FAQ

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.

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.

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.

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.

It is always possible to redo gynecomastia – if the problem is to remove more. But 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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

The indication for treating gynecomastia is that it is causing you a visual problem. Do you feel 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.

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.

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.

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.

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.

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.

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.

Nearly half of all of Dr. Teitelbaum's liposuction patients are men. No matter how hard men exercise and work out at the gym, there are some stubborn fat deposits that won't go away, even in the very thinnest and fittest men. Of course men with a more average build, and certainly those with a few pounds to lose have parts of their bodies that would be improved with liposuction. These changes are beneficial when undressed, in a business suit, in workout clothes, or in a bathing suit. And since the scars are hidden, liposculpture leaves little of the telltale sorts of signs of plastic surgery that concern men considering plastic surgery.

The results are actually better in men than they are in women. There are two shortcomings in liposuction in women. The first is the ability of the skin to contract. Men have thicker skin and tend to maintain more elasticity than women. The other is that with liposuction there is always a risk of seeing some waviness or irregularity under the surface of the skin. The thicker skin and greater number of hair follicles in men obscure those irregularities more than the skin does in women. Finally, fat deposits in men seem to be much more discrete, with delineated boundaries. This allows better sculpting of the treated areas into the surrounding areas, thereby making the result more natural and attractive.

Dr. Teitelbaum believes that male handsomeness is strongly related to having a well-defined lower jawline and lean neck. There are many men who shouldn't lose a pound yet have a double chin. Some do not quite have a double chin but have fullness in their neck that is unattractive. Others have just enough fat along their jawbone so that their jaw is not well outlined and visible. Even men who need to lose weight can still look much better if they have submental liposuction. What is great about this procedure is that no one can ever tell that you had the procedure done. Friends will usually not comment, but when they do they will only state that you look great; they will notice you look good, but won't know why or even suspect that you had plastic surgery.

Some men have extra fat on the inside around the organs, and some men have extra fat just under the skin. Liposuction only works for the fat that is under the skin. Men that can sit down and pinch a roll of skin and fat probably have fat under the skin (subcutaneous fat), and this is well treated by liposuction. But there are some men with very firm bellies who cannot really pinch a lot of skin and fat. It can be obvious even to them that the fat is on the inside. Surgery cannot do anything for them at present. Their only option is weight loss. But for the countless men who have too much subcutaneous fat, liposuction can work wonders. It works not just to make men thinner, but it is indeed very effective at sculpting a nice contour to their abdomens. Liposculpture can help emphasize a six-pack and the results can be very beautiful.

Men who ask for a tummy tuck have either lost a lot of weight or they have always had a "pregnant" look no matter what weight they have been at. These last patients often have what is called a "rectus diastasis," which is a separation between the muscles that would otherwise create a "six-pack." When those muscles separate, they can look like they are trying to push their stomachs out as far as possible.

It is actually unusual to do a tummy tuck on a man at his true goal weight. The procedure is usually done when a man's weight loss has slowed or come to a halt, even if he would like to still weigh a bit less. Oftentimes operating at that point creates a big enough improvement that the boost to his self-esteem helps him to go the rest of the way after the surgery. It is highly unusual for any remaining weight loss to require any sort of a revision.

If the looseness extends all the way around the waist to the back, and if your buttocks and thighs are loose or deflated, then a lower body lift may be the ideal procedure. Though it involves a scar all the way around the waist, it can significantly tighten the buttock and thighs and for the patients who need it the results are tremendous.

The muscles that go from the rib cage to the pubic bone are the rectus abdominis muscles. These are the muscles that enable you to do a sit up, and they are the muscles that can create a six pack. They are supposed to be fused in the center, but after children in women and sometimes congenitally in men they are separated. It is common to reconnect these when doing a tummy tuck in women after babies, but it is not common that a rectus diastasis occurs simply from obesity in either men or women. But there is a subset of men who seem to be born with a weak attachment between the rectus muscles, and they develop a "congenital rectus diastasis." These men will say that they have never been able to hold their stomach their whole lives and that people may have teased them that they even looked pregnant.

The problem with facelifts is that we only know the bad ones. We all see men with great facelifts every day, but they are simply not obvious. If you want a facelift but are hesitant because you think that all men with facelifts have to look fake and feminized, please do not worry. With the right surgeon and techniques a facelift can make you look much better without looking as if you have had surgery.

A weak chin suggests a weak personality. Cartoons of tough guys always are caricatured with excessively large chins. Weak men are satirized with small chins. The point of a chin implant is only to give a man a normal chin. When this is done, men look stronger, more athletic, younger, and sexier. There are many different shapes of chin implants. While women tend to look better with more rounded chin implants, men often look better with more square shaped chin implants. One of the most wonderful things about chin implants in men is that no one ever thinks about whether someone has had a chin implant. Restoring a small chin to become a normal size makes men look dramatically better and the fact that he had surgery is usually undetectable.

Liposuction under the chin – submental liposuction – works well to thin the neck. But liposuction of the face does not work. However there are two marble shaped pieces of fat in the cheek called "buccal fat" which can easily be reduced. Buccal fat is the fat that gives babies their chipmunk appearance. But that look can exist even in thin adults. With a small incision inside of the mouth, a small amount of this fat can be removed through a procedure called "buccal fat excision." By removing the bulge in the lower cheek, the face can be made to look much leaner. Because facial fat is lost as we age, plastic surgeons must be careful not to remove buccal fat without careful consideration as to whether that person has so thin of a face that they may look too thin after face is lost in the future. For the many patients who undergo buccal fat excision, they enjoy a much leaner appearance, and the surgery leaves no tell tale signs that anything was ever done.