Gynecomastia (Male Breast Reduction)

Though rarely discussed, an estimated 40 to 60 percent of the adult male population is afflicted with "women-like breasts" to at least some degree. This condition may affect one or both breasts, and is most noticeable at a beach or pool or in a locker room. For those who are self-conscious about their condition, known as gynecomastia (the Greek word for women-like breasts), a plastic surgeon can perform breast-reduction surgery.

Similar in many ways to the procedure for women, gynecomastia removes fat and/or some glandular tissue from the breasts and, in extreme cases, excess skin as well. The result: a firmer, flatter, better-contoured and masculine-like chest.

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Q. Who are good candidates for this procedure?

A. You are, if you're a man in good health but your breasts look more feminine than masculine. It helps to have firm, elastic skin that can be easily reshaped to a better-looking contour. However, if you're a heavy smoker or drinker, or you take steroids (which may cause gynecomastia), forget about it, unless and until you stop those habits. Men who are obese (and who often have feminine-looking breasts) are not good candidates for this procedure either. Nor are overweight-but not yet obese-men who first haven't tried to correct their breast problem via weight loss and exercise programs.

Q. What are the risks?

A. When the procedure is performed by a highly qualified cosmetic surgeon such as Dr. Kapoor, complications are rare and usually minor. However, as with any surgery, potential risks include infection, excessive bleeding, injury to the skin, adverse reaction to the anesthesia, excessive fluid loss, or fluid accumulation. In addition, the procedure may cause noticeable scars, permanent pigment change in the breast area, or slightly mismatched breasts or nipples (though the latter problem may be corrected by having a second operation to remove more tissue). Temporarily-up to a year or so-there may be a loss of sensation or numbness in the breast.

Q. What's the first step?

A. Arrange for a consultation at Dr. Kapoor's medical office. Bring along a copy of your medical records, so the doctor can look for any health conditions that may affect the surgery or its results. He will examine your breasts as well. Your records and/or the exam may reveal why your breasts became enlarged. It might be an impaired liver function or some other health problem. Or it may be due to your taking anabolic steroids or estrogen-containing medications. In extreme cases, a mammogram is taken, to help determine if there's any cancer, and to see how much fat and glandular tissue are present.

Q. What's the next step?

A. If it's determined that you're a good candidate for a surgical procedure to correct for gynecomastia, a date, time and place will be arranged. Depending on your insurance policy, the cost may, or may not, be covered. If it is, obtain a written pre-authorization from your insurer. If you're a smoker, stop smoking for one or two weeks before the surgery-and later, during the recovery period-because it decreases blood circulation and interferes with healing. Avoid alcohol, too.

Usually, Dr. Kapoor performs this type of surgery at an accredited surgery center or one of the several he's affiliated with in Los Angeles, California-on an outpatient basis. A typical procedure takes about two hours, but more time is needed for more complicated surgery. Depending on various factors, the anesthesia can be either local (along with mild sedation) or general.

Q. What takes place during the operation?

A. That depends on the suspected reason for the gynecomastia. If excess glandular tissue is the cause, it will be removed surgically. First, an incision is made in an inconspicuous location, either in the armpit area or on the edge of the areola (which surrounds the nipple). If a large amount of tissue and skin need to be removed, the resulting scars will be larger and more conspicuous.

Cutting through the incision, a patch of skin is lifted and your surgeon cuts away excess glandular tissue, fat, and skin from around the areola and also from the sides and bottom of the breast. To remove the excess fat, liposuction may be used; the fat is transformed into a liquid and then literally sucked out. Finally, the patch of skin is replaced and sutured in place. A surgical dressing is applied and the chest is wrapped to keep the skin firmly in place.

If your gynecomastia consists mostly of excess fatty tissue, ultrasound or power assisted liposuction will probably be used and there will be less scarring, because the incisions are smaller. A small (less than a half-inch long) incision is made around the areola of the breast or in the underarm area. Then a slim hollow tube called a cannula is inserted. Its other end is attached to a vacuum pump. As your surgeon moves the cannula through the layers beneath the skin's surface, the fat is broken up and suctioned out. You'll probably feel no pain-only a vibration or some friction. And the scarring is almost invisible.

Either way-traditional surgery or liposuction-a small drain may be inserted in each breast afterwards to drain off excess fluids. It will be removed in a day or two. After a brief stay in the recovery room, you'll be ready to leave. Have someone available to drive you home.

Q. What happens after the operation?

A. For a few days after the surgery, you'll feel some discomfort, of course, but any pain can be controlled with prescription medications. For a while-several weeks-you'll be bruised and swollen, wearing an elastic pressure garment for two weeks, and then for several weeks more but only at night. Most of the swelling will go down during the first few weeks, but it may be three or four months, or perhaps even longer, before your chest will look and feel normal. Your stitches should be removed one or two weeks after the surgery.

To aid recovery, do some walking around after you return home. When you feel up to it-which may be in just a few days after the surgery-you can return to work, if you can refrain from any strenuous activity for at least three weeks. Avoid sex for a week or two. Allow about a month before resuming your normal activities. Also, don't expose your scars to the sun for at least six months, or they'll turn dark. Using a strong sun block can help.

As numerous men-more than you might suspect-have happily discovered, having gynecomastia need not be a permanent problem. So if that is your problem, why not consult with Dr. Kapoor and his friendly staff about it. Especially if you're fed up with being embarrassed every time you take your shirt off in public.