Gynecomastia Surgery Info

For those contemplating surgery - Words of caution and encouragement

The goal of this site is to secure an excellent result with your surgery.

38% of patients are unhappy with their elective gynecomastia surgery result

Don’t be a victim - Do your research and prepare yourself.

This website is tailored to those researching about having a gynecomastia cosmetic procedure. This single-page guide as well as various articles cover a vast scope of the gynecomastia surgery, revisions, expectations, doctors, bad outcomes, reviews, and the cosmetic industry in general. There is a lot of information to cover for such a short surgery, but the potential results will last forever and it is important that the consumer is well informed. Much of the information available is filtered and does not show botched procedures, nor does it cover how manipulative the plastic surgery industry is. I went through two surgeries and my best word of advice is this: Question everything

Some of these pages contain somewhat graphic material such as a bare male chest or healing tissues.

Self-Assesement

Do I have Gynecomastia

Gynecomastia is a popular affliction in the world population, but it is completely normal. Surgery is never needed in order to live a perfectly normal life. The prevalence of gynecomastia is 60%–90% in adults, 50%–60% in adolescents, and up to 70% in men aged 50–69 years. It is extremely common, so chances are that you the reader have gynecomastia. The vast majority of males do not seek plastic surgery for treatment, however gynecomastia surgery has increased 32% from 2017 vs 2000

Gynecomastia is a combination of fat and glandular tissue. It does not matter if it is from breast tissue or fatty tissue. It is more common to have both since the breast tissue is intertwined with the gland.

You cannot necessary “feel” for a hard lump and claim gynecomastia

Even the most experienced surgeons cannot determine this before actually cutting into the skin and examining the tissue. All men have breast tissue. It is only when that tissue grows beyond your comfortable level that it becomes objectionable.

Sometimes breast tissue can feel firm and fat feel soft – and other times the fat can feel firm and the breast tissue feel soft. Even a surgeon’s educated hands can be wrong. It is therefore a fool’s errand to try to self diagnose one’s gynecomastia by simply feeling the chest. Gynecomastia New York

It is not a question of whether you have gyne or not – it is a question of whether you can live with it or not. Dr. Jacobs

If you are overweight, then simply lose weight and reevaluate later. It is impossible to differentiate fat from gland when the body is carrying excess fat on the chest from general weight gain. Surgery may not be warranted and having surgery at a non-ideal weight may present poor results when the weight is lost. Save your wallet and save your time. Hit the gym!

What Causes Gynecomastia

There are a few common causes of gynecomastia, of which the most common natural cause is due to puberty. Nearly 99% of the time it is a benign case

Gynecomastia can occur normally during three phases of life.

  1. Occurs shortly after birth. It can persist for several weeks after birth and can cause mild breast discharge called “witch’s milk”
  2. During puberty. Up to 60% of boys have detectable gynecomastia by age 14. Pubertal gynecomastia usually resolves within 3 years of onset.
  3. The third age range in which gynecomastia is frequently seen is during older age (>60 years). Evidence suggests that it may result from increased peripheral aromatase activity secondary to the increase in total body fat, coupled with mild hypogonadism associated with aging.

Men who are extremely young and still developing ( <20 years of age) should consider waiting until their body and hormones have stabilized. Of course, there are always exceptions and some teenagers breasts will not retract to a masculine contour even after weight loss and age.

Here is a flow chart to help decide the cause of your gynecomastia. Surgery is also an option that isn’t reflected in this diagnostic chart from The American Family Physician

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Here is another paper about causes

Below are some factors that could be causing your gynecomastia. This study is a must read for those that want an in-depth review of the causes of gynecomastia. Most of the material in this section is gleaned from that extensive publication.

Drugs

Around 20% of gynecomastia is caused by medications or exogenous chemicals. There are many drugs such as Propecia, Risperdal, SSRIs, Spironolactone, and steroids that have gynecomastia listed as a side effect. They increase endogenous estrogen production or they supply an excess of an estrogen precursor (e.g. testosterone or androstenedione) which can be aromatized to estrogen.

A full list of offending drugs can be seen in table 2 in this study

Hormone Levels

Estrogen and progesterone act in an integrative fashion to stimulate normal adult female breast development. Estrogen, acting through its ER receptor, promotes duct growth, while progesterone, also acting through its receptor (PR), supports alveolar development. Hormones affecting growth and differentiation of breast tissue

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It is advisable to see a general doctor and endocrinologist to perform a blood test. An endocrine panel can then be ordered. Some common factors to look at would be:

  • Testosterone (free and total)
  • Estradiol
  • FSH (Follicle Stiumulating Hormone)
  • LH (Luteinizing Hormone)
  • Prolactin
  • TSH (Thyroid Stimulating Hormone)

These tests should be taken as early in the AM as possible before eating. Testosterone spikes in the AM and quickly diminishes as the day goes on. These levels can help determine if low testosterone and high estrogen are causing a hormone imbalance and hence breast tissue development. A great subreddit on low Testosterone exists for people exploring their results. Low T != breast development such as in my case. A stable hormone profile, healthy diet and BMI with a noticeable case of enlarged breast may then warrant a consideration into surgery.

Diet

Malnourishment can cause gynecomastia due to decreased gonadotropin and T levels, coupled with normal production of estrogen from the adrenal glands. Patients who develop re-feeding gynecomastia are therefore often described to be undergoing a ‘second puberty’.

There are no definite studies that show soy products cause gynecomastia. There have been only singular reports on modified gender-related behavior or feminization in humans in consequence of soy consumption. In animals, the intake of phytoestrogens was reported to impact fertility, sexual development and behavior. Feminizing effects in humans can be subtle and identifiable only statistically in large populations

Certain Syndroms

Male hypogonadism and Klinefelter syndrome can lead to decreased T production. Klinefelter’s syndrome is associated with gynecomastia in approximately 80% of cases and is the only cause of the condition that additionally causes an increased risk of breast cancer.

Stress

Increased stress can stimulate the adrenal glands to secrete excess estrogen precursors.11 Increased serum cortisol and E2 levels, combined with decreased serum T, have been reportedin patients under extreme stress. Stress can also cause a decrease in T levels and an increase in estrogen. Daily strenuous exercise is an easy way to elevate testosterone levels.

Hyperthyroidism

Gynecomastia is observed in 10-40% of males with Graves’ Disease. You can easily get your thyroid stimulating hormone (TSH) level checked by a routine blood test. General doctors will set a wide range of acceptable. An endocrinologist will give a better insight as to what is low or normal.

Gynecomastia Treatments

Although no medical treatments cause the complete regression of gynecomastia, they may provide partial regression, or symptomatic relief. Several agents regulate the hormonal imbalance that is thought to cause the gynecomastia. However, most clinical trials evaluating their efficacy and effectiveness are small and uncontrolled. The major medical intervention options are androgens, anti-estrogens and aromatase inhibitors. These still come with their inherit risks and should be monitored by your general doctor, or better yet an endocrinologist or urologist.

Diet, weight loss, and exercise should be the initial attempt. Cutting your body fat to less than 12% will give a good indicator if surgery is warranted or not. Being overweight may give a false positive of needing surgery.

Lastly, surgery is the last resort option. It is the “gold standard” of treatment. Fat tissue that has been removed will not produce new cells and gland tissue will have a smaller change of recurrence assuming hormones are kept in balance.

Gynecomastia Pills

I wanted to mention this because it seems to be a top google search term related to gynecomastia.

No products exist on the market that have any clinical studies showing their efficacy in diminishing existing signs of gynecomastia. Some supplements may mitigate the breast tissue from growing further such as DIM (Diindolymethane) as well as stopping steroids and other hormone-inducing breast development. Buyer beware when it comes to these magical pills.

The FDA is not authorized to review dietary supplement products for safety and effectiveness. FDA

There are plenty of websites that eagerly attempt to blog about these. You should hover over the hyperlink or copy the URL form which these products are being sold and notice the referral link. It is common for websites to make money off of referral purchases even though the products they are pitching are essentially snake oil. Buyer beware!

Here is one such example of a website attempting to sell these snake oils.

Notice how this page contains fantastic before/after pictures of males who were supposedly taking a product called “gynectrol”. Now browse to Dr. Mordcai Blau’s website, a well-known NYC gynecomastia expert, where he show cases his post-op results. Notice how the background is the same color and some of the exact patient photos were stolen and marketed under a gynecomastia cure pill!

The “gynexin.com” link also contains a referral link:

http://react.go2cloud.org/aff_c?offer_id=75&aff_id=1299&url_id=48

Don’t be fooled. No one would undergo an expensive surgery if some simple pills would cure the condition - myself included.

Surgery

When medical therapy, diet, exercise, and hormonal imbalance replacement therapy is ineffective, particularly in cases of longstanding gynecomastia, then surgical therapy is appropriate. Surgical treatment should be postponed in pubertal gynecomastia.

Surgical treatment includes removal of glandular tissue coupled with liposuction. Severe cases require skin excision. Properly performed gynecomastia can be done in minimal scar techniques. The anesthesia options are local, local with IV sedation (most common), or general. Please continue reading below on how to maximize your chances at getting a great result if you do proceed with surgery.

As noted above, great surgical results with gynecomastia are actually rare. One must be extremely careful when deciding to get surgery. Choosing an excellent doctor and following all post-op instructions as well as great wound care should get you a great result. You must first do your research. Please read on.

Psychiatric Evaluation

It is a good idea to first get professionally evaluated by a specialist to ensure that you do not have body dysmorphic disorder. It is a condition most males don’t think of having until they get the procedure done and the results are either sub-par and they go into a spiral of depression or the results are good and they still refuse to accept their own “new” self.

Cosmetic surgery is a commonly sought treatment for individuals with BDD, with 26%-40% of individuals with BDD pursuing cosmetic surgery bdd. Around 7-15% of all male cosmetic patients are estimated to have BDD. Although the symptoms of body dysmorphic disorder might sound trivial, high proportions of patients require admission to hospital, become housebound, and attempt suicide.

In a sample of individuals with BDD who received surgical and minimally invasive procedures for their appearance concerns, 25% showed a longer-term improvement in their preoccupation with the treated body part, but only 2.3% of surgical and minimally invasive procedures led to longer-term improvement in overall BDD symptoms (Crerand, Menard, & Phillips, 2010). This means that obsessing over your chest may not resolve even after surgery.

In another study, 13.1% of all patients undergoing plastic surgery have BDD. Even worse than this study is that 1 in 3 males have BDD who seek cosmetic surgery! It is important that you are evaluated. Do not leave it to the plastic surgeon to determine this for you since they have an obvious interest in getting you on the operating table.

In a survey of 265 cosmetic surgeons, only 30 percent believed that BDD was always a contraindication to surgery

They also note that in a survey of 265 cosmetic surgeons, 178 (65 percent) reported treating patients with BDD, yet only one percent of the cases resulted in BDD symptom improvement

2% of cosmetic surgeons indicated that they had been physically threatened by a patient with BDD (Sarwer, 2002).

Where to get help

Please see the bdd.org website in finding someone who can help you. You must not see a general therapist for help. Seek a qualified practitioner that specializes in BDD!

There are two treatments. SRIs (serotonin reuptake inhibitors) and CBT (Cognitive Behavioral Therapy). The latter should be the front-line treatment.

Here is also another good resource

Surgery

So you’ve decided that surgery is the best route for you to take. There are LOADS of information a consumer must understand before deciding who to choose to perform the operation on you. The cosmetic industry is UNREGULATED, which means the consumer must bear full responsibility in selecting a qualified surgeon and facility. Insurance companies are not involved at all. The procedure for selecting a good cosmetic doctor is vastly different than selecting an orthopedic doctor for example. Insurance companies mandate certain restrictions before covering a procedure such as board certification, residency requirements, facility accreditation, etc. None of these checks are performed automatically.

Doctor selection is the #1 most important factor that influences a favorable outcome

Gynecomastia Surgery is Rare

First, one must understand that Gynecomastia surgery is rare. How rare exactly? Male patients who undergo plastic surgery for Gynecomastia are literally in the 1%. We already know that only 8% of all cosmetic procedures are male. Gynecomastia procedure is even rarer.

The following statements in this section are derived from the statistics gathered from the AMERICAN SOCIETY OF PLASTIC SURGEONS 2017 Report

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That is, 26,839 Gynecomastia procedures compared to a total of 1,662,550 surgical procedures.

Only 1.6% of all cosmetic surgeries are Gynecomastia operations

I put this in a pie chart to show how grave the situation is

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It gets even more dire when the money is factored in.

$16.7 billion was spent on cosmetic procedures in the U.S. Gynecomastia accounted for $97 million which means that 0.5% of all income generated from plastic surgery is from Gynecomastia.

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Regions of most gynecomastia procedures being performed is usually on the west coast or east. New York in particular.

TOTAL PROCEDURES New England East North Central South Atlantic East South Central Mountain West Coast
26,839 (8,891) 33% (4,588) 17% (4,299) 16% (3,151) 12% (5,910) 22%

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In the UK, from the BAAPS organization which is the equivalent ABPS src there were only 296 gynecomastia operations in the entire UK!

There are only 24,500 board certified plastic surgeons in the US and only ~26,000 gynecomastia procedures each year. The average plastic surgeon does around 300 procedures per year. On average then, a local plastic surgeon will perform 3 gynecomastia procedures each year with only a handful doing 50+ per year. This is critical to understand that most surgeons are not well experienced in this area!

In summary, understand that most surgeons are not well trained in this area. Why would a general plastic surgeon train in a specialty where 1/100 of his patients on average will request a gynecomastia operation?

Surgeon Selection

This step is the most critical and it deserves its own separate post. Please read more at How To Pick Your Gynecomastia Surgeon. Hopefully by following this guide thus far you are well versed on the procedures and your expectations. You should also be aware of rampant fake reviews and learn how to avoid believing in realself when choosing your doctor. Please do not allow price, reviews, and fake testimonies to sway your decision. Stick with the few experts in this area and you should get a great result.

Any medical doctor can legally perform gynecomastia surgery on you in the United States.

Any MD can claim to be a “cosmetic surgeon” and a “board certified cosmetic surgeon”. There is only one board in the USA that doctors must first attain in order to claim to be a board certified plastic surgeon and that is the American Board of Plastic Surgery (ABPS). This includes a 6 year program plus residency an exams. It is simply astounding to know that general doctors, cardiologists, ENT, and other disciplined doctors can literally perform plastic surgery legally without doing any formal training. They may even have impressive certificates on their wall saying they are a member of some prestigious cosmetic group or laser institute. It is bullshit - merit-less. This is all due to the unregulated nature of the industry. Buyer Beware

Please watch this short video that explains the importance of board certification

Here is another article that goes in depth why board certification is important. It is human nature to naturally trust what a doctor is saying to you. This tendency can be taken advantage of in the cosmetic industry if you don’t do the required research. Unlike doctors operating in a hospital such as your orthopedic surgeon, the doctor that you consult with for your cosmetic surgery may not be an actual doctor for that particular procedure. The insurance companies and healthcare industry requires proper training and certification that most everyone expects when they talk with a doctor to ensure that the information received is coming from someone that probably knows what they are talking about. This is not true for plastic surgery

A doctor that you consult with for plastic surgery may be an ENT doctor with no training in cosmetic procedures, or a Cardiologist that has no training or residency as a surgeon. It is important to look beyond the online reviews of your potential gynecomastia doctor. Doctors and their staff will attempt to convenience you of their skills by displaying pictures, reviews, and sometimes videos in their office. Side note: Be aware that PAID PROGRAMMING is a popular tactic. The video will make it seem that the surgeon is on the actual news, but in reality they have paid generously on a paid slot - see sonoranliving as an example.

Please see a list of common gyno experts and ones to watch out for. Also learn how to read between the lines of their reviews

Price

The National average cost of procedure was $3,641 in 2017 according the ABPS research report. This price is highly dependent on the location of the surgery as well as the skill of the surgeon and market rates. Do not pick your surgeon on price. A high price does not necessarily correlate to a competent surgeon either. Some things to consider by traveling overseas

  1. Follow-up care and monitoring may be limited.
    • Local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible.
  2. Bargain surgery can be costly. Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the United States

  3. Surgeon and facility qualifications may not be verifiable. Clinic facility and surgeons can all be verifiable by the ABPS and other hospital accreditation facilities such as the American Association for Accreditation of Ambulatory Surgical Facilities or The Joint Commission

There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside of the United States. Also, be weary of using medical spas or other discount services. These usually employ sub-par surgeons.

Please read the dangerous medical spa article that gives gynecomastia examples of common tactics.

Money can always be earned, but you are only given one body.

Insurance

Plastic surgery is rarely covered by insurance in the US, however it is NOT impossible to get your procedure covered. Some surgeons will simply not accept insurance as payment upfront, but will file a claim on your behalf. Scar revisions have a better chance of example of being covered by your insurance. The claim usually has to be filed as a FUNCTIONAL IMPAIRMENT in order for it to be deemed medically necessary to operate. Some people say to simply lookup your insurance policy and lie to have it covered.

Here are a few resources to help you attempt to get insurance to cover it:

You will undoubtedly need to fight for your cause since the insurance company has every incentive to NOT give you the procedure for free. Summary of steps to obtain an insurance claim.

  1. Get good medical insurance such as blue cross blue shield.

  2. Call insurance company’s customer support frequently and document all calls and communication. This includes: who you speak with, who their manager is, what was discussed, ask for a reference ID # for the conversation. Keeping a running log of all communication (phone, mail, fax, etc) limits their options for further denial

  3. Get a hormone panel completed by your general doctor or endocrinologist.

  4. Speak to a plastic surgeon (not a general doctor) who has already done the procedure with insurance covering it. Tell him about constant pain and how you can’t operate as a normal person with the condition. You must indicate all side effects in order to get it approved, even if it means exaggerating a bit. Pain is a gray area with insurance. You need to take advantage of that point of view.

It is critical that you still get the procedure by a well seasoned plastic surgeon and not by anyone else even if insurance is covering it

Do you want a cheap, but poorly done job or an expensive, yet excellent result? Money can always be made. Your body cannot. You can one body for your entire life.

Surgical Techniques

There will be scars. There are essentially four options you have:

  1. Tissue Excision
  2. Lipo Only
  3. Tissue Excision + Lipo
  4. Tissue Excision + Lipo + Skin Excision

The operation is performed as an out-patient procedure. You will need someone to drive you home afterwards.

Skin excision is reserved for the patients that have skin causing their boobs to droop. Every step should be taken to first try the minimally evasive technique and to see if the skin tightens sufficiently afterwards before committing to skin excision. Good surgeons know this and you would be amazed at the skin retraction in some patients. Here is a good example from daewoo on realself

Tissue Excision

Minimally invasive or keyhole techniques consists of cutting a small portion of the areola skin to extract the breast tissue and optionally fatty tissue. An areola scar is almost always necessary according to the seasoned doctors in gynecomastia. Liposuction cannot remove the breast tissue no matter what a local plastic surgeon. Recall that nearly all plastic surgeons are not experts in this area.

The incision heals generally well. Here is my excision scar that is 2 days post op and then 2 weeks post-op. It healed perfectly fine.

Lipo only vs Excision + Lipo

As someone who had incision only, I will recommend that you get both lipo and excision. Statistically speaking, you have a better chance of a good outcome if both are utilized even if you are skinny.

Overall complication rates among the excision only group was the highest (29.8%) followed by the liposuction only group (16.7%) and the liposuction and excision group (10.0%).

I was initially scared of lipo and thought that it was only intended for those who are overweight. The truth is that the instrument is vital in creating an even contour and it is extremely difficult except in truly thin (<8% BF) people to create a good contour without it.

Here is a quote that is all too common when someone performs lipo only:

It’s been about 10 weeks for me post-op, Lipo only. I did not have a severe case of gyno; what I and my doctor thought was just extra fat tissue. So lipo only was recommended. Wore my compression vest 24/7 for 4 weeks, then 12 hours a day for the next 4 weeks. But even after that first 4 weeks when I took the vest off, I also noticed small lumps under each nipple. They have since grown and become mildly tender, especially in the last 2-3 weeks. When I look in the mirror now I can’t even tell that I had surgery;

Here is what a few doctors have to say about other surgeons who claim liposuction can create an excellent result:

Dr. Litlriki

Liposuction is usually a necessary adjunct to excision of gynecomastia to help provide a good contour in the area and avoid a crater deformity, as well as to remove stubborn fat. Typically in patients who have gynecomastia, the fat of the chest tends to be resistant to fat loss as compared to fat elsewhere. This is similar to “saddle bags” or “love handles,” where the fat is resistant to weight/fat loss and sticks around in spite of adequate dieting

Dr. Jacobs

You are contemplating surgery with excision only and without lipo solely because it is public surgery. The fact is that lipo is an integral part of gyne surgery. It is used not only to smooth out the contours of the chest but also to help re-distribute the skin after excision. Without its use, you stand a good chance of having a crater deformity after surgery.

Dr. Cruise

I rarely perform liposuction only, because it doesn’t usually achieve the best result.

Dr. Jacobs

If you have read numerous posts on this forum, you will understand that in virtually all cases, lipo PLUS excision is needed to get an absolutely flat and contoured chest. Vaser lipo can only remove fat– not breast tissue.

Please look at these picture and notice how the gland is mixed in with the fat. The white on the left is gland. Nearly everyone will have gland mixed in with fat - even if you are lean. PERIOD.

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Liposuction only will certainly improve your condition, but it won’t eliminate the problem and you could always get a better result if excision was combined.

DO NOT GET LIPOSUCTION ALONE.

This cannot be stated enough. You must select a competent gyno surgeon to understand why.

Tissue Excision + Lipo + Skin Excision

Used in the most extreme cases, tissue excision just may be necessary. It is vital that your expectations are set before doing this procedure. The scars will most likely be obvious to the casual observer since they are not hidden. The chest tends to scar poorly. Hypertrophic scars may occur. Demand to see prior patients before committing to this. It is better to talk to a patient in real life to see his scars before ultimately deciding.

The nipple will also need to be moved. Sometimes the nipple can be sparred and be kept alive. Completely removing the nipple and areola will cause permanent nerve damage and you will not be able to feel the nipple when touched.

Here is a before/5-day-after of this procedure done by Dr. Caridi

Pull-Through Technique

Some doctors such as Dr. Jacobs and Dr. Schulster are capable of eradicating the breast tissue through a single lipo incision as the side of the chest. This is rare and there are only a few surgeons capable of doing this. Dr. Jacobs produces his own instruments to deal with the dense tissue and Dr. Schulster practices the “Pull-Through” technique.

This technique still requires fat removal alongside the dense breast tissue. Here are some pictures showing how the breast tissue is removed. You can see the actual tissue being dislodged in the first two and then removed externally out of the side of the chest in the third picture.

After the pull-through technique is per-formed, power-assisted liposuction is used to feather the remaining breast tissue to soften the breast contour and blend the nipple-areola-complex with the surrounding breast tissue. This final contouring is also necessary to remove fatty breast tissue that was dislodged after the dense framework of the breast was re-moved using the pull-through technique source.

Dr. Elliot Jacobs sells his cannula to other plastic surgeons so there may be more surgeons out there that can complete the entire procedure with tiny nicks to the sides of the chest

Ideal PreOp Condition

Ironically, plastic surgery is best suited for people already in good shape. You should plan to get in the best shape of your life before committing to surgery. This does two things:

  1. Allows you and your surgeon to determine if you do have gynecomastia after excess fat has been removed naturally via dieting and exercise
  2. Best results are seen when you are at a healthy weight. Less skin would need to be excised and the skin will retract more favorably.

Dr. Litlriki

You don’t need a specific body fat percentage, but if you diet down and it looks worse, you’ll know that there is glandular tissue. If it’s significant enough to bother you, you’ll likely need to have it excised

Puffy Nipples

This is one of the most common reasons to have surgery. Don’t make the mistake thinking this is easy surgery. You need an expert surgeon. You are at high risk of taking too much (crater effect).

Please do not be fooled in thinking this surgery is easier than other cases. Remove too much, and you have a crater. Remove too little and no appearance change. You are at an extremely high chance of receiving a crater. This is exactly what happened to me. Excision plus lipo is the recommended route to take. The liposuction tool will most likely be employed to re-drape the skin after the tissue has removed. The liposuction cannula can also be turned OFF in patients who are thin. Think of the re-draping similar to when a salmon has its skin removed from its tissue.

Puffy Nipples Big Challenges

Even if your extra tissue is a small nub directly under the nipple-areola complex, the procedure involves much more than pulling it out and placing a couple of small stitches. A gynecomastia expert will know just how much tissue to remove so that your nipples lie flat without crater deformities. He or she will also how to contour fat tissue as needed and re-drape the skin for a smooth appearance. (In our case, we use a cannula of our own design, often with the suction turned off.)

Post Operative

Each surgeon should give you instructions on what to do after surgery. Not all post-op instructions are created equal. My first surgery, which was botched, only had 7 bullet points compared to my revision in which I seeked an expert gyno expert and got a post and pre-op instruction sheet that was 7 pages long!

You will generally be in a compression vest for 4-6 weeks. It is critical that it is worn so that the skin will retract properly. Do not get lazy with this. It is worth your time now in order to secure a great outcome for the many years in your future.

Complications

Complications happen and will inevitably occur to most people reading this. Below are some of the common complications. Please note that most complications resolve over time with the exception of cratering or tethering.

Scar Tissue

Your tissues will inevitable turn hard as scar tissue start developing. All human wounds heal with scar tissue. It is impossible to avoid this. Scar tissue cannot be removed, but it can be managed usually with steroid injections after a few months post-op.

Dr. Jacobs

Our observation, grounded in three decades of specializing in gynecomastia, is that scar tissue does not disappear if it’s massaged. Wait until six to eight weeks after surgery before starting massage. Prior to that, it may actually cause swelling.

Please also watch Dr. Caridi’s scar tissue youtube video on how to deal with scar tissue post-op.

An average or sub-par result can still happen even if an excellent surgeon is used such as shown in Dr. Caridi’s 1 year post-op youtube video. The scar tissue is still apparent and even the patient himself rates the result as a 6/10.

Hematoma

This is a common complication that can occur to no fault of your surgeon. Sometimes the body will heal in unpredictable ways. You must return to your surgeon or another local plastic surgeon if you traveled in order to get the blood collection aspirated. It is vital that this fluid is removed as soon as possible since it will cause permanent staining of the skin called Hemosiderin Staining. Please see my two pictures below which show a horizontal collection of blood immediately following surgery. 3 months later, the line is still visible, however it is slowly abating.

Here is a youtube video that shows pretty bad staining of the skin after Gynecomastia surgery due to the hematoma.

hemosiderin staining

Craters

Getting a crater is a terrible outcome and one of the worst complications besides nipple necrosis. I got bilateral craters and was able to get the issue resolved via the fat flap technique. Please read the craters article which covers how to improve this issue.

Please don’t go with fat grafting alone. First try to find a gyno expert willing to perform fat flaps where the odds of success are much greater than 0.

Residual Tissue

Left-over tissue usually happens when liposuction is performed alone. This is usually easily overcome by going to a gyno expert for your second time around. Revision surgery is always more difficult and so it is vital that it is done right the second time. Each surgery adds scar tissue and it is additive meaning that it cannot be removed.

Abnormal Scars

These can be treated with scar revision (after 1 year) or with time. Lasers may help reduce the redness but will have no effect on the width of the scar. Here are two pictures showing how a scar revision can present a dramatic change in the hypertrophic appearance.

Before Scar Revision After Scar Revision

Please see the gyno wound care post to see how to properly maintain great scars. In short, don’t move a whole lot and keep the wounds moist by slathering a generous amount of Neosporin on the incisions and covering them with a band-aid.

Outlook

Your results will be permanent. They will look best if you keep at a healthy weight. Recursion of the breast tissue is rare. Scar tissue will 100% develop like any other surgery. You can massage this for years or get steroid injections. The best time for a good result is the first time around, so take your time when choosing your surgeon. Enjoy!

Resources

  1. Dr. Elliot Jacobs FAQ
  2. Dr. Elliot Jacobs Overview
  3. https://www.aafp.org/afp/2012/0401/p716.html