May 1st, 2012 Â
On December 6, 2011, there is a blog on “stage two sugery” for the cosmetic plastic surgery patient that has moderate to severe gynecomastia showing a patient with moderate male breasts. This is an excellent example of a recent case for a patient that had severe gynecomastia.
 Extreme gynecomastia
 
Patient on the operating room table after gland excision, liposuction, superior crescent lift and external lift sutures.
He is seen six months later
He is seen two weeks after stage two surgery
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April 12th, 2012 Â
A crater deformity is a crater or depression on the male chest under the nipple/areola complex that has had inadequate blending of surrounding tissue for a firm smooth contour. This condition can appear after gynecomastia surgery when too much fat and/or breasttissue has been removed during male breast reduction surgery. This will necessitate revision surgery.
Experienced surgeons have techniques for corrective surgery of this type. Once the patient has completely healed from the initial gynecomastia breast surgery, revision surgery can take place. The fat flap in general is the best choice and has become the most predictable. The fat flap is where the skin is elevated and the fat that surrounds the crater is sewn together filling in the depression. Sometimes the use of fat injections (also known as fat transfer or fat grafting) can take place but it all depends on the architecture of the defect.
Corrective surgery of this type is more challenging due to the fact that now there is scar tissue the surgeon must deal with from the original surgery. In addition to the scar tissue, the skin elasticity may have been somewhat compromised.
It is important that the patient chooses a Board Certified Plastic Surgeon that has a lot of experience with male breast reduction in order to avoid such a complication. 35% to 40% of Dr. Delgado’s gynecomastia surgeries comprise revision surgery of this type.
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March 27th, 2012 Â
The American Cancer Society estimates about 2,190 men will be diagnosed with breast cancer in 2012. Chances are 1 in 1,000 for men versus 1 in 8 for women. Most men develop breast cancer between the ages of 60 to 70, but can happen at any age. Breast cancer in the male breast is the uncontrolled growth of abnormal cells in the breast tissue.
The risk factor for men can be:
• Family history
• Exposure to radiation
• High estrogen levels
High levels of estrogen can be caused by obesity or liver disease such as Klinefelter’s syndrome which is a genetic disorder where men are born with a Y (male) chromosome and 2 or more X (female) chromosomes. Another liver disease more common would be cirrhosis (scarring) of the liver which can result from alcohol abuse or chronic hepatitis or rare genetic conditions. With cirrhosis, liver function is compromised and the male and female hormones in the bloodstream are altered.
Symptoms that men should be aware of are:
• Firm non painful mass located just below the nipple
• Skin changes in the area of the nipple such as, ulceration, puckering or dimpling, redness or the nipple turning inward
• Bloody or opaque discharge from the nipple
Less than 1% of cases affect both breasts. Dr. Delgado states that San Francisco Bay Area and Sacramento men are notoriously negligent in seeking medical advice for symptoms; usually the women in their life are responsible for them getting an early evaluation which is critical for a good prognosis.
With all this being said, most lumps in men’s breasts are not cancerous but represent true gynecomastia. Sending breast tissue at the time of male breast reduction surgery also known as gynecomastia surgery may seem unnecessary and expensive to many men, unless you are one of the unlucky ones that have a positive result.
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February 7th, 2012 Â
Being proactive in preparing for gynecomastia surgery has some huge benefits. Studies show that patients who are mentally and physically prepared have quicker recoveries, less pain and fewer complications.
Surprisingly there are many things that you can do that affect the outcome of your male breast reduction surgery. Patients who follow these recommendations find that they are mentally prepared and have less anxiety than the patient that just shows up for surgery.
1. Be in the best health possible by eating a healthy diet and have a regular exercise routine, even if it is just walking every day.
2. If you smoke, quit. See the blog dated November 26, 2011 that addresses the dangers of smoking.
3. Limit alcohol consumption; if possible stop drinking one month prior to surgery or cut back to no more than 2 drinks per day. As your surgery date approaches, follow your surgeon’s recommendations.
4. Be sure to inform your surgeon and anesthesiologist of all supplements and medications (prescriptions and over the counter) that you are taking. Blood thinners need to be avoided to help prevent bleeding issues during surgery. Many supplements such as ginkgo biloba, fish oil, St. John’s Wort fall into this category, to name just a few. Dr. Delgado gives his San Francisco Bay Area patients a three page list of supplements and vitamins that need to be avoided.
5. Take a good multiple vitamin that does not contain vitamin E (it is a blood thinner). 
6. Be prepared to give your surgeon and anesthesiologist your complete medical history including details of any surgeries you may have had.
7. Get plenty of rest.
8. Arrange for someone to pick you up from surgery and to stay with you for the first 24 hours.
9. Stock your pantry and refrigerator with healthy easy to prepare meals and drinks. Drink lots of water.
10. Have all your medications filled prior to surgery and have pen and paper handy to keep track of the time you have taken them. It is easy to forget especially if you are taking pain medication, so write it down! Note if it needs to be taken with food.
11. Have loose fitting, soft, comfortable clothing available that are easy to get on and off. Avoid pullover shirts, instead choose ones that button or zip up.
12. Remember not to eat or drink anything prior to surgery per your gynecomastia surgeon’s instructions!
By following the above recommendations you should have a safe, successful gynecomastia surgery.
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January 15th, 2012 Â
Prolactinoma is the most common type of non-cancerous tumor produced by the pituitary gland. The pituitary gland is a small bean shaped gland located at the base of the brain and regulates important functions of the body such as growth, blood pressure and reproduction. Tumors are caused by over production of the hormone prolactin. Prolactin stimulates the breast to produce milk and many other functions such as mood regulation.
Prolactinoma is not a life threatening condition but can impair vision and cause other side effects unique to men and women.
For men, an increase of prolactin can cause:
• Decreased sexual interest
• Uncommonly enlarged breasts (gynecomastia)
• Decreased body hair
• Headache
• Vision changes
• Infertility
• Low bone density
• And more
Some men may not have any symptoms, and not everyone needs to have treatment. For those that need treatment, medication is successful for most. A few may need to have surgery if the tumor may damage vision.
The cause of these tumors remains unknown. Possible causes of overproduction of prolactin may be:
• Prescription drugs
• Under active thyroid gland
• Injury to the chest
• Stress
While male breasts caused by Prolactinoma are fairly rare, Dr. Miguel Delgado reviews a patient’s medical history to determine possible causes for the gynecomastia breast and will refer the patient to an endocrinologist if he feels further evaluation is necessary before proceeding with male breast reduction surgery.
San Francisco Bay Area patients find valuable information and support at gynecomastia.org where there are forums available allowing members to interact with each other.
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December 6th, 2011 Â
For the man with moderate to severe gynecomastia also known as moobs, it may be recommended that a secondary procedure be performed after the initial male breast reduction surgery. This would be for men that have a large amount of redundant skin usually caused by weight loss and older men who have lost a lot of skin elasticity.
During the initial consultation, Marin County cosmetic surgeon, Dr. Miguel Delgado discusses all options with his Bay Area male breast reduction patients. He can tell if a patient may need the second stage surgery and informs them before any surgery has taken place.
Some patients are pleased with the results of their first surgery and do not choose to have the second stage, this is a personal decision and the satisfaction of the patient is most important. But for those that want the best possible outcome, the second stage can proceed after about four to six months of recovery from the first procedure, after the blood supply reestablishes itself underneath the nipple-areolar complex.
Some surgeons may opt to do a mastectomy type surgery to do everything in one stage, but Dr. Delgado feels the resulting scar is almost as obvious as the gynecomastia itself.
The procedure consists of an incision around the nipple-areolar complex doing what is referred to as a “Peri-areola donut mastopexy”, whereby you excise skin with a purse-string closure.
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November 26th, 2011 Â
Many of my male breast reduction patients that smoke ask; “How critical is it to stop smoking prior to surgery?” It is extremely critical; there are risks of complications and severe skin healing issues including skin loss and necrosois of the skin resulting in significantly more healing.
At the 2010 annual meeting of the American Society of Anesthesiologists in San Diego, a study was presented comparing over 82,000 smokers versus nonsmokers and the findings showed smokers were:
1. 50% more likely to develop pneumonia
2. 57% more likely to have cardiac arrest
3. 80% more likely to have a heart attack
4. 73% more likely to have a stroke
Smoking increases inflammation and inflammation increases the risk of complications. Also the risk of infection is far greater requiring the possible necessity of having to be put on mechanical ventilation. It has also been noted that patients who smoke have higher levels of pain after gynecomastia surgery. There is some evidence second hand smoke may also delay healing or cause problems. 
Smoking interferes with special chemicals that allow the release of oxygen to the cells for healing. There are more complications stated in an article published by the Mayo Clinic in 2005. But newer studies show that contrary to what is stated in the article, the use of nicotine gum is not an alternative; the nicotine can interfere with healing in the same way as nicotine in cigarettes and it is imperative that one stops smoking at a minimum of two weeks prior to surgery.
For San Francisco Bay Area patients planning corrective surgery to get rid of man boobs, this is an exciting life changing event. All precautions are taken to ensure the safety of the patient. If you are a smoker and are considering surgery, you must stop smoking as soon as possible then reward your efforts with the surgery you desire.
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October 24th, 2011 Â
In most cases, insurance will not cover male breast reduction. Unfortunately insurance companies do not see gynecomastia breast reduction as medically necessary, but view it as a cosmetic procedure.
Adolescent boys have a higher chance of getting coverage than do men, but it is still an uphill battle. There was a court case in 2007 where a father sued his insurance company for not covering his son’s surgery, it went all the way to the New York Supreme Court and ultimately the insurance company had to pay $5000 of the $7500 fee. This did not however, set a precedent as hoped. 
There is an excellent article on gynecomastia.org called “A Success Story-Start to Finish” written by a Mother about her son and everything they went through to get their insurance to cover his surgery. In the article she explains exactly what they did and how they did it to finally get approval. This is a long and difficult process and you can’t be sure of an outcome in your favor.
Dr. Delgado is always willing to submit a letter to insurance companies on behalf of any of his gynecomastia patients that he feels may have even a slight chance of getting coverage. Even though the surgery itself most likely will not be covered, there are expenses that under most policies will be covered, such as; required blood tests prior to surgery, pathology, and all prescriptions.
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September 8th, 2011 Â
Years ago, gynecomastia or male breasts, was not something that people talked about openly. In fact the term, gynecomastia is still unknown to many men who have the condition. It used to be that bald men suffered teasing and criticism for a condition they could not control. Now a day’s men are shaving their heads for what is a very popular look.
Due to media coverage and shows such as “Seinfeld”, male breasts have become a joke with many nicknames such as: man boobs, moobs, bitch tits etc. If it wasn’t hard enough to deal with years ago, today it is worse for the man with gynecomastia breasts, in becoming a public joke.
Many men discussing this issue on the popular website http://www.gynecomastia.org/ have stated that their girlfriends or wives do not find their extra breast tissue offensive at all. Having the gynecomastia breast is a very personal issue and for some it can be the extreme feeling of self hatred. This is such a tragedy when sometimes just having a good support system can make a huge difference.
Some men tried to hide their condition all through their teen years from not only their friends but also their family. They were too embarrassed to even address the issue. It is unfortunate though as many discovered that once they were able to share with their parents the humiliation it caused them, their parents only wanted to help them find a resolution. But then there are those that do not have the support and have to find their own way of coping. Sometimes therapy can make a difference, but for many the option of gynecomastia surgery can be a life changing event.
For those boys and men that do not find a good support system at home, Dr. Delgado recommends that they reach out to www.gynecomastia.org. This website has many different discussion boards with topics on all issues that men with breasts face. Anyone can become a member at no cost, and the support one receives from other men facing similar situations can be invaluable.
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August 22nd, 2011 Â
Many San Francisco gynecomastia patients ask if drains are really necessary. My answer to this is that it is up to the surgeon, each plastic surgeon determines what they feel is best for their male breast reduction patients. I drain!
For the average gynecomastia breast patient I perform an aggressive and wide exposure approach, thereby creating a large area of “open space” or “dead space”. Fluid loves to ooze into this large pocket of “raw space” and by placing a drain in this area, it will collapse the space, evacuate the fluid and the cavity will have negative pressure which encourages it to close down. I also have my patients wear a compression vest for 6 weeks creating the perfect healing environment.
Early in my career I let the complexity of a case determine if I used drains. More than 10% of the time fluid would accumulate inside the “dead space”. This fluid is called a seroma, not blood but yellow body fluid. So every 4 to 5 days it would require needle aspiration, which is easy to do but inconvenient to the patient. This would continue until the cavity collapsed but can prolong the healing. All will work out fine as long as the complication is handled properly in this manner.
After twenty years of experience, I now drain all cases…let me explain further.
Being able to observe what is coming out of the drain can give me some very important information as to what is going on inside! By seeing the consistency of the fluid, the thickness and the speed that it is coming out alerts me and my staff to determine:
• Do we need to observe him longer in the recovery room?
• Possible blood accumulation which necessitates removing the vest to check for swelling
• Or best yet, the fluid is thin, which means all is normal!
My seroma rate is now near zero however there are tradeoffs, the incision from the liposuction or drain site leaves a tiny scar which causes concern for many of my male breast reduction patients. It can be more noticeable than the incision around the areola, which by the way is almost invisible. But I listen to my patients and their concerns are mine and I now have an instrument so that I can take the incision high up in the armpit and toward the back. This makes for a win win situation, patients now have a hard time finding the scar and the drains have become a non-issue.
Many of my gynecomastia patients come from out of town; I need for them to heal without any complications, so that they can return home as soon as possible.
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