Most San Francisco Bay Area gynecomastia surgery patients that have had significant breast tissue removed will have spontaneous shrinkage of the areola as the chest heals. The diameter of the areola can decrease as much as 10% to 50% of the original size, but it depends on the quality of the skin and how aggressively was the removal of the tissue underneath the areola.
After male breast reduction surgery, it is important to wear a compression vest 24/7 for six weeks. The final outcome of the shrinkage of the areola may take up to 3 months. One needs to be patient. For the few that may need further areola reduction it is a simple procedure.
Many San Francisco Bay Area male breast reduction patients express their concern to Dr. Delgado, a Board Certified Plastic Surgeon, about wearing the compression vest after gynecomastia surgery. Their complaint is that the vest is cumbersome and somewhat uncomfortable. Dr. Delgado, who specializes in gynecomastia surgery, designed custom vests for his male breast reduction patients making the issue of discomfort a thing of the past. 
The vests have special pockets for the drains to rest in and can be removed after the drains come out.
The vest helps the skin to contract, reduces swelling and bind the chest tissues together by closing the “dead space” created by the surgery.
Sacramento gynecomastia patients have asked Dr. Delgado if they can remove the vest for a few hours a day. Dr. Delgado emphasizes that once the drains have been removed the vest can be removed to shower only. The vest must be worn 24/7 for a total of six weeks. The vest is removed after six weeks, and then the patient may resume all normal activities.
 Before gynecomastia surgery |  Hematoma |  2 months after evacuation |
Complications after male breast reduction surgery are rare, but the most common would be a hematoma, which appears as a bruise of various degrees from minor to severe. If treated immediately there will be no long term bad effects.
Sonoma County patients have asked, “What is a hematoma and how is it treated?” A hematoma is a collection of blood under the skin around the gynecomastia breast. This can happen during or after gynecomastia surgery from a small artery or vein which allows blood to seep into surrounding cavity which is formed by the removal of the breast glandular tissue. If it happens during surgery, the surgeon is able to correct it and stop the bleeding. Patients are monitored very closely after surgery with this being one of the things they are watching for. In Dr Delgado’s practice, 80 percent of the hematomas are seen in the recovery room and taken back to surgery. In fewer cases yet a hematoma may develop a day or two after surgery and it is important for the patient to keep his surgeon aware of any unusual bruising and swelling.
Precautionary steps are taken prior to surgery to reduce the possibility of excessive bleeding. A blood test is required to determine a patient’s clotting time and patients are warned to avoid taking aspirin or any other blood thinners for a minimum of two weeks prior to surgery and two weeks after to all San Francisco Bay Area patients to help decrease clotting time.
When looking for a surgeon that specializes in gynecomastia surgery, many men are surprised to find that there isn’t one in a city nearby, or perhaps even in their state. Some are aware that a Board Certified Plastic Surgeon is an important criterion and may end their search there. This can be a mistake, although there are many excellent surgeons, if they do not routinely do gynecomastia surgery they may not be up to date on the latest techniques. If the surgery has to be revised, this will end up costing more than traveling to an experienced gynecomastia surgeon in the first place and the revision may have new complications such as; scar tissue, possible loss of sensitivity and good skin retraction may be compromised.
There are many discussions on the forums of gynecomastia.org where members share stories such as; pros and cons of surgeons they have picked, some who have traveled out of their area to find an experienced surgeon, and some who have had revision nightmares for their male breast reduction surgery. Gynecomastia.org offers a directory to help patients find experienced surgeons in their area. Also, see the blog dated June 5, 2010 for some important guidelines in finding a gynecomastia surgeon.
To help defray travel costs, Dr. Delgado offers a generous travel package to his Marin surgery center, see the section for Out of Town Patients for details.
Recently released are the annual statistics from the prestigious American Society of Plastic Surgeons (ASPS). The overall number of cosmetic plastic surgery procedures performed on men is up 6%. Interesting to note that of the top 5 procedures for men, only male breast reduction and facelift procedures have gone up.
• Nose Reshaping 62,000 -2% from 2010
• Eyelid Surgery 29,000 -9% from 2010
• Liposuction 23,000 -3% from 2010
• Breast Reduction in Men 20,000 +8% from 2010
• Face lift 11,000 +3% from 2010
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
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.
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.
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.
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.
