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