Gynecomastia is breast tissue or fullness in men. Breast fullness is common in adolescence. Usually it improves with time. If it does not, it can be socially difficult. True gynecomastia is a combination of glandular breast tissue, fat, and skin.
Obesity is the most common cause of gynecomastia / chest fullness in men. If the issue is only fat, not glandular tissue, it may be called “pseudogynecomastia” or “lipomastia.” Gynecomastia from fat tends not to have much droopiness or “ptosis,” the areola are normal sized, and it is easier to correct. Usually I correct this with simple liposuction. As the fat in the breast tends to be fibrous and tough, I prefer to use ultrasonic UAL liposuction in addition to traditional liposuction for fat removal. Many believe the ultrasonic energy also helps the skin retract better.
If it is true gynecomastia with a glandular component, there are other causes that need to be evaluated: puberty, anabolic steroids, marijuana use, genetic disorders and syndromes, chronic liver disease, tumors, and some medications.
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True “physiologic” gynecomastia is thought to be due to an altered estrogen/androgen balance or from increased sensitivity of the breast tissue to normal estrogen level. In puberty, breast enlargement can occur in 60-70% of adolescents, with a median age onset of 14 years. Many of these patients will have the issue resolve spontaneously in an average of 18 months. If the tissue is painful, inactive fibrotic tissue (not proliferating), or is greater than 4 cm it is more likely to persist into adulthood.
True “pathologic” gynecomastia is associated with too much estrogen or too little androgen. This can be caused by:
Gynecomastia is graded by severity:
To treat gynecomastia with a glandular component, a combination of excision of the breast tissue with liposuction is done. If the areola is enlarged, its size can be reduced.
True gynecomastia is a two part surgery.
If it isn’t true gynecomastia and it is just fat, there is no direct excision needed and treatment is done with liposuction alone.
Recovery is quick but follows the usual course of many surgeries: first week you are taking it easy, on medication, not working. Second week you are off medication and back to your day job (if it isn’t strenuous). Back to exercise around a month.
You wear a compression garment for the first 3-4 weeks.
Gynecomastia is seen as being cosmetic by most insurance, even if you have true gynecomastia with breast tissue.
It is an outpatient surgery, taking about 2 1/2 hours. Cost is around $8-9000. Many times men will combine this surgery with liposuction of the back, love handles, and abdomen to contour the entire area.
HSA may be usable. Financing is also offered.
We now have an ultrasound machine in our clinic to evaluate tissue. We have found it helpful to look at gynecomastia to see if it is simply fat or if there is true breast tissue as well.
The ultrasound we use is Clarius, a hand held ultrasound machine. There is no cost to you for this service, which we perform as part of your initial consultation. (*please note: we are not certified ultrasound technicians. We offer this as a service to you. For a formal confirmation of your tissue, you can do mammogram or ultrasound with a radiology clinic.)