June 17th, 2013 Miguel A. Delgado Jr, MD
 San Francisco, CA-Risperdal is a drug manufactured by Janssen a subsidiary of Johnson and Johnson (J & J). The drug was approved for adults by the Food and Drug Administration (FDA) in 1993 as an anti-psychotic drug for the treatment of schizophrenia. In 2003, Risperdal was approved for expanded use to include treatment of acute manic or mixed episodes associated with Bipolar I disorder in adults. In 2006, Risperdal received its first approval for treatment of children between the ages of 5 and 16 for irritability associated with autistic disorder. In 2007, it was approved for children as young as 10 for treatment of schizophrenia and Bipolar I disorder as for adults.
 It has been noted that the drug elevates the hormone prolactin, high amounts are normally found in breast feeding women, for others high amounts can cause breast budding, breast growth, gynecomastia, and even production of milk in all patients including young girls, boys and adult men. In several studies, the elevation of prolactin became apparent after only eight weeks of being on Risperdal.
 Under Federal law, drug manufacturers can promote only the approved uses of their medicines. “Off label” means using it for other than its approved use. There are claims that the drug had been promoted for “off label” use to treat such conditions as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), oppositional-defiant disorder (ODD), conduct disorder (CD), disruptive behavior disorder (DBD), Tourette’s syndrome, post-traumatic stress disorder (PTSD), and pervasive development disorder (PDD).
 The FDA’s approval for children was limited, and J & J is facing multiple lawsuits, some have been settled, and some are still pending. A Philadelphia attorney supports the claim that the drug caused gynecomastia in many of his clients. In addition to lawsuits he has filed on behalf of his clients, he has filed a petition with the FDA with the goal to get the FDA to ban the use of the drug for children until long term safety of the drug can be determined, or in the alternative immediately require labeling to include a” black box warning” on the lack of sufficient safety data.
 The petition goes on to say that Risperdal and other anti-psychotic medications are often prescribed by health professionals who habitually do not conduct physical examinations including assessments of adolescent boys and young men for abnormal breast growth, testicular development and sexual maturation. Generally the patients and their parents are not warned to be on the lookout for abnormal breast growth. In fact, most patients and their parents don’t even know what the term “gynecomastia” is and that it is related to abnormal male breast growth. In addition, Risperdal can cause excessive weight gain; with these two Risperdal induced side effects the adolescent’s endocrine system can be greatly affected. The risk of gaining weight is greatly understated in the label warnings which may lead to many physicians to attribute the development of gynecomastia to over nutrition or puberty. Continuation of the drug may contribute to the gynecomastia becoming a permanent condition instead of one that could resolve as a young man passes through puberty.
 There are many drugs that are known to cause gynecomastia, but there isn’t a drug that will reverse it, leaving only surgical intervention of male breast reduction as an option.
Be sure to consult with your treating physician regarding this issue if you are taking or have taken this drug.
Posted in Adolescent gynecomastia, Gynecomastia causes, Home | Comments Off
May 31st, 2013 Miguel A. Delgado Jr, MD
Claudius Galenus
San Francisco, California-The term “gynecomastia” comes from the Greek words “gyne” meaning woman and “mastos” meaning breast. Today there are terms such as; man boobs, moobs and bitch tits that unkindly refer to male breast enlargement.
The term gynecomastia was introduced in the second century A.D. by the famous physician and philosopher Claudius Galenus, also known as Galen. He described the condition as an abnormal amount of fat within the male breast. Interestingly, he was also aware of some men having abnormal amounts of breast tissue but did not consider it the same condition. History does not support any indication that there were any attempts to treat the condition until five centuries later.
Byzantine physician Paulus of Aegina is believed to be the first to attempt surgical correction. He described a number of characteristics that are still considered important today, including; the prevalence of gynecomastia in the adolescent, and the occurrence of fat deposits in some but not all cases. He also noted the need for secondary surgery for some patients.
Some surgical procedures are documented for the eighteenth and nineteenth centuries, but it was the contribution of two surgeons in the early twentieth century, Dufourmantel and Webster that has made the greatest impact. Surgeons continued to improve on technique with the goal of minimizing scars and to sculpt the chest to give the most natural result.
With all of the advances and techniques available, today men are able to have male breast reduction surgery with contoured natural results and almost undetectable scars.
Posted in Adolescent gynecomastia, Gynecomastia surgery, Home | Comments Off
May 15th, 2013 Miguel A. Delgado Jr, MD
Before surgery of areola reduction
San Francisco, California-There have been several San Francisco Bay Area men that have complained about having large areola, some have minimal gynecomastia or even a normal male chest. Large areola can give a feminized appearance prompting many men to seek a solution.
The good news is there is a procedure, an “areolar reduction” that can be performed in conjunction with male breast reduction surgery, or by itself. This involves a peri-areolar incision around the entire circumference of the areola where part of the areola is excised, and the incision is closed with “purse string” sutures, as is done with second stage gynecomastia surgery.
The incision heals very well with the scar almost completely hidden by the color difference between the areolar skin and the adjacent skin of the chest.
After surgery for areola reduction
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April 30th, 2013 Miguel A. Delgado Jr, MD
This is an 18-year-old man who underwent gynecomastia breast gland excision and liposuction, with removal of a 6 x 5 x 3 cm tissue on his right and 6 x 5 x 3 cm tissue on his left. In addition he had a superior incision for a crescent areola lift for superior advancement of the areola tissue. The goal is to eradicate or reduce the lower breast fold.
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San Francisco, California-The degree to which a man’s skin shrinks after removal of fat and breast tissue from his chest during male breast reduction surgery varies greatly depending on the condition of the patient’s skin and the amount of excess skin.
Some men may need a minor breast lift to reduce sagging skin below the nipple/areola complex. A minor lift is accomplished by removing a crescent shaped piece of skin just above the areola. The trade off with this procedure is a slightly more visible scar as the incision is above the areola instead of below it.
One of the big advantages of the minor lift is it can all be done in one procedure instead of two stages. It is difficult to give a cost for the additional procedure as each case is unique. In general, the surgeon’s fee can range from $500 to $1500, and the additional operating room time can vary from a half hour to an hour and a quarter, adding to the surgery center fees anywhere from $1,000 to $2750.
In order for men to plan for their male breast reduction surgery, it is understood that it is important to know the costs that will be involved. The best way to get a precise quote would be to see Dr. Delgado for a personal consultation at; 450 Sutter St. Suite 2433, San Francisco or 165 Rowland Way, Suite300, Novato California. For out of town patient’s, we are happy to arrange a phone gynecomastia consultation with Dr. Delgado by calling (415) 898-4161.
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April 15th, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-The variables in gynecomastia surgery are numerous. It is almost like asking how much does a new house cost. For a house you need to factor in the location, the size, the experience of the builder, materials used, are you going to change the plans and add new features?
Male breast reduction surgery is similar in that the location of your surgeon can make a difference. Fees for surgeons in metropolitan areas generally run higher than those from smaller towns and fees for a surgeon with a lot of training and experience, who is Board Certified in Plastic Surgery, is going to have higher fees than the surgeon who is less experienced. Gynecomastia comes in many different forms, from mild to moderate to extreme. Some types of gynecomastia only involve the areola and nipple. Some mild forms of gynecomastia that are caused by fat alone (pseudo-gynecomastia) may be treated with liposuction and not surgical excision. In the situation where the man has an extreme case of enlarged male breasts, it may be necessary to schedule the reduction in stages requiring two or three separate surgical procedures.
Many San Francisco Bay Area men decide to add additional procedures to their male breast reduction surgery. Most commonly added is additional liposuction, usually the “love handles” and abdomen, and sometimes the lower armpit area or back. These additional procedures will add more time to the surgery and will increase the fees.
Determining the actual cost for a patient is highly individual; some men need to know approximately what the surgery will cost so that they know if they can even consider it. Dr. Delgado’s fee for the average gynecomastia surgery is $4500 to $4700, and the average time is 3.5 hours. The cost for the surgery center would be about $2450.00, and the fee for the anesthesiologist would be about $1050. In addition, there is a fee for garments and supplies that run about $300, so ball-park would be about $8500. For out of town patients, Dr. Delgado offers a free consultation on Skype or by phone, simply forward photos via mail or email. This gives a prospective patient a personal consultation with a precise quote prior to traveling.
In the search for a gynecomastia specialist, it is most beneficial to consider the experience and credentials of the surgeon. Too many men have experienced poor results only to find the solution to be a second (revision) surgery. Having revision surgery doubles the cost and recovery time. Currently, 50% of Dr. Delgado’s gynecomastia patients have come to him for revision surgery due to unsatisfactory results from their original surgery and surgeon.
Gynecomastia.org is an excellent website to learn from other men what their experiences have been with male breast reduction surgery.
Posted in Gynecomastia consultation, Gynecomastia costs, Gynecomastia surgery, Gynecomastia travel, Home | Comments Off
March 30th, 2013 Miguel A. Delgado Jr, MD
Before and After Gynecomastia Surgery
San Francisco Bay Area men have asked if their men breast or gynecomastia is caused by excess breast tissue or by fat alone, hoping that if it is fat alone they may be able to get rid of it by weight loss or liposuction. Most often it is a combination of both, or sometimes caused by skin and sagging tissue.
Breast tissue feels firmer than fat, but the patient probably cannot tell the difference. It is almost impossible to tell if the gynecomastia breast is fat or gland from a photo, even with clinical examination it can be difficult to determine.
Some men choose to try weight loss to correct the condition before having male breast surgery. This may be successful if the developed breast is caused by fat alone, however if there is glandular tissue involved, once the fat has been reduced the remaining breast tissue may be even more apparent.
The patient can try feeling the breast for signs of a firm lump under the nipple, which may or may not be accompanied by tenderness or soreness. If a lump is felt it is recommended to see a physician or Board Certified Plastic Surgeon to determine if it is a benign symptom of gynecomastia or a rare form of breast cancer in men.
It is believed that the use of marijuana or anabolic steroids, medications containing estrogen, or impaired liver function may contribute to gynecomastia.
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March 15th, 2013 Miguel A. Delgado Jr, MD
Before and After Gynecomastia Surgery
San Francisco Bay Area men frequently ask where the incisions will be for male breast reduction surgery. This is a good question because once the decision is made for surgery; men do not want to trade the presence of breasts for unsightly scars. It is the gynecomastia specialist’s goal to make the incision as hidden as possible. With today’s techniques, the specialist is able to achieve excellent results.
For the man with true gynecomastia (a combination of fat and breast tissue) liposuction and surgical excision is performed. First, through a 3 millimeter incision in the arm pit I use liposuction to reduce fat content of the chest. Then I make an incision around the bottom half of the areola to excise the breast tissue. For men with more excess skin it is possible to include a minor lift by excising a crescent piece of skin above the areola, but leaves a slightly more visible scar on top of the areola.
For severe cases of gynecomastia, a second stage procedure may be scheduled 4 to 6 months after the initial procedure. The second stage also known as the “Peri-areolar lift” is a more aggressive approach for removing excess skin. An incision is made around the nipple-areolar complex, excising a donut of skin and closing with purse string sutures, which heals very well blending into the areola. The second stage procedure is highly preferred over a single stage mastectomy which would leave an obvious scar across the chest.
Then there are some cases where a less invasive procedure can be done for the man with mild to moderate gynecomastia, called “the light pull-through procedure“. This procedure involves even a smaller incision at the edge of the areola. See the picture below. Each patient is unique and at the time of the consultation it can be determined which procedure will be the best and what type of incision will be used.
The amount of time it takes for the scars to heal depends on the individual. Protect the incisions from sunlight and apply silicone sheeting as instructed for optimal results.
The Light Pull-Through Procedure
Posted in Gynecomastia recovery, Gynecomastia surgery, Home | Comments Off
February 28th, 2013 Miguel A. Delgado Jr, MD
Skype Consultation
In the search for a well-qualified gynecomastia specialist, Los Angeles California men discover that they may need to travel out of their area. Same is true for many men from out of state, or even out of the country. The internet provides a wealth of information for men with questions about gynecomastia, also known as moobs. The best informational website is www.gynecomastia.org (see the blog dated July 6, 2010). Besides having many forums where members can share stories and ask questions of each other and of surgeons, there is a directory listing many Board Certified Plastic Surgeons who specialize in gynecomastia, from all over the United States and beyond. Many male breast reduction patients still opt to travel out of town, sometimes even to another state, to have treatment by the surgeon of their choice.
In order to assist his patients, Dr. Delgado offers a free consultation via Skype allowing the patient to make only one trip to the San Francisco Bay Area for surgery. For those patients that do not have a webcam on their computer, one can be purchased inexpensively online or at a computer store. If that is not an option, pictures of the chest can be emailed or sent through regular mail and followed up by a phone consultation. Contact the office for detailed instructions at 450 Sutter Street, San Francisco, CA 94108. Phone (415) 898-4161.
To help defray travel costs, Dr. Delgado offers a generous travel package to his Marin surgery center; see the tab for Out of Town Patients for details.
Posted in Gynecomastia consultation, Gynecomastia travel, Home | Comments Off
February 15th, 2013 Miguel A. Delgado Jr, MD
Before and After Gynecomastia Surgery
Numbness or heightened sensitivity of the nipples is possible after gynecomastia surgery. There are hundreds of tiny nerve endings that provide sensation to the nipples of men breasts. During male breast reduction surgery, some nerve endings are injured. Usually the injured nerves reconnect but the healing can be very gradual for men and adolescent gynecomastia patients.
During the healing process, it is normal to have itching, tingling and sometimes shooting pains and super sensitivity of the nipples. It can take up to a year or longer for sensitivity to return for the majority of men who have reduction of the gynecomastia breast, for some it may never return; only time will tell. I tell my San Francisco Bay Area patients that this is one of the risks of surgery.
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January 30th, 2013 Miguel A. Delgado Jr, MD
Adolescent gynecomastia before and after surgery
Up to 60% of boys have detectable gynecomastia by the age of 14. The cause is not certain but usually is attributed to an imbalance of sex hormones brought on by puberty.
It is very important for San Francisco Bay Area parents to be aware of the possibility that their son may be experiencing this condition so they can help him understand what is happening. The breasts may look enlarged, or the nipples puffy or unusually large.
Though it is a benign condition, many young men are humiliated, and or embarrassed and try to hide their chests. Classmates tend to use cruel terminology such as man boobs or moobs, and even worse, bitch tits… causing many boys tremendous suffering, which can lead to depression and other psychological issues.
For 80% to 90% of adolescent gynecomastia cases, it will resolve itself usually within several weeks up to 3 years without treatment.
Realize that it may be very difficult for your son to talk to you about his male breasts. Letting him know he has your support and that you understand what he is going through can be invaluable as he goes through puberty. It is recommended for you and your son to seek a consultation with a Board Certified Plastic Surgeon who specializes in male breast reduction surgery so that all of your questions can be answered and you will know what your options are. For the 10% to 20% of boys that the gynecomastia breast does not resolve itself, surgery by a gynecomastia specialist is an option.
Posted in Gynecomastia causes, Gynecomastia symptoms, Home | Comments Off
