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