Male breast reduction is more popular than you think.
Breast reduction is the fourth most popular cosmetic surgical procedure among males, according to the American Society for Aesthetic Plastic Surgery (ASAPS). With the exception of male breast cancer, which represents roughly 1% of all breast cancers and typically occurs in older men, this is a benign condition.
Generally speaking the root cause is not really known.
There are a myriad of causes of enlarged male breasts. One of the most common is obesity or previously being overweight. Other reasons are associated with steroid use, drugs and hormonal imbalances. In the vast majority of cases the cause is unknown, however a history and physical should be part of the evaluation, as the treatment is determined by an underlying cause. Examples include liver disease, use of estrogen medications, steroids, Beta blockers, antacids and marijuana. Referral to an endocrinologist may be recommended.
Your initial consultation is very important.
My experience has shown that a physical exam cannot reliably determine what is gland and what is fat. Therefore I obtain a preoperative mammogram to help delineate whether an incision will be required to remove any gland that is present. The relative proportions of skin and fat will be assessed, and the likelihood for skin removal, requiring scars, will be discussed. Ulthera® may be recommended for non surgical skin and fat shrinkage.
The surgical technique will depend upon whether your condition is primarily comprised of excess glandular tissue, or fatty tissue.
If excessive fatty tissue is the primary cause, lipoplasty alone will suffice to remove the fat. If the underlying cause stimulates growth in the glandular elements, such as drugs or hormonal imbalance, then the gland must be surgically removed. Although attempted in the past, lipoplasty, including the use of “cutting cannulas” does not effectively remove glandular tissue. Therefore, if glandular tissue is present in significant amounts, an incision part way around the perimeter of the areola, but nearly imperceptible, will be required. A-cell’s Matristem®, a stem cell stimulator, can be employed to aid in cosmesis.
The key is not to leave a depression when the entire gland is removed, but to leave a well sculpted disc to maintain a smooth contour. Lipoplasty is used as a blending or contouring adjunct, smoothing the transition to the surrounding areas for a more aesthetic contour.
If too much skin remains and Ulthera® is not considered a viable option, a breast lift can be effectively employed. Lifts are generally disfiguring (visible scarring unless you have a hairy chest) on the male chest wall (with the exception of a circumareolar lift). I have written a chapter on Gynecomastia and published a paper on this particular subject.
Often the patient’s major complaint is a large areolar diameter.
This can be treated with lipoplasty alone in fatty breasts or glandular resection when the gland is enlarged and the areola will passively shrink, sometimes with the help of Ulthera®. In some cases, not only fat and breast tissue is removed, but also excess skin. Depending upon the amount of breast tissue and redundant skin, a circumareolar breast lift may be indicated.
Scars can be minimized. Ulthera® may provide a non surgical(no scars) option and Matristem® stem cells stimulator will help improve scar quality by having more normal skin cells participate in the wound healing.