It is important to note that real gynecomastia is primarily caused by the excess tissue rather than the fats alone.  For this reason, men with large breasts due to overweight or obesity will most likely be required to shed their extra weight before they even consider having plastic surgery

In severe cases of gynecomastia, a patient not only has overdeveloped breasts but also enlarged areola which is the pigmented part of the skin.  Fortunately, this problem can also be addressed with plastic surgery through a particular excision technique.

Since gynecomastia surgery is an invasive procedure, most plastic surgeons perform this using general anesthesia or intravenous sedation (rather than local anesthesia) to provide comfort to their patients.

Once the numbing effect of the drug takes effect, most plastic surgeons will start the procedure by performing liposuction through the use of a suctioning probe attached to a vacuum pump.  This instrument, which is inserted to several small cuts, is designed to dislodge and remove the fatty deposits from the body.

In most cases, the liposuction incisions are placed near the armpits and along the crease of the breasts.

Because liposuction can only remove the excess fats, plastic surgery specialists also use excision techniques to remove the excess tissue and skin to further reduce the size of the male breasts.  Meanwhile, the length and placement of the incisions largely depend on the severity of the problem and the expectations of a patient.

One of the most common gynecomastia surgical techniques is the U-shaped incision in which doctors create a continuous cut starting from the breast crease to the top of the areola, curving downward from the middle.  Another incision is made around the areola to free it from the skin.

With this approach, the scar falls along the breast crease which makes it almost unnoticeable.

Another common excision technique uses a diamond-shaped incision which starts from the breast crease to the top of the areola, curving upward from the middle.  With this procedure, a horizontal scar will form across the areola, making it more visible.

For patients who need a minimal correction, they can benefit from a smaller incision placed below the areola where doctors can reshape the tissue and remove any excess skin.

Nowadays, most plastic surgeons use the tumescent liposuction which is probably the safest technique to remove the fats underneath the skin.  In this approach, they inject the fatty area with a solution that primarily consists of lidocaine which is a type of local anesthesia, and epinephrine which is a drug that tightens the blood vessels to prevent bleeding.

The introduction of this fat removal technique in cosmetic plastic surgery has significantly made liposuction safer and more effective compared to the previous years when doctors used the dry technique (because no solution is introduced in the body) which has been criticized for exposing patients to excessive bleeding and high levels of surgical trauma.

Meanwhile, the use of the tumescent solution has made it possible for plastic surgeons to utilize slimmer suctioning probes to remove the fats from the body.  These instruments, which are called micro-cannulas, usually have a 2mm-diameter body which can fit to smaller incisions.

According to doctors in LA plastic surgery, smaller incisions are associated with shorter recovery and almost no risk of visible scarring—a common problem during the previous year when doctors were still using large cannulas.

Aside from the tumescent solution, the use of vibrating micro-cannulas has further made liposuction safer and more effective.  In fact, a recent study shows that these instruments can collect 30 percent more fats compared to manually moving the probe back and forth, a technique which may cause trauma to the surrounding tissues.

Because of the effectiveness of modern liposuction, some plastic surgeons use this as a substitute to abdominoplasty (tummy tuck) for patients whose main problem is the excess fats rather than the hanging skin.  However, abdominal liposuction is usually not the right approach for patients who have a significant amount of excess skin and fats in their upper and lower abdomen.

Some surgeons also use liposuction in conducting male breast reduction surgery especially if the problem is primarily caused by the bulging fats.  But in case that there is also some extra tissue, they usually complement the fat removal procedure with excision technique that will allow them to remove any excess skin and manipulate the underlying tissue.

While the condition is not life threatening, this may have a negative impact to some men, particularly on their emotional health.  In fact, some sufferers have reported relationship problems with the opposite sex and low self-esteem.

Contrary to a popular belief, gynecomastia does not improve even with rigorous exercise and diet since the problem is primarily caused by excess breast tissue and skin rather than fats.  For this reason, plastic surgeons use breast reduction surgery that can remove the excess tissue through strategically placed incisions.

To start this procedure, plastic surgeons administer general anesthesia or intravenous sedation to their patients.  Once the drug has taken its effect, they may perform liposuction if there is a significant amount of fatty deposits in the breasts.

Breast liposuction involves the use of a cannula, a thin hollow tube attached to a vacuum pump.  This instrument is inserted to small incisions in the fatty area and is moved back and forth to dislodge the fats, which is then removed from the body.

Once the fats are removed, doctors in plastic surgery will create several incisions directly into the breasts.  In most cases, they use the almond-shaped incision (starting from the crease traveling to the upper part of the breast) together with a circular incision around the edge of areola.

However, there are cases in which the U-shaped incision provides a better result.  In this approach, the middle of the upper incision curves downward to allow doctors to relocate the areola to a higher position.

In the almond-shaped incision, the scar line travels horizontally in the middle of the areola, while in the U-shaped incision, the scar is placed along the breast crease which makes it look like a natural fold of skin.

If needed, some plastic surgeons also reduce the size of an enlarged areola to further make the male breasts appear smaller and more natural.

Because of the invasiveness of the procedure, most doctors in plastic surgery see this as the last resort to treat gynecomastia.  With this, they may require their patients to lose some weight (for those who are overweight) or change their medication if a certain drug is causing the problem before conducting any surgery.

After Gynecomastia Surgery

Many guys go to a cosmetic plastic surgeon, embarrassed about their large, fleshy female-like breasts wanting their “man boobs” reduced. They also usually have a few things on their collective mind, such as

• Causes

Gynecomastia often starts in puberty when a teen has either too much
female hormone or his breast glands react abnormally to the
hormone already in his system. Male breast reduction surgeons say

they can feel a rubbery ring of  extremely dense breast tissue just under patients’nipples.

• Drugs & Diseases

Gynecomastia’s causes can often be traced to the following, among other factors:

• Alcoholism
• Street and prescription drug side effects or
• An undiagnosed medical condition

For instance, Kleinfelter syndrome often causes large male breasts.
Gynecomastia surgery is often done to help Kleinfelter sufferers
cope with their social lives. (Read more about Kleinfelter and male breast reduction.)

Marijuana, heroin and bodybuilding steroids can also produce gynecomastia. Diseases like chronic liver disease and Gilbert’s Syndrome or surgical procedures like castration can also be responsible.

• Overweight

Some teens and men hate their large breasts so much, they gain large
amounts of weight to better mask it. But the much-hated breasts will also grow. The
problem is compounded because chest skin has been stretched beyond its ability to
spring back again. If the patient does have surgery, he will
also have to have skin removal and that increases scarring.

• “Man boob” behavior

Almost all gynecomastia patients try to hide their breasts by donning bulky sweatshirts,
jackets and other heavy clothes – even in hot weather. They also avoid swimming pools and
beaches while never appearing shirtless, even in the most intimate moments. Junior high
“shirts and skins” basketball games are a nightmare to these guys.

• Gynecomastia treatments

Medical experts know that surgery is the only effective treatment for gynecomastia. Nonetheless, a sea of ads offering “special” creams, pills, herbs, electronic gizmos and other bogus cures are often seen on the Internet and in print ads. True gynecomastia can’t be liposuctioned away… although some liposuction of the chest is usually part of male breast reduction surgery.

• How many have it?

According to gynecomastia.org, the condition is very common with anywhere from 40 to 60 percent of younger and mature men and teens afflicted with it. During 2010, The American Society Plastic Surgeons (ASPS) counted 18,210 male breast reductions performed in the U.S.

Look at some gynecomastia surgery before and after pictures.

Wikipedia says the male bra, or the “bro” as some wags have named it, is only used by men who are potential gynecomastia surgery patients.

But most of the wearers seen in videos — like this male Japanese bra wearer on YouTube — really have nothing to put into the virtually flat cups of made-in-Japan male bras.

Other wags have suggested calling the garment, a “Manssiere.”

It really started with a T.V. sitcom from the 1980s and ’90s, Seinfeld. One character had a very fleshy chest so the lead character, Kramer, came up with the male bra concept as a comedy routine.

That may have been the first mention of men’s large, fleshy breasts, which is still something of a taboo subject.  Medically, the condition is known as gynecomastia.

Many, many teens and young men are embarrassed to the point of tears due to female-like chests. Locker rooms, beaches, swimming pools, shirts-and-skins basketball teams and public showers are a literal nightmare for these guys.

But a way around the embarrassment is through gynecomastia surgery. Working through a small incision in the nipple area, surgeons:

• Remove excess breast tissue
• Use liposuction to remove fat deposits
• Prescribe a chest compression garment for two weeks

Elliott Jacobs, M.D., a board-certified New York City plastic surgeon has always advocated breast reduction surgery for teen boys with fleshy breasts.

Although conventional surgery wisdom says to wait — because the lad may outgrow the condition — Dr. Jacobs (who himself has gynecomastia) says the teen years are so precious, they should not be given over to the constant ridicule that goes hand-in-hand with gynecomastia.

Dr. Jacobs has never forgotten the pain of high school when he returned to his gym locker and found a woman’s bra waiting for him.

View some gynecomastia before and after pictures of men who had their large breasts surgically changed into a more flat and masculine chest

Would you let your 15-year-old son have the surgery?