July 18th, 2011
The necessity to have gynecomastia surgery for male breast reduction under general anesthesia was addressed previously in a blog dated September 21, 2010. Equally important is the working relationship between your surgeon and your anesthesiologist. As with other forms of team work such as with musicians, and great athletes, the ability to be “in sync” can make for a winning outcome!
When you work together for years it is not uncommon to see partners almost able to communicate without speaking, and such is the situation between Dr. Delgado and his Board Certified Anesthesiologist, Dr. Randy Gaynor. They have been doing surgery together since Marin Cosmetic Surgery Center opened in 2001, where Dr. Delgado treats his San Francisco Bay Area patients.
For Dr. Delgado, having his own private surgery center allows him the ability to pick his own superior surgical team for all his cosmetic procedures including surgery for the gynecomastia breast(moobs). Unlike performing surgery in a hospital where you may have a different team each time.
Dr. Delgado and Dr. Gaynor have traveled together to Guatemala as part of a “Faith in Practice” surgical team, donating their time and their surgical skills for much needed surgeries for burn victims and children with cleft lip/palates and birth defects.
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June 20th, 2011
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The American Society of Plastic Surgeons states that gynecomastia, male breast reduction, is in the top 5 of the most popular surgical procedures for men. There are many options being offered to men through advertising in the media and internet to control or cure this condition. It is no wonder that many of Dr. Delgado‘s San Francisco gynecomastia patients question if these methods can offer quick relief by taking a pill or from weight loss. It is important to know fact from fiction by the various methods being offered.
The fat content of the male breast also known as “moobs“can definitely be reduced by weight loss.The gynecomastia breast however is composed of glandular tissue and fatty tissue, so the glandular tissue will not be affected. Exercise will help with the development of the pectorals in terms of making it more bulky or enhancing its definition, but will not alter the gynecomastia except bringing it more forward thus more prominent.
There is no scientific evidence to support the claims of advertised pills or drugs to reduce gynecomastia. There is some thought that some of these products that have estrogen blocking agents may halt the continued development of the breast tissue but it cannot remove gland that has already formed.
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If an adolescent’s hormones are off balance, it is possible that an endocrinologist can possibly adjust them during the early developmental stages. In some cases boys with gynecomastia, will find it will resolve itself once past puberty. Many surgeons will advise the patient and his parents to wait until the end of puberty before seeking surgery, unless it is a severe case or has significant psychological issues. However, once the gynecomastia is established, and the young man is past puberty and the teenage years, usually it does not resolve on its own without surgical intervention.
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Some men that have a milder case, may have “pseudo-gynecomastia” which can be caused by fat alone and can be removed by liposuction or weight loss. And some men with genuine gynecomastia may have only a mild to moderate amount of glandular tissue and fat which means they might be a candidate for the “Light Procedure” that is much less invasive than the regular gynecomastia surgery.
For those men with moderate to severe gynecomastia, surgery is the only real option for “curing” this condition. To get a well sculpted chest it is important that the surgeon uses a combination of liposuction for the fat removal, and surgical removal of most but not all of the breast tissue.
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April 13th, 2011
Puffy nipples represent true Gynecomastia. The fullness and protuberance that causes a dome effect of the nipple areola complex is due to the dense Gynecomastia breast tissue underneath the nipple areola area. This is the original placement of the breast bud during development in puberty. This breast bud can grow to various degrees of size in the teenage years. The “Puffy Nipple Syndrome” is often seen in younger males opposed to older males. The reason that it causes the cone shape of the nipple areola complex is because the fatty tissue around this area is not extensive but the lack of fat in the region makes the gland protrude even more causing puffy nipples.
Many of my San Francisco, Bay Area patients ask what treatments are available as seen in this post on gynecomastia.org. You may need to become a member in order to read the posts but there is no charge and it is a great forum with many questions and answers posted by members and Board Certified Plastic Surgeons.
In many cases this condition will resolve on its own after puberty, however if it doesn’t, the treatment of the nipples is the same, it requires glandular excision in which an incision is made around the areola and the gland is dissected free from around the areola and the deeper tissue. This removes the fullness in this location and allows the nipple areola to shrink and flatten.
Many patients feel that the Puffy Nipple Syndrome is improved when the nipple is cold or they are in water. This is due to the contractual muscle that is in the areola that upon stimulation causes contraction, tightening, and flattening in that location. Once the stimulation is removed the muscle relaxes and the puffiness is allowed to return.
The treatment of puffy nipples is very successful with extremely high satisfaction rate and often times the Gynecomastia like procedure which I explained in my previous blogs about the male breast and on my website can be performed in this situation.
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March 4th, 2011
Britain and Europe are usually not too far behind the United States when it comes to popularity in plastic surgery procedures. The demand for male breast reduction (gynecomastia) surgery in Europe has been evident for quite some time to Dr. Delgado because of the large amount of inquiries he receives and the multitude of patients that travel to see him in their quest to find a specialist in gynecomastia surgery. The popular website gynecomastia.org, shows a tremendous amount of questions and comments from our European neighbors.
Recently there was an article in the BBC News pointing out the increase of breast reduction in men had jumped 80% from 2008. In a previous article,also in the BBC News from Sept. 2009, it states that “moob jobs” had risen 44% between 2007 and 2008. Nigel Mercer, the president of the British Association of Aesthetic Plastic Surgeons (BAAPS) stated, “The public’s interest in aesthetic surgery appears to remain strong and indeed growing quite considerably among UK males despite the economic downturn”.
The article goes on to state the numbers for men seeking gynecomastia surgery have shot up by 1000% over the past five years. Removal of the gynecomastia breast for men has become the fifth most popular plastic surgery procedure for men in Britain after; nose surgery, eye lifts, ear corrections and liposuction. This trend is the same in the United States as stated in an article by the American Society for Aesthetic Plastic Surgery (ASAPS), except hair transplants were in the top five instead of ear surgery.
Many men from England, Europe and all over the world travel to the United States and specifically Northern California’s San Francisco Bay Area to be treated by Dr. Miguel Delgado who has specialized in gynecomastia surgery since 1989.
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February 5th, 2011
It is a known fact that gynecomastia, male breasts, can occur in boys and men for several different reasons. What may cause development of the gynecomastia breast in one man may not affect another. I have found this to be true in my San Francisco, Bay Area practice. Some of the more common causes are use of steroids, hormonal imbalance, weight gain, marijuana, and heredity.
Researchers continue to explore new possible causes. Recently there has been a lot of interest in Tea Tree Oil and Lavender Oil as being possible triggers. According to Wikipedia, Tea Tree Oil, which is indigenous to Australia, has been around for a long time.
Using the crushed leaves or inhaling the oils has many medicinal purposes from treating coughs and colds to wound treatment and skin ailments. It wasn’t until the 1920’s that the extracted oil itself became common practice. The oil has been used for many different applications such as; an antifungal agent, treatment for acne, and an effective treatment for dandruff. It is meant to be used only topically, if swallowed it could be very toxic.
According to an article in “The New England Journal of Medicine”, prepubertal gynecomastia was investigated in three otherwise healthy boys, between 4 and 10 years of age. The mother on one of the boys used a “healing balm” containing lavender oil. Another boy used a styling gel and shampoo daily that contained lavender and tea tree oil. The third boy used lavender scented soap and occasionally a lavender scented lotion. In all three cases the gynecomastia resolved completely a few months after discontinuation of the products. This suggests these oils may possess endocrine disrupting activity that can cause an imbalance in estrogen and androgen.
Studies are still ongoing and there is some controversy to these findings. It is important for patients to be aware of the possibilities and have an informed discussion with their surgeon.
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January 7th, 2011
Often during an initial consultation at both of the Bay Area offices, San Francisco and Marin, a patient will ask if other procedures can be done at the same time as their male breasts reduction surgery. The answer is, most definitely, in fact it is very common to have a combination of elective procedures done at Marin Cosmetic Surgery Center. Many men have localized fat deposits in the abdominal area, also the “love handles” and even the back. Liposuction is easily incorporated into the gynecomastia breast surgery, saving the patient time and money. It is easier for the surgeon to get a sculpted finished result when doing all procedures together. Of course a work up will be done including blood tests, checking vital signs and a consultation usually by phone with our Board Certified Anesthesiologist, Dr. Randy Gaynor; to be sure the patient is in good health for surgery.
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November 23rd, 2010
A major concern of Bay Area gynecomastia patients is: “what is the probability of the gynecomastia breast returning?” In making the decision to precede with surgery this is a very valid concern, while some men are fortunate to have a mild case and only need a minimal correction, most will need the full procedure and who wants to go through that and the expense only to have it return?
During surgery at Marin Cosmetic Surgery Center, a small amount of the breast tissue and fat are not removed in order to have a natural chest contour and for survival of the areola.
Sometimes, medications or hormonal imbalance can cause recurrence of male breast tissue. Weight gain however, is more likely the culprit since not all fat is removed.
If the cause of the male breast enlargement is from drugs (such as marijuana) or steroid use and it is not curtailed, it is very likely that there will be recurrence. Dr. Delgado will want to discuss your medical history with you in detail at the time of consultation at either the San Francisco or Marin office. Even though the cause of gynecomastia is not always known, there can be some good indicators that will help with prevention of the gynecomastia breast in the future. It is important to have a healthy diet and lifestyle to maintain the new chest shape.
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October 21st, 2010
CORRECTING THE OVER-RESECTED MALE BREASTS WITH FAT INJECTIONS
Revisional male breasts reduction surgery can take on many forms. One of the most common complications of gynecomastia breast surgery is over-resection of tissue. This is very easy to do and sometimes patients desire to have an even over-flattened appearance. Fat injection is one of the most common ways to fill in volume loss. The Sydney Coleman technique of fat preparation in an injection has become very popular for volume filling with your own tissue. 
The photograph that is shown here is a picture of fat after it has been taken, then centrifuged and then harvested for injection into a volume defect. Surprisingly, the fat replacement has a large amount of “take”. The fat actually gains vascularity and becomes a living structure.
Patients who have had over-resection of their glandular or fatty tissue in their male breasts may be good candidates for fat injections for refilling the area.
Below are two patients of Dr. Delgado’s that have had fat injections along with their surgery done at his Marin Cosmetic Surgery Center in the Bay Area near San Francisco.
Dr. Delgado has vast experience with gynecomastia breast surgery as well as revisional surgery that incorporates approximately 30% of his gynecomastia practice.
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September 21st, 2010
Isn’t local anesthesia better? The short answer is “no”…..
Many patients are concerned about anesthesia for their upcoming surgery for gynecomastia breast reduction, as they should be as this is one of the most important aspects of any surgery. Anesthesia has come a long way in recent years, the dangers that we have all heard about in news stories has been greatly minimized. There are many cases these days where babies need to have major surgery that can last several hours, if the anesthesiologist can make surgery safe for them, it is safe for you too. However not understanding how anesthesia for your particular surgery is going to work can make for needless apprehension.
During your consultation with Dr. Delgado, for male breasts reduction surgery, also known as “moobs”, he will explain in detail everything you can expect to take place; before, during and after your surgery. Dr. Delgado does not perform gynecomastia breast surgery under local anesthesia, even for his less invasive “Light Procedure“. Dr. Delgado wants to keep the patient as comfortable as possible, and therefore he has Dr. Randy Gaynor
who is a board certified anesthesiologist, assist him in surgery at his private surgery center, Marin Cosmetic Surgery Center. There can be exceptions to this preference, but it would be after consultation at either his San Francisco office or Marin with the patient, Dr. Delgado and Dr. Gaynor. Dr. Gaynor wants all of Dr. Delgado’s patients to know that he is available to speak on the phone or have a personal consultation with him to discuss any aspect of anesthesia. All patients receive a phone call from him prior to surgery to discuss their medical history and any previous experiences with anesthesia.
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August 17th, 2010
DOES SMARTLIPO OR ULTRASONIC-ASSISTED LIPOSUCTION WORK FOR GYNECOMASTIA? 
This is a very good question and one that is often asked in consultation. I have used ultrasonic liposuction and I continue using it today for liposuction. However, I do not use SmartLipo or ultrasonic liposuction with my gynecomastia cases. The reason I do not use ultrasonic-assisted liposuction is because in some cases the ultrasonic heat will cause some undue trauma to the skin and can be difficult to control. Therefore, I do not use the ultrasound in the chest itself; however, I do use it sometimes in the axillae (under the arms) for extraction of that fat. I think that it is a mistake to use ultrasound or SmartLipo to treat gynecomastia only. These modalities will treat the fat well, but will not extract the glandular tissue and, therefore, it will remain and the patients seeking male breast reduction, in most cases, are not happy with the results. Approximately 25%-30% of my gynecomastia practice is redo surgeries from other establishments and the primary reason is that a patient has had liposuction only. Due to the scar tissue caused by liposuction, the corrective surgery may be more difficult and sometimes the contraction of the skin is a little bit more unreliable when liposuction has been done first. The liposuction is very adequate for patients that have pseudogynecomastia, which is gynecomastia due to fat accumulation. This would be caused by weight gain in men or boys past puberty. Therefore, my suggestion is that if you do not have pseudogynecomastia, that a combination of liposuction, whether SmartLipo or ultrasound or tumescent liposuction, in conjunction with glandular excision is the best means for a good outcome. In some cases, you can do the light gynecomastia technique with a small incision depending on the extent of the gynecomastia, as explained in an earlier blog dated March 31.
MIGUEL A. DELGADO, M.D.
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