There are several causes of gynecomastia resulting in overdeveloped male breasts. When the body produces too much estrogen or too little testosterone, the glandular tissue of the breast swells. Genetics, steroids and drugs are the most common causes. Gynecomastia does not discriminate by age and occurs in babies, teen boys, and older men.
Many of our Los Angeles gynecomastia patients are men who never lost the extra bit of puffiness they had on their chest during puberty. They may be fit or work out, but no matter what they do, they cannot see the outline of their pecs.
Others may have taken steroids for weight lifting, and these steroids can cause a rapid growth of the breast tissue. In the case of weight lifting, usually there is a very firm marble or walnut that they can feel.
An important part of gynecomastia surgery is the preoperative assessment. For some men the problem is predominantly excess fat; for some it is firm glandular tissue, and for other men it is a combination of both. Dr. Teitelbaum will assess what is going on with your body and will help to guide your treatment.
But in the past few years, the treatment of gynecomastia has finally become mainstream. It is not just the weightlifters and teenagers with the really bad cases seeking male chest reduction; it is the men in their 20s and 30s with just enough extra tissue in their chest for them not to look as good as they should. Male breast reduction in Los Angeles is now one of the most common operations performed by Dr. Teitelbaum. Why the sudden change? Quite simply, the answer is the Internet.
Unlike women who talk to one another about their breast augmentation, breast reduction or liposuction, men do not talk to one another about gynecomastia. They hide it under their clothes, and so even their best friends are often totally unaware. Once fixed with surgery, they go forward with their lives as if they never had it. But thanks to the Internet, men can now privately research embarrassing topics such as gynecomastia, male breast reduction, man boobs, moobs, male chest reduction, etc., and learn that there is a very effective solution.
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.
Some Los Angeles gynecomastia patients just need one procedure (excision or liposuction) 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 be 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.
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 male breast reduction 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.
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.
It is always possible to redo male breast reduction surgery, 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.
Unfortunately in most cases they will not cover the treatment of gynecomastia. Insurance companies change their rules daily, with little regard for logic. But if there is any trend, it is for them to pay for this less and less often. It has been a long time since I have had an insurance company pay for this. In one case, it was an adolescent who had it so severe his chest looked like a woman's breast, and the other was a man with a firm mass in which we were concerned about cancer. The insurer paid for the biopsy, but that was but a small amount of the total cost for the procedure.
Dr. Teitelbaum has been performing plastic surgery on men since the early 1990s. He is one of the leading gynecomastia surgeons in the United States and has seen a substantial number of male patients for plastic surgery. Gynecomastia patients often ask for additional procedures to be done, contributing over the years to Dr. Teitelbaum's broad and deep experience with male plastic surgery.
As the first plastic surgeon in Southern California to acquire an ultrasonic liposuction machine back in 1998, many men sought his expertise because this machine has some advantages in removing the dense fat deposits characteristic to men. At that time, he was also starting to use a novel neck lift technique that is excellent for men.
With the success of both techniques, and others, Dr. Teitelbaum has seen this portion of his practice continue to grow substantially. He has devoted considerable thought to the ideal placement of scars in men. He has always followed his patients closely over time, and has learned from all the follow-up which scars fade into obscurity after surgery.
Dr. Teitelbaum is very conscious of keeping, and enhancing, the masculinity of the patient and he considers this goal to be a core component of achieving the best possible results for men. He and his staff perform male breast reduction surgery in Los Angeles with such regularity that you will feel safe, comfortable and well cared for by an OR team very experienced with gynecomastia.
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