

Saturday, December 26th, 2009

The condition known as ‘Man Boobs’ is getting a lot of attention in the media recently. Known medically as gynecomastia, any enlargement or expansion of an otherwise flat chest in a man is being given this unflattering name. The man boob problem is a wide spectrum of chest wall deformities that are just as variable in appearance as breasts are in women. While being overweight is certainly associated with excess chest tissue, I have seen many patients in my Indianapolis plastic surgery practice that have ‘man boobs’ and are not overweight or significantly out of shape.

Numerous websites and e-articles tout that gynecomastia can be treated with weight loss or pectoral or chest exercises. While this approach may have some benefit in the overweight male, it will not get rid off excess breast tissue in an otherwise weight-appropriate body frame. While diet and exercise can reduce overall body fat, it is much more challenging to try and achieve spot reduction on the chest wall. The type of fat that is on the chest is of a different consistency than that of the abdomen, for example. It is more of a fibrofatty tissue particularly around the nipple-areolar complex. Such tissue type is more resistant to typical metabolic fat reduction approaches.

 Gynecomastia in the younger male can be classified into four types. Types 1 and 2 are when the breast tissue enlargement is limited to just underneath the nipple (1) or fans out to within four and 5 cms from the nipple. (2) Types 3 and 4 are much larger and become more mound-like as is characteristic of a female breast. An important determinant of the proper treatment approach is how this breast tissue feels. Is it soft and squishy or does it feel like a harder lump or mass?

Two plastic surgery operations exist to treat these younger forms of gynecomastia. The first is the exclusive use of liposuction. This is a very effective approach when the breast tissue is soft, regardless of its size. Through a small incision (3 to 4mms) on the side of the chest wall, the equipment to do liposuction can be introduced. No incision is needed around the nipple. While there are advocates for different types of liposuction, I find the Smartlipo (laser-assisted liposuction) is ideal for the fibrofatty tissue of the male chest. By first liquefying the tissue site and getting the internal temperature to just under 50 degrees C, significant tissue can be removed. While this tissue was always more difficult to remove adequately with traditional liposuction, Smartlipo makes the process more effective. The heating of the underside of the skin allows for some contraction, particularly of the areola which is often enlarged from the breast tissue expansion.

When the breast tissue is more firm or a specific lump can be felt, open excision needs to be part of the surgery. Through an incision on the lower half of the areola, breast tissue can be directly removed. Sometimes this may be all that is needed in Type 1 gynecomastia. But in type 2, the open excision must be combined with liposuction to feather the edges of the excised area out for a smooth chest contour. In some uncommon Type 2 cases, the areola may be excessively enlarged in diameter. When this exists, the open excision can be combined with an areolar reduction through a ‘donut’  excisional technique.

Smaller amounts of gynecomastia in the young male can not usually be reduced with any form of exercise or dieting, particularly if one is not overweight. Laser liposuction and scar-friendly excision can solve these gynecomastias with one hour of surgery. Recovery is fairly quick with the need to only wear a narrow chest wrap for a week or two. One can resume running in two weeks and weight lifting in three weeks.

Barry L. Eppley, M.D., D.M.D.

Indianapolis, Indiana

Scarless Male Breast Reduction with Smartlipo

Wednesday, October 14th, 2009

is a much more common condition than many men realize. While it is manifest by developing excess tissue in the breast. it also has varying degrees of nipple and chest skin deformities. Often the amount of chest skin and nipple position determines the quality of a gynecomastia reduction result. In any case, it is an  embarrassing condition for both teenagers and older men alike.

For gynecomastia that consists mainly of fat or breast tissue deposits, liposuction would be the appropriate treatment. Because of the density and increased fibrous tissue of male breast tissue, traditional liposuction is effective but not ideal. It can take a far amount of trauma to maximally loosen up the tissue to be aspirated. At the least, this results in significant bruising and discomfort…as well as the risk of not removing enough breast tissue.

Dense fat is better removed with a method liposuction that relies on other mechanisms to break up the tissue than just mechanical trauma alone.  Such a technology is Smartlipo. Using directed heat and the concept of heating tissue zones to a set temperature, more breast tissue can be removed in a less traumatic fashion. There may also be some heating benefit on the skin resulting in some shrinkage and tightening, although never enough to be a substitute for chest skin tightening through skin removal.

In those men that have breasts which contain a combination of fat and glandular tissue which is particularly dense under the nipple, many surgeons feel that liposuction alone is not adequate. The use of open incisions around the nipple is often used to remove this glandular tissue, often causing unsightly scarring or inversion of the edge of the nipple from scar contracture.

Having worked with Smartlipo in my Indianapolis plastic surgery practice for a while now, I have found that open excision of subareolar glandular tissue can be avoided with its use in some cases. Some have dubbed this scarless male breast reduction.

By using Smartlipo only, it is possible to now break up hard glandular tissue and remove it through the suction cannula used to perform liposuction. This procedure takes about an hour or so to do. Depending upon the patient, their age, and transportation issues, it can be done with either a local,twilight anesthesia or general anesthesia  on an outpatient basis. Most scarless male breast reduction patients can return to a sit down job within days or a more strenuous one in several weeks. There certainly will be some discomfort but the heat from the laser makes it less than what I have seen with traditional liposuction. There is no question in my experience that the pain and bruising is definitely less.

The concept of scarless male breast reduction refers to avoiding any incisions around the areola. There does have to be some small entrance sites for the laser probe but these are at the sides of the chest wall. These incisions are left open to drain after surgery which is different than traditional liposuction. They will drain for 24 to 48 hours and consists of liquified fat (oil) and some blood. This drainage is actually a good (but potentially messy) thing as otherwise it would have to be absorbed by the body which would prolong swelling and bruising. Under the applied chest wrap at the ene of the surgery are absorbent pads to catch this drainage. These small scars close down quickly and actually heal the same later as if they has been sutured.

Dr. Barry Eppley

Indianapolis, Indiana

Nipple Reduction and Areolar Gynecomastia Treatment in Men

Tuesday, July 7th, 2009

Gynecomastia (male breast enlargement) comes in many forms, from a large almost female looking breast to just a scant amount of excessive nipple or areolar projection. In my Indianapolis plastic surgery practice, I have seen more ‘minor’ cases of gynecomastia in the past few years. In these minor expressions of gynecomastia, there is a special subset in which the main aesthetic problem is that of excessive nipple projection.

 

 

Excessive nipple projection can occur in the teenage years as well as in the older male as well. The prevalence in the younger teenage and young male patient has a lot to do with cultural influences to which we are exposed today. The current appearance of the male models that are used in advertising show a chest that is both hairless but very smooth including a flat nipple. I call this the ‘Abercrombie Fitch’ look which helps drive a young males perception of attractiveness. As young male are often shirtless given their activities, this look can be very influential. Older male, conversely, are primarily bothered by the protrusion of the  nipple that can be seen through shirts.

 

 

In many cases, this nipple and areolar protrusion may or may not be part of an underlying mild gynecomastia. Some men merely have hyperactive nipples or more promiment nipples than others. In other cases, there may be a small or areolar gynecomastia that pushes the nipple forward by volume displacement.

 

 

Correction of these nipple and areolar protrusions are quite simple and uncomplicated. If the areolar is flat, but the nipple is undesiringly protrusive, a simple nipple reduction can be done. This is done by taking a wedge from the center of the nipple and closing it, making the nipple flat and permanently disrupting its ability to stick out any further. Some nipple sensation will be lost but this is usually irrelevant in a male. If the  areola is protrusive, then breast tissue must be taken out from underneath it. Through a semi-circular incision on the bottom part of the areola, the nipple and areola is lifted up and a wedge of tissue is removed. The amount of tissue removed should be sufficient enough that there is a slight indentation at the time of closure.

 

 

Both nipple reduction and areolar gynecomastia are simple outpatient procedures that have virtually no recovery and only a short limitation from strenuous activities after. Both heal with virtually no detectable scarring and consistent aesthetic improvement.

 

 

Dr. Barry Eppley

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

 

 

 

 

Severe Gynecomastia Treatment – Large Male Breast Reduction

Tuesday, June 2nd, 2009

Gynecomastia, or male breast enlargement, is a not uncommon problem experienced by young men. It is particularly common in teenagers and males who are overweight as there is a correlation between breast tissue enlargement and weight. While many gynecomastias are relatively small and can be easily ‘cured’ with a single operation with liposuction or excision, more severe cases pose more difficult problems.

 

When gynecomastia becomes large and a real saggy breast is the result, this problem defies a single operative solution or a final satisfying ideal solution. Unlike the female breast, where reductions and lifts leave scars but they are on the bottom side of the breast, the goal of gynecomastia surgery is a flat chest without a breast. Any scars that are placed on the skin, with the exception of the lower chest crease (inframmary fold), are going to be very apparent. Combine that concern with the amount of breast tissue and skin that is present mandates that a different approach be taken for these more massive gynecomastia problems.

 

I have found that the most satisfying method is to use a modified mastectomy technique. By removing the nipple first as a full-thickness graft, the large overhang of breast tissue and skin can be removed placing the scar along the inframammary crease. The superior skin flaps can be thinned out of breast tissue so that only a centimeter or two are left on the skin flap. When closed along the inframammary fold, a dramatic flattening of the chest can be easily obtained. The nipples are put back as skin grafts into a measured position that is optimally oriented. I must be careful to not get the nipples placed too high or too close to the sternum. This will look very unnatural.

 

This approach leaves scars along the lower breast crease and around the nipple which is very acceptable given the magnitude of the original problem. Free nipple grafts always lose considerable pigment which is most apparent in darker skinned patients. But color tattooing can easily be done later. This depigmentation is a small price to pay for a very flat chest result and good nipple positioning.

 

A variation of this technique is to leave the nipples attached to the underlying breast tissue and leave them as a pedicled nipple flap. But this usually means that there will remain some fullness to the chest as the flap needs a certain thickness for the nipples to survive. This can always be liposuctioned down later.

 

Dr. Barry Eppley

Indianapolis, Indiana

Gynecomastia (Man Boob) Reduction – Matching the Operation to the Problem

Monday, May 11th, 2009

For younger or older men with severe gynecomastia (man boobs), plastic surgery is the only effective option. Regardless of age, the amount of extra skin you have is the single most important determinant of what type of procedure would be effective. Extra skin can not be made to go away, in most cases, by breast tissue or fat removal alone.

In the younger patient, particularly a teenager or in your twenties, the amount of extra skin may be quite small but the breast tissue enlargement is the main problem. In these cases, liposuction alone may be all that is needed to get a flatter chest. You can tell this on your own by looking at your chest and looking at the position of the nipple. If it is in a good position on your  chest wall and is located in the center of the enlarged breast mount, then taking down the mound with liposuction alone will probably work well. While there are different types of liposuction techniques, I find that Smartlipo (laser liposuction) works best for me because the heat generated by the laser does a good job of cutting through tough tissue, melting fat, and helps in some skin tightening.

If these is extra skin (as noted by a hanging or low positioned nipple…or if your nipple is pointing downward) then liposuction alone is not going to create the result you are after. It will deflate the balloon, so to speak, but will also cause a greater sag of skin and a nipple that may hang even lower. In teenagers and young men with significant breasts that actually could have a cup size….or in older men where sagging skin is the real culprit, the extra skin must be dealt with through excisional methods.

How to deal with the loose skin is the real art form and expertise of gynecomastia surgery. It is all about the skin removal pattern and what types of scarring can the male patient live with. This is largely determined in my experience by whether one wants to look better in or out of a shirt. Those are very different objectives. These are several main types of gynecomastia skin removals (all of these are done in combination with liposuction to remove breast tissue and fat as well) that either result in a scar above or around the nipple (areola technically) or scars that lie along the lower breast crease and around the nipple. The amount of extra skin and how much the nipple sags determines which method may be better.

How many operations one wants to have will also have a bearing on what method is used. For severe gynecomastias, one operation methods (with more prominent scars) will be different than those who want to limit scarring and are not opposed to going through a staged gynecomastia surgical approach.

Gynecomastia presents in many forms in both young and older men. While simple gynecmastias can be easily treated by liposuction, complex and severe forms of gynecomastia require thoughtful preoperative planning to strike a balance between scarring, number of operations, skin removal methods, and an acceptable final result.

Dr. Barry Eppley

Indianapolis, Indiana

 

 

 

 

Reshaping the Chest in Men with Severe Gynecomastia

Sunday, January 18th, 2009

In men who have lost a lot of weight or in overweight men in general, breast enlargement is a common problem and concern. As a general rule, these forms of more severe gynecomastia are not just about having large breasts but having breasts that are large enough to have significant sagging. This form of gynecomastia poses much different problems than lesser degrees due to the low nipple position and excessive hanging chest skin. While traditional forms of gynecomastia respond well to liposuction or open excision through a nipple incision, these more complicated forms will not.

The fundamental surgical concept that must be incorporated in improving this form of gynecomastia is that of a breast lift…..and the scars that will be created. Not only must breast tissue be removed, but skin as well. In addition, the nipple must be repositioned and the overall chest reshaped to be as flat as possible rather than end up looking like a female breast mound. When breast lifts are involved, it is all about how much the nipple must be moved upward and how much scar can be tolerated to achieve this reshaping.

The most effective radical gynecomastia procedure is a simple mastectomy with free nipple grafting. Unlike a mastectomy for female breast cancer which would leave a straight line scar across the center of the chest, the ‘male mastectomy’ removes the overhanging breast tissue and places the scar along the inframammary fold, which is in a more natural skin crease. The nipple is first removed and then put back as a skin graft in a farther northern position at the end of the procedure. While nipple sensation will be lost (which isn’t that useful to most men anyway) and the nipple will never look quite normal, this approach is the most assured way to get a dramatic improvement in a single operation.
Using the traditional anchor or inferior pedicle approach is another radical gynecomastia surgical approach. This is the least desireable from a scar aesthetic standpoint (vertical and horizontal scars are more obvious) but its primary benefit is that it keeps the nipple alive because of the underlying attached pedicle. Because you can’t thin out the breast tissue under the pedicle very much, for fear of having the nipple die afterwards, a second liposuction procedures may be needed to bring the chest mound prominence down further.

The most aesthetically pleasing, but the most difficult gynecomastia operation to perform, is the periareolar (around the nipple skin excision or donut procedure) operation. The whole purpose of this approach is to not only keep the nipple alive but keep the scar limited to around the nipple only. What makes it difficult is not the surgery per se, but that it will take at least 3 and sometimes 4 operations to get the final result. Only some much skin can be removed in a donut fashion each time as well as only so much breast tissue. This is a long road to go in severe gynecomastia cases and poses some obvious economic hardships. But for those men who want the least scar possible, this is the only way to go.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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