Male Breast Reduction (Gynecomastia)
The presence of excess soft tissue in the chest can be a source of embarrassment for adolescent boys and men. The soft tissue of the breasts swells at the time of puberty in about 30% of boys, but usually disappears by late adolescence. If it has not gone away by about age 16 to 18 years it probably will not. If excess glandular tissue is the primary cause of breast enlargement, as it is in most of these patients, it can be excised. The excision may be performed alone or in conjunction with liposuction if fat is also present. In a typical procedure, an incision is made in an inconspicuous location - either on the edge of the areola, the flat part of the nipple, or in the underarm. Working through the incision, the surgeon cuts away the excess glandular tissue, fat, and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. If liposuction is used to remove excess fat, the instrument used to remove the fat, called a cannula, is usually inserted through the existing incisions.
If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. A small incision, less than a half-inch in length, is made around the edge of the areola - the dark skin that surrounds the nipple, or the incision may be placed in the underarm area. The cannula, attached to a vacuum pump, is then inserted into the incision. Using deliberate strokes, the surgeon moves the cannula through the layers beneath the skin and suctions it out. If the amount of fat is relatively small, the surgery can be carried out under local anesthesia, and patients may feel a vibration or some friction during the process, but generally no pain. In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the remaining skin to re-adjust to the new breast contour. These procedures are usually carried out under general anesthesia.