Male Breast Reduction (Gynecomastia)

Male breast reduction is the third most-performed cosmetic surgery procedure in Tampa for men, after nasal surgery (rhinoplasty) and Liposuction. While most cases of adolescent gynecomastia typically disappear without treatment, adult male breasts that are excessively fatty, sagging, and cosmetically unacceptable may require plastic surgery.

Gynecomastia treatment with Vaser Ultrasonic technique

Marvin Shienbaum, MD, uses the state-of-the-art VASER ultrasonic energy technique to achieve a “melting” of the breast fat with an enhanced shrinkage of the excess skin. A specially designed VASER cannula utilizes ultrasonic energy to pierce and flatten the breast glandular tissue and withdraw the offending fat. Nerves, blood vessels, and other significant tissues are left relatively functional and intact. Surgical excision and unsightly scars can be avoided.

Gynecomastia treatment in Tampa Bay, Florida

For the past 30 years, Dr. Shienbaum has performed gynecomastia treatment, also known as male breast reduction, for patients throughout the entire Tampa Bay area including Brandon, Riverview, and Lakeland, Florida.

“Man Boobs”

Gynecomastia, or male breast enlargement, is sometimes referred to as “man boobs” or “man breasts” and is often misspelled ginecomastia. This excess in male breast tissue can result from puberty, obesity, hormonal changes, and a variety of medications and drugs. Puffy nipples often occur with this condition and are a source of social embarrassment. Most men affected are very reluctant or unwilling to expose their chests in public.

Male breast reduction by Vaser Liposculpting

The ultrasonic energy of the VASER system can often disrupt the glandular tissue enough to allow adequate flattening and skin contraction, and can achieve a satisfactory result without the need for surgical gland resection. This is Dr. Shienbaum’s preferred method as it avoids the often unsightly scars, numbness, and indentations associated with surgical gland excision. The VASER system offers a significant advantage with its enhanced ability to shrink the protruding and lax breast tissues.

Male breast reduction & skin excess

Male breast reduction is most suitable for healthy, well-motivated men who still retain firm, elastic tissues. This enables the excess breast skin to re-drape over the underlying chest musculature. Many patients who are obese, elderly, or who have undergone massive weight loss have lost these elastic qualities to their breast tissues. It is in these situations that VASER ultrasonic treatment is essential in attempting to reshape the breast to its natural contours.

Male breast and chest sculpting

Dr. Shienbaum has been sculpting male breasts for many years in Tampa. In his hands, the VASER procedure has been the single most important advancement in the treatment of gynecomastia. He utilizes the precision technology to more than simply de-bulk and flatten the chest’s surface. The breast area can now be sculpted to highlight the underlying muscle contours and anatomy. The ability to accentuate a patient’s natural chest structure has optimized Dr. Shienbaum’s male breast reduction results.

Gynecomastia surgical gland resection

Dense glandular tissue can be very fibrous and adherent to the underside of the nipple and areola. Direct surgical exposure is traditionally performed via a small elliptical incision along the lower edge of the darkened areola tissue. Cutting into the gland carries a risk of numbness, scarring, and collapse of the nipple-areola complex. Dr. Shienbaum takes a unique segmental approach where thin strips of glandular tissue are sequentially removed through a tiny areola incision.

Gynecomastia excess skin resection & breast mastopexy

If the breast skin is excessively sagging and protrudes below the breast fold, the drooping, excess skin may need to be removed and the breast tightened. This is especially true if the skin has thinned out due to old age or has lost its normal elasticity. A male breast mastopexy or skin tightening procedure involves additional incisions of the breast skin.

Gynecomastia types

The male breast is composed of skin, fat, and glandular tissues. Gynecomastia is often classified as either predominantly fatty or glandular. In reality, most presentations of gynecomastia are combinations of the two components with varying amounts of glands and fat tissue. A benign proliferation of male breast glandular tissue is typically caused by an increase in estrogen activity, a decrease in testosterone production, or the effects of drugs, supplements, or certain diseases. The fatty portions of the male breast can be effectively reduced by liposuction while the glandular portions require disruption by ultrasonic VASER energy or removal by direct surgical excision.

Glandular Gynecomastia

Predominantly glandular male breasts are typically found in bodybuilders. Anabolic steroids may be broken down into feminizing estrogen-like compounds while androgenic supplements can suppress the body’s natural production of testosterone. The body will convert any excess supplemental testosterone into feminizing and breast stimulating estrogen. Mammary tissue growth occurs whenever there is an abnormal proportion of breast-stimulating estrogens to androgens. The enlarged pectoralis muscle hypertrophy can often mimic true gynecomastia. Frequently, there is a small bud of glandular tissue palpable immediately beneath the nipple area.

Adolescent–Pubertal Gynecomastia

Young males undergoing puberty may experience temporary enlargement of their breasts. Most pubertal male breast enlargements will typically resolve without intervention. It is uncommon for this form of gynecomastia to persist beyond 18 years of age. Often, these presentations are referred to as hereditary gynecomastia in Tampa.

Fatty Gynecomastia, or “Pseudo Gynecomastia”

Fatty male breasts are most commonly seen with male obesity. Overweight males may have breasts largely composed of fatty adipose tissue. These men often have feminizing characteristics due to altered ratios of male to female hormones. Fatty gynecomastia is also thought to occur when there is an abnormal sensitivity to estrogen. It is sometimes referred to as Lipo Mastia or Pseudo Gynecomastia– fatty breasts without any proliferation of glandular tissues.

Adult Gynecomastia

Adult gynecomastia affects up to 60 percent of middle-aged and elderly men. It is made up of an excess of both fatty and glandular components. Often, the gland can be felt as a thickened and firm area just under the nipple-areola complex. Most cases of gynecomastia in adult men are caused by:

  • Drug Inducement: 15-30%
  • Prior Adolescent Gynecomastia: 30%
  • Hormonal Abnormalities: 5%
  • Undetermined Causes: 40%

Causes of Gynecomastia

The mechanism of adult gynecomastia represents an imbalance of the normal androgen-estrogen levels, combined with an ongoing decline in testosterone production. Late-onset male breast enlargement seldom resolves spontaneously and often requires surgical intervention for complete resolution. Various anti-estrogen and synthetic testosterone replacement drugs only provide partial and transient reductions in breast size.

Male breast ptosis

Male breast ptosis is another term for drooping or sagging male breasts. Many patients with severe gynecomastia also suffer from this condition. The excess skin redundancy can often be visible beneath clothing and can become a source of embarrassment and insecurity.

Gynecomastia after weight loss

Excessive looseness of the breast tissues and skin typically results from dramatic weight loss. The breast skin has been stretched and distended by the weight of the excess fatty tissues. The normal skin elasticity has been lost. As a result, the skin is unable to recoil back to its former size. A downward-projecting breast and nipple can complicate the result. This saggy breast appearance is cosmetically unacceptable to many men.

Gynecomastia and anabolic steroids

The longtime usage and cessation of anabolic steroids and bodybuilding regimens commonly results in a residual looseness of the breast area. Without the prior fullness of the underlying chest musculature, the breast appears empty and without shape or form.

Gynecomastia and aging

Advancing age is accompanied by gradual and persistent loss of muscle mass. As the pectoral chest muscles wither and atrophy, the supporting breast ligaments anchoring the skin become flaccid and frail. This allows the breast tissues to hang loosely from the chest wall.

Gynecomastia and puffy nipples

Puffy, protruding nipples can be composed of excess fat or glands. The tissues have herniated forward, producing a noticeable bulge on the breast surface. A firm, glandular breast bud is often palpable within the prolapsed tissues. Pure, glandular, puffy nipples with no underlying fatty tissue or excess skin can typically be directly removed through a small inconspicuous incision in the areolar border.

Gynecomastia and Vaser Ultrasound

Using advanced VASER ultrasonic techniques, Dr. Shienbaum can typically flatten the glandular protrusion as well as extract the surrounding fat without surgical excision. The technique is virtually scarless and is highly effective in shrinking the surrounding breast skin envelope. The need for an additional mastopexy procedure (skin excision and lift) is usually avoided.

Gynecomastia and elongated nipples

Excessive nipple protrusion can occur without underlying gynecomastia. During nipple reduction surgery, the nipple is set back to a normal height with a simple office procedure performed under local anesthetics.

Male Breast Reduction pill?

There are many herbal medications which claim to specially target and reduce the fat located in the breast. One of these, Gynexin, has been around for many years, but there is little hard data or evidence that it works.

Moreover, none of these medications work on the excess glandular tissues which are typically present in gynecomastia. The FDA has not approved any over-the-counter medications or dietary supplements for gynecomastia reduction.

Will insurance cover Male Breast Reduction surgery?

Gynecomastia surgery is typically not covered by insurance. While a case can sometimes be made for breast pain or documented glandular abnormalities, insurance companies remain reluctant to offer coverage for this procedure. This is especially true if the breasts are predominantly fatty.

What does Male Breast Reduction surgery cost ?

The cost of Gynecomastia surgery in the Tampa Bay area can vary between $ 2500 to upwards of $8000, if performed in a hospital setting. Remember that there are separate surgeons, facility, anesthesia, and pathology fees to consider.
Most Gynecomastia surgeries performed at Brandon Plastic Surgery are done in our accredited office surgery facility on an outpatient basis. This allows for a significant reduction in the overall cost, making it affordable for most individuals.

How soon can I work out after Gynecomastia surgery?

We allow our patients to perform upper-body exercises in approximately 2 to 3 weeks. This is when most swelling or bruising has subsided and disappeared. Strenuously exercising the pectoral musculature prematurely can cause irritation, swelling, and a prolonged recovery.

However, light lower body exercises can be resumed very quickly. The important thing is to maintain compression until the skin has adhered to the underlying chest wall and there is no residual fluid accumulating in the prior Gynecomastia space.

How soon will the results of my Gynecomastia surgery be noticeable?

You should typically begin to see visible results in approximately three weeks. This is when the associated edema and swelling will begin to absorb and dissipate. However, any excess breast skin shrinkage will require contraction of the underlying fibrous tissue which may take several months.

Are there visible scars following Male Breast Reduction?

Most Gynecomastia surgeries can be performed through a small inconspicuous periareolar incision placed at the inferior margin of the areola. As the incision line matures, it will continue to soften, flatten, and lighten in color. This small scar blends well with the surrounding breast tissue and typically fades away over time.

How long do I need a compression garment after Gynecomastia surgery?

Usually, two to three weeks or until all swelling and bruising is absorbed. We recommend that our patients wear the compression vest continuously for the first several days post-operation. Later, you can switch to a less-conspicuous exercise muscle shirt. Often an initial Velcro type waist-binder can be placed around the chest for additional compression. It should fit comfortably and be snug and firm.

Is massage recommended following Gynecomastia surgery?

Massage can be helpful following your male breast reduction surgery to help diminish residual edema, soften indurated areas, and smooth out any irregularities. A small hand-held, battery-powered massager applied over the compression garment is both effective and convenient and is all that is needed.

Can exercise correct Gynecomastia?

Chest exercises can build up your pecs, and aerobic exercise may help you lose weight, but neither will help with Gynecomastia.

Exercise alone cannot remove the dense, fibrous, glandular tissue immediately behind the nipple-areola region, nor shrink the surrounding breast fat and skin.

It is interesting that many Gynecomastia patients were prior competitive bodybuilders and weightlifters.   Excessive pectoral-directed exercises may have the undesired effect of further enhancing the fullness of the upper chest.

Is Gynecomastia surgery permanent?

Patients frequently ask if their “Man Boobs” can return or grow back following their male reduction procedure. Once the glandular and excess fatty tissue have been resected, these typically do not reoccur.

However, significant weight gain, organic disease, hormonal changes, or use of some medications including steroids and recreational drugs may contribute to the recurrence of some components of your Gynecomastia.

When can a teenager with Gynecomastia have Breast Reduction Surgery?

A frequent question is, what is the earliest age that we perform male reduction surgery? Because of the hormonal changes that accompany puberty and frequently cause breast hypertrophy, many physicians suggest postponing surgery and waiting to see if the hormonally-induced breast fullness resolves spontaneously. Unfortunately, between 15-25% of cases can and often will persist into adulthood.

At Brandon Plastic Surgery, the decision to perform breast reduction surgery on teenagers is made on an individual basis. While there is no definitive youngest age, we frequently recommend waiting a minimum of two years after onset. This is when approximately 75% of pubertal gynecomastia will disappear on their own.

Can men have the size of their areolae reduced?

Enlarged areolae are frequently encountered with gynecomastia. The average male areola is somewhere between 20 to 30 millimeters across, depending on chest size. Typically, the areolar fullness is treated with removal of the underlying glandular and fatty fibrous tissue. This flattens the protruding areola and usually resolves the issue.

When skin reduction is required, a buried purse string type closure around the areola is utilized to reduce the areolar diameter and minimize scarring.

How much time does Gynecomastia surgery require?

Typically, between one to two hours of operative time is required. The male reduction surgery is performed in two parts. Initial liposuction is used to remove the excess fat, followed by surgical removal of the enlarged glandular tissues. Most procedures are performed with IV sedation on an outpatient basis.

How do I know if my Gynecomastia is glandular or fatty?

True glandular Gynecomastia will feel firm, thick, and nodular in texture. Pseudo Gynecomastia, which is predominantly fat, will have a softer, more pliable feel with no distinct, palpable texture.

Ultrasound or MRI can delineate the difference, but this is seldom required as surgery will address both issues.

Can additional procedures be performed with Gynecomastia surgery?

Dr. Shienbaum performs many different combination treatments for men. Gynecomastia surgery is frequently combined with Liposuction of other areas of excess fat, including the waist, chest, flanks, underarms, and back regions. This affords a more complete sculpting of the overall physique. Additionally, the removed fat can be used to fill and rejuvenate other parts of the body including the face and buttock areas.

How much weight can I loose with Gynecomastia surgery ?

This surgery is predominantly a body-contouring procedure and is not designed for significant weight loss. Typically, the involved tissues weigh only a pound or two. Although the weight loss is minimal, the associated improvement in your body image can be huge– especially when this is combined with Liposculpting elsewhere.

How are puffy nipples treated?

The glandular tissues beneath the nipple need to be removed surgically. Liposuction will not remove the fibrous gland and is only useful for sculpting the surrounding breast fat .

Where does the term Gynecomastia come from ?

The origin of the term Gynecomastia is Greek, combining “Gyne” for “woman,” and “Mastos” meaning “breasts.”

Gynecomastia surgery?

There will be some loss of sensation following surgical removal of the breast gland. This is because some nerve fibers will be inevitably severed during the resection of the glandular tissues. This will improve with time and is seldom noticed by patients. Liposuction is performed bluntly and preserves the adjacent nerves.

Will excess skin tighten after Gynecomastia surgery ?

Following Gynecomastia surgery, it can take up to six months for the excess skin to fully contract and tighten. Maintaining compression helps, as does the use of Vaser ultrasound during surgery. The degree of tightening is dependent upon the skin elasticity. A donut, purse string type areola skin resection may be required in severe cases to remove the excess remaining breast skin.

Pain after Gynecomastia surgery?

Most Gynecomastia patients will experience generalized chest soreness rather than localized pain following their procedure. The majority will get by on several days of Tylenol or other non-aspirin medications. Narcotics or Opioids are seldom necessary, as they frequently cause nausea, vomiting, and constipation.

Liposuction or Tummy Tuck for male belly fat?

Liposuction will benefit you if you have good skin quality with sufficient elasticity to snap back and retract into place. Otherwise, you will be left with disappointingly saggy skin.

If you already have a loose abdomen with saggy skin and poor elasticity, a Tummy Tuck may be a better choice. This is especially true when there is belly protrusion from separated abdominal muscles which require tightening.

How best to remove male belly Fat

Male Belly fat can be either external (beneath the skin) or internal (inside the abdomen). Most male fat is stored internally, around the visceral organs. This produces the common “beach ball” abdominal protrusion commonly referred to a “beer belly.” Unfortunately, this internal fat cannot be suctioned. Only a strict diet and dedicated exercise can eliminate this visceral interior fat.

What is male Liposculpture ?

Liposuction was originally designed to simply remove and debulk fat. Alternatively, Liposculpture is a contouring technique in which the remaining fat is shaped to accentuate the underlying muscles. Liposculpture will result in a more toned and athletic result with more muscle definition.

Best doctor for male Liposculpture?

Look for an experienced, board certified plastic surgeon who specializes in this technique. Request to see their results and thoroughly examine their before and after photos. Ask how many procedures they have performed and if they have they been granted hospital privileges to perform these procedures.

And remember that the least expensive surgeon is seldom the best.