Steven P Davison, MD, DDS, FACS | Ximena Pinell, MD | Katherine Long Lijoi, MS

5 Min Read

In recent years there has been a tremendous surge in interest in contouring of the male chest. Gynecomastia, or male breast tissue, is a common medical condition that affects a third of men in their lifetime. Why the sudden interest for such a prevalent condition? Clothing patterns are to blame, the Under Armour or compression workout fashion that projects a vision of health and vitality. A trip to any mall will have the senses assaulted with images of buffed bodies with defined peck muscles sheathed in tightest fitting workout shirt or less. For the not-inconsiderable population with male breast tissue, this has driven the question of what can be done! 

Gynecomastia, or male pattern breast tissue, is a medical condition with excess contour to the chest. It can be fat, true breast gland tissue, or a combination of both. Paradoxically, losing weight will improve a fatty male chest but will accentuate one caused by breast gland. In no way is male gland tissue a feminine trait or symptom; it is just an exaggeration of the natural breast that every man, as a mammal, has.

There are generally considered to be three causes of Gynecomastia. They can be independent or combine to make the condition more prominent. The first is a hormonal imbalance, most common in puberty. The most common time to develop gynecomastia is the worst emotional burden: while in middle school. Occasionally an endocrine or hormonal tumor can cause gynecomastia, but they are rare. The second cause is medication. Any medication that interferes with hormone balance, decreases testosterone, or increases estrogen byproducts are common culprits. Spironolactone, Propecia, Saquinavir, and cimetidine are examples of such medications. Paradoxically, some of these are medications used to reverse other psychologically traumatic conditions like male pattern hair loss. Marijuana in significant doses can cause male breast tissue to enlarge¹. The final cause is weight gain. Obesity or weight gain can cause fat to infiltrate the breast and distort the man’s chest. This is the simpler problem to address with weight loss or liposuction. Unfortunately, the stretch of the chest skin can leave a less than ideal contour. 

The good news is that after a patient has been ruled out for a major medical condition by history or exam, excellent options for treatment exist. The interest in surgical solutions has taken off with Gynecomastia surgery being one of the hottest growing procedures in the field. In fact, Gynecomastia surgery increased 22.6% from 2012 to 2017². Before recommending a surgical solution, the surgeon must first determine the underlaying composition and contour of the male breast. 

Size and Shape: Is the breast mostly fat or is there a pronounced presence of breast tissue located under the nipple? Is the problem of fullness alone or is there excess skin? The excess skin is much more of a problem than bulk of breast tissue. It requires contouring of the skin envelope often with additional scars. How big is the man’s areola? Is it normal sized (19-23 mm) and oval or is it bigger like a woman’s at 40+mm in size? Does it need to be reduced or reshaped into a more oval areola located lower and more to the side of the breast than that of a female patient?

Treatment Options: 

Weight loss: This will only work for obesity-related, fat-infiltrated chest contour. True Gynecomastia or male pattern breast tissue will be made worse as the man’s body fat decreases. The Breast bud doesn’t reduce and with weight loss, becomes more prominent as a bump.

 Liposuction: Various Liposuction techniques can contour the breast. Some deal only with fat. Other modalities such as ultrasonic accentuation (Vasar) can manage to reduce mild breast glands without open surgery. 

Debridement: Mechanical debridement or rotary tools can reduce breast tissue from limited incisions. The limitation of this is completeness of the treatment and managing extra skin. 

Open or Direct Surgery: This is when a limited incision around the nipple is used to remove the breast mound. Liposuction is often added to smooth out the edges. 

Skin Removal: This is a more extensive treatment to address an oversized areola, drooping breast, or a severe female pattern gynecomastia, where the breast looks like a woman’s. It uses skin excision to better shape the breast to that of a man’s. The scars are usually longer but well worth the change in shape and size. 

Surgery: It takes 1-2 hours based on how much is required. Unless very limited, it is more comfortable with IV sedation or general anesthesia. Most plastic surgeons use some form of tumescent fluid to reduce discomfort and decrease bleeding. The recovery is a week or so with potential for drains to collect fluid and old blood. 

Scar Care: With silicone sheeting, lotions, and occasional injections scars can be softened to enhance the results. The use of a compression chest not unlike the workout shirts that started this whole conversation are common for up to a month after surgery. As the male breast is vigorously supplied with blood vessels, the risk of post-operative bleeding or hematoma is not insignificant. The very desire to have the best chest shape, that drives the request for surgery, fuels a not insignificant demand for minor revision of the chest. These should not be considered a failure, but almost an expected sequel to gynecomastia treatment. 

In Conclusion: Gynecomastia, or male pattern breast tissue, is very common and nothing to be ashamed about as it affects a third of men at some time in their lives. Treatment is highly successful with excellent patient satisfaction as long as the patient and surgeon appreciate there may be tweaks to achieve the final result. It is one of the fastest growing surgical requests and most Board-Certified Plastic Surgeons will be happy to consult with you in depth on the solution that would suit you best. 

Interested in Learning More?

If you would like to learn more about gynecomastia surgery in Washington, DC, contact DAVinci Plastic Surgery by calling (202) 966-9590 or by filling out our online contact form.

References:

1. Thompson DF, Carter JR. Drug-induced gynecomastia. Pharmacotherapy. 1993;13(1):37–45
2. American Society for Aesthetic Plastic Surgery (2017). Cosmetic Surgery National Data Bank Statistics. [ebook] New York, NY: American Society for Aesthetic Plastic Surgery, p.10. Available at: https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf [Accessed 4 Feb. 2020].

One of the least desirable features for a man would be male breasts, medically called Gynecomastia. Men may not have as much social pressure related to their appearance. However, in the case of Gynecomastia, it often contributes to self esteem issues and a lower self perception of masculinity because of the femininity associated with breasts.

Causes

The cause of Gynecomastia can be a result of genetics, developing more readily in some men that others, as well as earlier on in life. It is a hormone related issue. As a matter of fact, more than half of male babies are born with enlarged breast tissue because of exposure to their mother’s estrogen in utero, even though they subside within 2 to 3 weeks. It often appears due to the hormone changes of puberty, but in most cases subsides by the age of 20.

Medications and medical conditions can also be a culprit of Gynecomastia. Particularly any medications with human growth hormones, as well as some medications used to treat ulcers, and depression. Gynecomastia can be induced by medical conditions related to poor testicular hormone production, impaired liver, Klinefelter’s Syndrom and Gilbert’s Syndrome. Medical and recreational marijuana can also be a reason.

Some herbal products can also increase estrogen and decrease androgen. Bisphenol A, which is in some kinds of plastics increases estrogen, and many sources of non organic animal products contain a cocktail of hormones that transfer to humans through consumption and throw off the balance of hormones.

Another cause of a kind of Gynecomastia, officially called pseudogynecomastia, is carrying extra body fat that is deposited in the breast tissue. Exercising to build muscle in the chest can define the chest shape and get rid of the fat accumulation, but if there is extra breast tissue present or stretched skin, that will remain and continue to have a breast like appearance.

It’s Common

With all the potential causes of Gynecomastia, you can imagine that more men deal with it than you realize. Actually, about 50 percent of men have it to some degree, so if you’re struggling with this, you are not alone. It is a struggle for many men, and there’s no reason to be ashamed because it doesn’t make you any less of a man. If you have Gynecomastia, and you want to have masculine confidence about your chest area, there is a surgical option to sculpt the upper body.

Male Breast Reduction Surgery

Contour the chest area with Male Breast Reduction Surgery, which removes excess skin, fat and glandular tissue. As with any face or body shaping procedure, it takes great technical and artistic skill to create the desired outcome within the balance of the body as a whole. After an inconspicuous incision is made in the armpit or areola, the tissue will be removed, as well as liposuction of any fat, and then the resculpted tissue and muscle will be draped in a way to form a masculine pectoral.

Finally feel comfortable with your shirt off. Schedule a consultation today at www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

The stigma that cosmetic procedures are only for women has almost completely dropped off. There are procedures, such as Rhinoplasty, Chin Augmentation and Liposuction that men have been getting for decades, but the doors have been opened for men seeking to improve their image in other ways. Here are some procedures that more men are taking advantage of:

1.    Hooded eyelids and bulging under eyelids can impede vision and add years to anyone’s appearance. They tend to be extremely prominent in some men, which can also cause a tired, sickly or gruff appearance. While wisdom comes with age, these features can be off putting. Blepharoplasty rejuvenates the upper and lower eyelids to look more alert, healthy and friendly.

2.    Deep forehead creases above and between the brows also can make an appearance look always concerned, gruff or scolding. Softening these deep wrinkles can also soften people’s perception of how you’re feeling so that you’re not misunderstood. Crow’s feet, nasolabial folds, and pock marks that ripple and indent the skin contribute to a possibly harsh appearance. Botox and can be used in conjunction with Injectables, such as Juvederm, to smooth and make an appearance more welcoming. Botox, affectionately called Brotox for men, can affectively change your appearance without any downtime. This is very appealing to people with busy schedules who don’t have time for a surgery induced recovery.

3.    Masculine features, such as a flat chest and “V” shaped torso can boost confidence. Maybe due to genetic predisposition, age, medicine side effects, or weight gain, these masculine features have been replaced with male breasts (gynecomastia) and a bulging waist with a spare tire around the middle. Many men have applied the benefits of surgery to sculpt their upper body with Male Breast Reduction and torso with Abdominoplasty (Tummy Tuck) to remove fat and extra skin or just Liposuction to remove fat. A non surgical option for men who want a quick in office procedure that provides effective fat reducing results is Sculpsure, which uses laser energy to melt fat away.

4.    While in some cultures a double chin is a sign of prosperity, in America it isn’t received as desirably. Unfortunately, this is one of the most difficult areas to address naturally with diet and exercise. Many people want to restore their chin and facial definition. Fortunately, there are surgical and non surgical options to remove the excess fat in this area. If there is under chin fat and stretched neck skin, this can be removed with Neck Liposuction and a Neck Lift (Platysmaplasty). If the skin is firm enough then the most effective non surgical option to remove submental fullness is Kybella. It is an injectable of deoxycholic acid to destroy fat cells so they can no longer accumulate.

Men are made to feel welcome and comfortable in our office with our staff. There are many options to discuss how to achieve the changes you’re looking for, surgical and non surgical. To schedule a consultation to discuss the changes you’d like to make, visit www.davinciplastic.com.

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

More men are seeking enhancements than ever before.  
Their perspective on it has changed and they believe cosmetic surgery creates a competitive career edge… and is a confidence booster. Also, men today see plastic surgery and non invasive cosmetic treatments as part of their regular health care routine, like going to the gym or eating healthy.

Botox for Bro’s = Brotox
Botox for men has been coined  -“Brotox.” Brotox can reshape a tired or gruff appearance into a more friendly, rested look. Men also like this because there is no down time – so no productivity loss. Brotox is often done in our office during a lunch break or in between meetings. Also, Brotox allows for gradual minor – subtle changes. Men love being told that they look more rested, happier or healthier…and no one but you knows why!

Move Over– Mommy Makeovers — Here Comes Daddy Do Overs
The most recent years have seen big increase in “Mommy Makeovers” to help women get their pre- baby body back. It’s a well deserved group of rejuvenation procedures for women who have sacrificed physically and emotionally for their their family. Yes, The effects are different for men, but raising kids takes its toll on men’s bodies too. So …They want to look and feel younger and have many more years to enjoy their children and grandchildren. This is also why more men are choosing to get “Daddy Do Over” surgeries as part of their health routine.

More Popular Procedures for Men…

• Along with Brotox, Injectables like Juvederm are popular because they don’t require down time.
• They minimize deep forehead creases, crow’s feet or nasolabial folds.
• They can also fill in pock marks that give the skin a smoother appearance.

Blepharoplasty reduces hooded eyelids, bulging under eyelids that can age and impede vision. This rejuvenates the upper and lower eyelids to rejuvenate a tired or gruff appearance.

Male Breast Reduction corrects the gynecomastia (male breasts) to sculpt their upper body and help restore their feeling of masculinity.

Men want that masculine “V” shaped torso again, which can be restored with Abdominoplasty (Tummy Tuck) to remove fat and extra skin or Liposuction to remove fat.

Through roughhousing and sports, guys are more likely to have their nose broken, which affects the appearance, and ability to breathe. Rhinoplasty restores the appearance and breathing caused by blocked nasal passages.

Men still desire a strong chin as a sign of masculinity, which can be accomplished by a Chin Augmentation with implants or Injectable Fillers. Also a double chin can be removed with Liposuction or Kybella.

Men, let’s talk about what I can do to help you with confidence, performance and satisfaction with your appearance and physique.

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

I’ve written several articles this year about men and cosmetic procedures…because men want the information, they appreciate the education and, they love the results they get from each procedure. The trend is that men are having more cosmetic and reconstructive procedures of every type, every year. Male Gynecomastia surgery is done to reduce the size of male breasts (same as breast reduction in women) for various other reasons.  I perform many of these operations every year to help my male patients regain self esteem, get renewed confidence and a new “physique” they can show off without embarrassment.

DATA:  40% to 60% of all men are affected with enlarged women like breasts

• Male Breast reduction is ideal for men who are self conscious about their condition
• Gynecomastia usually begins during adolescence & continues for life if not corrected
• It psychologically impacts men of all ages…starting in the early teen years
• Causes of large male breasts include:  obesity, Klinefelter’s Syndrome, Gilbert’s Syndrome, normal aging, hormone fluctuations, RX medications, anabolic steroids, impaired liver function

Male Breast Reduction Surgery… Results in a chest that is flatter, firmer, more contoured. Men and boys who suffer with Gynecomastia have found this surgery to be the ideal solution to their problem.  1) Male breast reduction is typically an outpatient surgery performed under general or local anesthesia. 2) I work through one small incision to  and remove excess fat and skin and to sculpt the breast to a masculine appearance. 3) My advanced techniques/skills and experience results in inconspicuous scars. 4) As with any operation, there is some swelling, bruising and discomfort for 2 to 3 days.   Oral pain medication manages this nicely. 5) Final results are seen when all swelling has resolved…usually 2 to 3 months.

Questions Men Ask Most Often:  See my website for info: http://www.DAVinciplastic.com

How much work will I miss?   My patients report back to work in 1 to 2 days.  Choose a long weekend for your procedure.

Will Activities be Restricted?   Yes.  No sex for 1 to 2 weeks following your surgery and no heavy, strenuous exercise for about 3 weeks.    Will Male Breast Reduction surgery change my looks?  NO.  You will look like yourself…just more fit, trim and contoured!

Will Male Breast Reduction negatively affect my sexual activity?  NO…in fact…men report to me it really enhances it due to their renewed self esteem and pumped self confidence!

OK. This gives you a good overview.  Come in soon and let’s talk.

Steven Davison M.D.

“DAVinci….where I combine the supreme elements of art and surgical science.”