Common Questions

Men Common Questions

Who is a candidate for gynecomastia correction surgery?

Men who have a chest that is disproportionately large from some combination of fat or glandular tissue.  This process can be normal in adolescents and subside by the late teens.  But surgery can be done on mid-teens if the deformity is so severe that in consultation with the patient’s pediatrician it is agreed that the patient would benefit from male breast reduction surgery.

What are the most important factors to consider when deciding whether or not to get gynecomastia?

The key issue is whether it bothers a patient enough to be worth undergoing surgery.  Usually men will talk about being embarrassed to take their shirt off at the beach, their shirt clinging too tightly to their chest and looking odd when working out, and puffiness developing in the nipples, particularly when their nipples are warm.

What causes gynecomastia?

True gynecomastia is caused from hormones causing a growth of breast tissue in the male chest.  This can be from normal hormones made within the body or from steroids such as those taken by body builders.  Being overweight can sometimes lead to a disproportionate amount of chest growth, and even after weight loss this can remain in some men.

Are there any nonsurgical treatments for gynecomastia?

Losing weight can help overweight men, though it doesn’t necessarily cure gynecomastia.  But for men that are thin, surgery is the only option for reducing gynecomastia.

How is gynecomastia by liposuction performed?

A patient can be put to sleep, given IV sedation, or be given just local anesthesia.  It depends on patient preference and the nature of their problem. One or two ¼ inch incisions are made in each side of the chest.  A long acting anesthetic is placed.  After waiting for it to distribute and take effect, small tubes are placed through those incisions and fat is removed and the shape of the chest contoured. Those incisions are closed with just several small sutures that are removed after about five days.

How is gynecomastia by excision performed?

Excision means cutting out tissue.  This can be done with general anesthesia, IV sedation, or local anesthesia.  That decision will be based upon a patient’s particular anatomy and preference.  A small incision is made from about 5-8 O’Clock on the areola and the excess tissue is removed.  Stitches are placed that will dissolve.

How will you decide which type of procedure is best for me?

Some patients just need one procedure and some need a combination of the two.  There are two types of tissue that can be responsible for the enlargement of male chests.  In true gynecomastia, the cause of the chest enlargement is purely glandular tissue.  This is a very firm and rubbery tissue, and it cannot be removed by liposuction; it must bre excised.    On the other extreme there can be just a localized excess of fat.  Fat is easily removed with liposuction and thus liposuction is the choice.  Some patients have a combination of both.  Men that are very thin will rarely have fat and thus won’t need liposuction. Men that are overweight will invariably need liposuction.  Steroid use causes the development of firm tissue that requires excision.

Is there a problem with removing as much fat as possible?

Whether fat or gland, the goal of good gynecomastia surgery is the restoration or creation of a nice contour to the chest.  While there is often the desire by both the patient and surgeon to remove as much as possible, in actuality it is normal for there to be some glandular tissue beneath the areola and some fat throughout the chest.  The goal should be to create just a normal configuration, which means removal of the bulge and creation of a smooth contour.  A complicating issue is that the chest looks different when the arms are at the sides than when they are raised above the head.  Just try raising your arms now and you will look a lot flatter.  Sometimes when the chest is made to look flat with the arms at the side there can be a bit of a depression deep to the areola when the arms are raised above the head.

Are the results permanent?

Gynecomastia patients are warned about the possibility of it coming back.  But after performing a great number of gynecomastia cases, the only cases Dr. Teitelbaum has seen reoccur were in men who went onto anabolic steroids after surgery.  There have been cases in which a decision was made to just do liposuction and not excision in which the patient later wished that excision would have been done.  That is why a careful preoperative assessment and discussion with the patient are so important.

If I want to have the procedure redone later on is that okay?

It is always possible to redo gynecomastia – if the problem is to remove more.  But if a if the problem is a depression or an irregularity then that is a much more difficult problem to deal with.  It is a problem that is best avoided.

Can I have other procedures done at the same time?

It is safe and common to perform other procedures at the same time as gynecomastia.  The most common would be liposuction of the stomach or love handles.

Other plastic surgery procedures such as otoplasty (for prominent ears) and rhinoplasty are also common.  

What are the downsides to having gynecomastia surgery?

The biggest drawback is that there can be some amount of contour irregularity.  For men who need a lot of liposuction, particularly out towards the under arm area, there can be some irregularity in contour if the skin isn’t tight enough to snap back.  If there is a lot of fat in the chest itself, there can also be a risk of contour irregularity and waviness, particularly if the skin isn’t particularly tight.  The most common area in which men will notice problems is a depression deep to the areola when raising arms above the head.  The overwhelming majority of men do not notice these problems and are thrilled with their result.  And even if they do notice something, it is usually relatively minor compared with the dramatic improvement that was made for them.

If I am overweight can I have gynecomastia surgery?

Many patients undergoing gynecomastia surgery are overweight.  Obviously it is much healthier and contour is better if a patient loses weight on their own.  Surgery cannot make someone look as good as they would look with their own weight loss.  But even with weight loss, oftentimes some excess chest fat remains, and so overweight men often still want to have surgery on their chest after they have lost weight.  Finally, it is important that when men are overweight that only enough is removed from their chest to make it proportional with the abdomen. There is a tendency among patients and plastic surgeons to remove as much as possible, but when the chest is made much less prominent than the abdomen, and this does not look good.  And this can become even worse if the patient loses weight after their gynecomastia surgery.

If I gain weight after having the procedure will my gynecomastia come back?

If your problem was glandular, then gaining weight will not be a problem.  If the problem was fat, then it is possible that some of it will come back, if you gain a lot of weight back.  But whatever was removed is forever gone.

What form of anesthesia will be used for my procedure?

Most patients prefer to go totally to sleep.  But there are situations in which IV sedation or even pure local anesthetic work equally well.  This is something that Dr. Teitelbaum will discuss with each patient.

Will there be scars?

There are often two very small incisions that are used for the liposuction portion of the procedure.  If an excision needs to be done, there will be a scar at the border of the areola from between 5 and 8 o’clock.  Dr. Teitelbaum is very careful with how he closes the incisions and usually the scars are quite excellent.  It seems many patients today shave the hair on their chest.  If you can grow chest hair, it is good to let it grow before surgery so that it can help conceal the scars during the early healing process before the scars have had a chance to fade.

Will I lose nipple sensation after the procedure?

It is always possible to lose sensation but it is very uncommon to do so.

Does insurance cover gynecomastia?

Insurance companies vary widely in what they will cover.  In recent years Dr. Teitelbaum has only seen insurance companies cover gynecomastia surgery when it is extremely disfiguring and the man’s chest has a very female breast-like appearance.

Do I need to go to an aftercare facility after my gynecomastia surgery?

Patients can go home after gynecomastia surgery so long as someone is there to help look after them.  But some gynecomastia patients are very private and may go to an aftercare facility if they want no one to know.

Will I get a phone call from the doctor the night of my surgery?

Dr. Teitelbaum calls all of his gynecomastia patients the night of surgery to check on how they are doing.  Equally important is for patients to call him if they have any concerns.

How painful is the recovery from male breast reduction surgery?

Men will say that it will feel very sore such as after a big work out or getting punched in the chest.  Patients will be given narcotic pain pills, but most men do not need to take them after gynecomastia surgery.  It is safe to say that the pain is relatively minor and manageable, even for teenage boys.

How soon can I go to work?

So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work about three days after gynecomastia surgery.  Some people go back even sooner, and many work from home the next day.

When can I drive?

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car.  That is ultimately a decision that I cannot make for you.

When can I resume exercise after male breast reduction?

It is best to wait about three weeks to go back to the gym, but if you only had liposuction it is okay to work out after about ten days.

When can I sunbathe?

It is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.

When can I shower/take a bath?

Dr. Teitelbaum wants you to keep your initial post surgical garment on for two days.  At that point you can take it off and shower.  You should put your compression vest back on after that.

How long does the swelling last?

Swelling increases after surgery, usually peaking about 5-6 days after gynecomastia surgery.  After that, the swelling will subside, rapidly at first, and then gradually.  After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Will I have a special garment to wear after surgery? How long will I have to wear it?

You will have a vest with foam underneath it put on in the OR.  Remove this after two days, throw away the foam, and just wear the vest.  When you are around the house, wear the vest.  When you want to leave, put on a tight Under Armour type of shirt or vest.  There is no absolute period of time that you need to wear compression, but the more you wear it the faster your swelling will go away.  In general men will wear this for about a month.

What is gynecomastia?

Gynecomastia is breast development in boys and men.  It happens in up to 80% of adolescents and usually goes away on its own.  But there are millions of young men in whom it did not go away.  In its mild form it can allow for a little bit of protrusion of the nipples when the nipples are warm, and in its most severe form the male chest can almost look like female breasts.  It is very embarrassing to men, limiting their willingness to take their shirts off at the beach, leading many to always wear an undershirt and an overshirt, and it causes their jackets to hang off of their chest making them look heavy when they really are not.  Fortunately this is almost entirely correctable with surgery.

What is pseudogynecomastia?

Gynecomastia refers to a growth of the glandular cells of the chest. It tends to be firm and sometimes painful.  Pseudogynecomastia  is not a pure enlargement of the glandular cells.  Rather, it means that there is a disproportionate deposit of fat in the chest, occasionally alongside some increase in the glandular tissue.  Overweight men and boys will often have a disproportionate amount of fat in their chests.  When they lose weight, for some reason that fat is extremely stubborn.  That is the most typical form of pseudogynecomastia.

How are gynecomastia and pseudogynecomastia treated?

Liposuction works beautifully to remove extra fat in the chest and sculpt a nice shape.  But it only can tease away soft fat cells.  If there is a firm mass in the chest, then that needs to be removed through a small incision along the lower border of the areola.

How do I know if my condition is worth treating?

The indication for treating gynecomastia is that it is causing you a visual problem.  Do you fell your clothes are tight in your chest?  If you are sweating does your shirt cling to your nipples?  Is the contour of your chest as nice as it should be relative to the rest of your body?  Most patients can easily answer for themselves if they have enough of an issue with gynecomastia to investigate whether they want to treat it.

Who is a candidate for gynecomastia correction surgery?

Men who have a chest that is disproportionately large from some combination of fat or glandular tissue.  This process can be normal in adolescents and subside by the late teens.  But surgery can be done on mid-teens if the deformity is so severe that in consultation with the patient’s pediatrician it is agreed that the patient would benefit from male breast reduction surgery.

What are the most important factors to consider when deciding whether or not to get gynecomastia?

The key issue is whether it bothers a patient enough to be worth undergoing surgery.  Usually men will talk about being embarrassed to take their shirt off at the beach, their shirt clinging too tightly to their chest and looking odd when working out, and puffiness developing in the nipples, particularly when their nipples are warm.

What causes gynecomastia?

True gynecomastia is caused from hormones causing a growth of breast tissue in the male chest.  This can be from normal hormones made within the body or from steroids such as those taken by body builders.  Being overweight can sometimes lead to a disproportionate amount of chest growth, and even after weight loss this can remain in some men.

Are there any nonsurgical treatments for gynecomastia?

Losing weight can help overweight men, though it doesn’t necessarily cure gynecomastia.  But for men that are thin, surgery is the only option for reducing gynecomastia.

How is gynecomastia by liposuction performed?

 

A patient can be put to sleep, given IV sedation, or be given just local anesthesia.  It depends on patient preference and the nature of their problem. One or two ¼ inch incisions are made in each side of the chest.  A long acting anesthetic is placed.  After waiting for it to distribute and take effect, small tubes are placed through those incisions and fat is removed and the shape of the chest contoured. Those incisions are closed with just several small sutures that are removed after about five days.

How is gynecomastia by excision performed?

 

Excision means cutting out tissue.  This can be done with general anesthesia, IV sedation, or local anesthesia.  That decision will be based upon a patient’s particular anatomy and preference.  A small incision is made from about 5-8 O’Clock on the areola and the excess tissue is removed.  Stitches are placed that will dissolve.

How will you decide which type of procedure is best for me?

 

Some patients just need one procedure and some need a combination of the two.  There are two types of tissue that can be responsible for the enlargement of male chests.  In true gynecomastia, the cause of the chest enlargement is purely glandular tissue.  This is a very firm and rubbery tissue, and it cannot be removed by liposuction; it must bre excised.    On the other extreme there can be just a localized excess of fat.  Fat is easily removed with liposuction and thus liposuction is the choice.  Some patients have a combination of both.  Men that are very thin will rarely have fat and thus won’t need liposuction. Men that are overweight will invariably need liposuction.  Steroid use causes the development of firm tissue that requires excision.

Are the results permanent?

 

Gynecomastia patients are warned about the possibility of it coming back.  But after performing a great number of gynecomastia cases, the only cases Dr. Teitelbaum has seen reoccur were in men who went onto anabolic steroids after surgery.  There have been cases in which a decision was made to just do liposuction and not excision in which the patient later wished that excision would have been done.  That is why a careful preoperative assessment and discussion with the patient are so important.

 

If I want to have the procedure redone later on is that okay?

 

It is always possible to redo gynecomastia – if the problem is to remove more.  But if a if the problem is a depression or an irregularity then that is a much more difficult problem to deal with.  It is a problem that is best avoided.

What are the downsides to having gynecomastia surgery?

 

The biggest drawback is that there can be some amount of contour irregularity.  For men who need a lot of liposuction, particularly out towards the under arm area, there can be some irregularity in contour if the skin isn’t tight enough to snap back.  If there is a lot of fat in the chest itself, there can also be a risk of contour irregularity and waviness, particularly if the skin isn’t particularly tight.  The most common area in which men will notice problems is a depression deep to the areola when raising arms above the head.  The overwhelming majority of men do not notice these problems and are thrilled with their result.  And even if they do notice something, it is usually relatively minor compared with the dramatic improvement that was made for them.

If I am overweight can I have gynecomastia surgery?

Many men undergoing male breast reduction surgery to treat gyncecomastia are overweight.  It is healthier if a patient loses weight on their own. Surgery cannot make someone look as good as they would look with their own weight loss. 

But even with weight loss, often some excess chest fat remains, and so overweight men often still want to have male breast reduction surgery after they have lost weight. 

Finally, it is important that when men are overweight that only enough is removed from their chest to make it proportional with the abdomen. There is a tendency among patients and plastic surgeons to remove as much as possible, but when the chest is made much less prominent than the abdomen, this does not look good.  And this can become even worse if the patient loses weight after their gynecomastia surgery.

Do I have to lose weight before surgery?

 

It is obviously best for overweight people to have plastic surgery at their ideal weight.  From a practical point of view, that should be refined to mean that surgery should be done at the weight a patient is most comfortable maintaining because it allows the plastic surgeon to contour the chest out to the surrounding areas so that it blends most beautifully.  Some later weight gain or weight loss would not noticeably impact the result.  Many men who are much more overweight decide to do liposuction of their chests before losing their weight because it gives them a nice jump start. They feel better about wearing tight or clingy athletic clothing and the surgery really can boost their self esteem and get them on their way to perfecting their bodies.

 

If I gain weight after having the procedure will my gynecomastia come back?

 

If your problem was glandular, then gaining weight will not be a problem.  If the problem was fat, then it is possible that some of it will come back, if you gain a lot of weight back.  But whatever was removed is forever gone.

What are shortcomings of gynecomastia surgery?

 

When you raise and lower your arms, you will see that your chest will somewhat smooth out when your arms are up.  So if your chest is smooth after surgery when your arms are down, sometimes there can be a bit of a depression when you raise your arms all the way over your head.  In some situations – though uncommonly so – there can be a bit of a depression even with the arms down.  With gynecomastia surgery, the plastic surgeon is obligated to remove the entire piece of abnormal glandular tissue, no matter how big it is.  When large, it may have compressed the normal tissue around it.  Dr. Teitelbaum is excellent at sculpting this tissue.  Nonetheless, it is possible to have some bit of a depression in that area.  If the skin is loose after a large weight loss, or if there are lots of stretch marks, then the skin may not tighten up well after the gynecomastia tissue is removed.  These patients still have a big improvement, but they may not get a chest that is as tight as ideal. If a lot of liposuction needs to be done and the skin isn’t tight, then sometimes some subtle waviness or irregularity in the contour is possible.  All in all, these problems are mild when taken in context of the huge improvement of the surgery, but each patient deserves to know going in the likelihood they may have one of these issues.

What if I am not happy with the result?

 

Dr. Teitelbaum is dedicated to making his patients happy.  If there is anything at all he can do to tweak a result after gynecomastia surgery or any other surgery he will do it.  It takes close to a year for the result to totally settle down.  It is best to wait as long as possible so that you don’t end up chasing your tail, reducing one side to match the other, only to end up over-corrected or under-corrected.  The tissue also softens over time which gives Dr. Teitelbaum a greater ability to create a nice contour.  It is very unusual for any of Dr. Teitelbaum’s patients to ask for a revision, but he does it when it is necessary. Far more often he revises gynecomastia surgery on patients dissatisfied with their previous result elsewhere or who have had several failed attempts at fixing their problem.

 

Can the gynecomastia come back?

 

All gynecomastia patients are warned that it can come back.  But the only gynecomastia patients in whom Dr. Teitelbaum has seen it return were men who took anabolic steroids after having their gynecomastia surgery.  Some patients may have had inadequate initial treatment, such as doing liposuction but not an excision.  Such patients didn’t really have a recurrence of their gynecomastia, but merely need more done.

 

Will liposuction alone work to treat gynecomastia?

 

When the tissue is soft and just fatty, then liposuction is the ideal treatment.  But pure glandular breast tissue is too dense to be removed by liposuction and must be surgically cut away.  There are some cases in which the problem seems to mostly be fat because no firm mass can be felt before surgery.  But after doing the liposuction, gradually the firm area emerges like an almond in the center of a melting chocolate bar.  In some situations there is a combination of fat and glandular tissue, but the patient may opt to just do the liposuction, accepting that the result will not be as complete but preferring to have a slightly easier recovery.

Can you do gynecomastia surgery on teenagers?

 

Gynecomastia should be considered normal in teenagers.  And it goes away most of the time.  So when should a teenager consider surgery?  Sometimes the severity of the gynecomastia is just too severe to expect the child to live with.  Instead of just being  a bit full or having a pointy shape, there can be a significant amount of asymmetry or the chest may develop very much of a breast like shape.   Parents might tell from their son’s behavior that it is affecting their self-esteem.   They may not want to take their shirt of and swim or go to a pool party.  They may avoid playing a sport because they don’t want someone to see their chest in the locker room.   Dr. Teitelbaum frequently helps teenagers with their gynecomastia.  In all cases he speaks extensively with the boy, his parents, and the child’s pediatrician.

What form of anesthesia will be used for my procedure?

 

Most patients prefer to go totally to sleep.  But there are situations in which IV sedation or even pure local anesthetic work equally well.  This is something that Dr. Teitelbaum will discuss with each patient.

Will there be scars?

 

There are often two very small incisions that are used for the liposuction portion of the procedure.  If an excision needs to be done, there will be a scar at the border of the areola from between 5 and 8 O’clock.  Dr. Teitelbaum is very carefully with how he closes the incisions and usually the scars are quite excellent.  It seems many patients today shave the hair on their chest.  If you can grow chest hair, it is good to let it grow before surgery so that it can help conceal the scars during the early healing process before the scars have had a chance to fade.

 

Will I lose nipple sensation after the procedure?

 

It is always possible to lose sensation but it is very uncommon to do so.

Does insurance cover gynecomastia?

 

Insurance companies vary widely in what they will cover.  In recent years Dr. Teitelbaum has only seen insurance companies cover gynecomastia surgery when it is extremely disfiguring and the man’s chest has a very female breast-like appearance.

Do I need to go to an aftercare facility after my gynecomastia surgery?

 

Patients can go home after gynecomastia surgery so long as someone is there to help look after them.  But some gynecomastia patients are very private and may go to an aftercare facility if they want no one to know.

Do I need to get a ride home?

 

No matter the type of anesthesia, you will have had surgery on your chest.  Your ability to use your arms safely and avoid an accident will be impaired by the surgery.  You must therefore get a ride home.  If you just had local anesthesia then you could take a cab home, but if you have general anesthesia then you will need to be taken home by the person who will stay with you and take care of you that day.

Will I get a phone call from the doctor the night of my surgery?

 

Dr. Teitelbaum calls all of his gynecomastia patients the night of surgery to check on how they are doing.  Equally important is for patients to call him if they have any concerns.

How painful is the recovery from male breast reduction surgery?

 

Men will say that it will feel very sore such as after a big work out or getting punched in the chest.  Patients will be given narcotic pain pills, but most men do not need to take them after gynecomastia surgery.  It is safe to say that the pain is relatively minor and manageable, even for teenage boys.

How long does the swelling last?

 

Swelling increases after surgery, usually peaking about 5-6 days after gynecomastia surgery.  After that, the swelling will subside, rapidly at first, and then gradually.  After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Do you use drains?

 

Dr. Teitelbaum only uses drains when he has to take out very large amounts of breast tissue.  He will tell you ahead of time if this will be necessary.

Will I have a special garment to wear after surgery? How long will I have to wear it?

You will have a vest with foam underneath it put on in the OR.  Remove this after two days, throw away the foam, and just wear the vest.  When you are around the house, wear the vest.  When you want to leave, put on a tight Under Armour type of shirt or vest.  There is no absolute period of time that you need to wear compression, but the more you wear it the faster your swelling will go away.  In general men will wear this for about a month.

When can I drive?

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car.  That is ultimately a decision that I cannot make for you.

How soon can I go to work?

 

So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work about three days after gynecomastia surgery.  Some people go back even sooner, and many work from home the next day.

When can I resume exercise after male breast reduction?

 

It is best to wait about three weeks to go back to the gym, but if you only had liposuction it is okay to work out after about ten days.

When can I sunbathe?

 

It is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.

When can I shower/take a bath?

 

Dr. Teitelbaum wants you to keep your initial post surgical garment on for two days.  At that point you can take it off and shower.  You should put your compression vest back on after that.