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GYNECOMASTIA SURGERY

Although rarely talked about, gynecomastia, or “woman-like breasts” or “moobs,” is a common condition affecting nearly 40 to 60 percent of the male population. There are many factors that play into the cause of this condition, such as genetics, drug and alcohol abuse, and/or steroid use. If you would like to alleviate the embarrassment of this condition, you have the option of undergoing male breast reduction surgery (“gynecomastia surgery”).

It is important that you find a plastic surgeon who is experienced and knowledgeable in surgery for gynecomastia; Miguel A. Delgado, M.D., F.A.C.S., at Marin County Surgery Center is a gynecomastia surgeon who has extensive training in male breast reduction surgery, with more than 20 years in cosmetic surgery.

Gynecomastia correction primarily involves the reduction of glandular fatty tissue through surgical removal. This technique is used in conjunction with liposuction of any surrounding fatty tissue to achieve an ideal result. In some cases, the excision of excess skin may be necessary as well. The skin has a tremendous capacity to shrink and contract after surgery; much like a stretched rubber band retracting back to its original shape/size.

These are the basic elements of gynecomastia surgery, but each case is unique and is evaluated on an individual basis. There are many types of chest deformity that can appear. It can be as minimal as "puffy" nipples, or as significant as a C or D cup breast size. The treatment plan and results a patient can expect will differ depending on the situation.

During the initial consultation, I thoroughly discuss the pros and cons of gynecomastia surgery, along with the results that can be expected. I have numerous before and after photos, courtesy of my patients, which exhibit the typical results achieved after surgery. Often times, new patients will find examples of situations similar to their own, and can observe their potential results.

If you decide to proceed with surgery, a pre-operative appointment will be scheduled approximately two weeks prior to your surgical date. Before you come in for this appointment, a surgical information booklet will be mailed to you. It will contain pre-operative and post-operative instructions, and an extensive warning list of medications you must avoid for two weeks before and two weeks after surgery, as they may interfere with your surgery and healing process.

When you come in for your pre-operative appointment, we will discuss risks, complications and goals. A medical history will be noted, a physical will be done and you will be given prescriptions, as well as an order for the required blood test(s).

When choosing a surgeon, the most important quality to look for is extensive experience and expertise. It is equally important to see before and after pictures of the surgeon's past patients. Ideally, you will be able to review a multitude of examples and a variety of cases to get a good understanding of the surgeon's technique.

DAY OF SURGERY


The day of surgery creates a mixture of excitement and anxiety. It is natural and expected to be nervous before the procedure, and is nothing to be worried about. You will arrive at our state-of-the-art surgical facility and be taken care of by our expert surgical team, who has been with me for many years.

Just a word about the facility, Marin Cosmetic Surgery Center: The outpatient surgery center is in the Medical Office building of Novato Community Hospital, part of the Sutter Hospital campus. The facility is certified by the American Association for Accreditation of Ambulatory Surgical Facilities, Inc. (AAAASF) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the highest quality accreditation available in the United States. We are very proud of our facility and maintain the highest standards in the industry.

Dr. Gaynor is our anesthesiologist, and is renowned for his expertise in outpatient surgery. You will feel very comfortable under his care. His objective is always to make the entire surgical experience as pleasant and free of discomfort as possible.

Once surgery is completed, you will be taken into the recovery room where the attending nurse will observe you for an hour and a half. Once you are fully awake, have urinated, and have no signs of abnormal chest bleeding, you will be sent home with another responsible person of your choice. If you live more than one hour away, we strongly advise staying at a local hotel for the first night. This will enable us to evaluate you at a moment's notice if needed. Should you experience an emergency in which I feel you will need immediate medical attention, you could not risk the drive to my facility if you are too far away. Your care would be out of my control and the hospital expenses would be highly unpredictable.

Your first follow-up appointment will be within two to three days after surgery to remove your drains. Sutures will be taken out one week after the procedure, the compression garment will stay on for six weeks, no exercise for five to six weeks, and you will be able to return to work in three to five days, depending on the nature of your occupation.

SURGICAL PROCEDURE


My techniques for surgical treatment of gynecomastia are far from new. They were developed by innovative surgeons who came before me. I have taken these time-tested tools and refined them for my own use, performing hundreds of such procedures over the course of my career. My technique continues to evolve as technology improves and experience is gained.

The technique I choose to use for each procedure is dependent on the patient's unique situation. The typical patient wishes to achieve the result of the ideal male chest. This is not always possible and largely depends on the patient's anatomy. I work closely with my patients in consultation to reach realistic goals and expectations.

My surgical technique begins with an injection of tumescent fluid. This is a special solution composed of salt water, lidocaine (a local anesthetic), and epinephrine. Epinephrine is a "vasoconstrictor," which greatly reduces bleeding and allows me to operate with great ease. The solution takes six to seven minutes to take effect. Liposuction is then performed through a three-millimeter incision in the armpit to reduce the fat content of the chest. Liposuction is performed primarily around the nipple-areolar area, not high up on the chest where the bulk of the pectoralis provides the masculine appearance desired.

In many cases, I find that men have fat accumulation in the axillae, or the lateral aspect of the chest surrounding the armpit. Often times, this area needs aggressive liposuction to gain an even contour with the neighboring chest area.

Next, an incision is made at the bottom half of the areola. The skin is elevated from the underlining gland and fibrofatty tissue. The key to this procedure is to emulate how the chest sits when the body is in the standing position. This is important, because it is in this position that we observe ourselves. To achieve this during surgery, the back of the operating table is elevated to 80 degrees. The look of the chest changes dramatically from the horizontal position. The gland and fibrofatty tissue is sculpted to a masculine shape, using specialized razor sharp scissors. I am aggressive in my approach, but take great time and care to make the contour as smooth as possible.

Another goal of my technique is to obtain as much skin contraction as possible. To accomplish this, a significant amount of the subcutaneous tissue must be removed from the skin. This allows the skin to shrink to the maximum extent and form a natural appearance. The degree to which the skin contracts also depends on the patient's skin quality and amount of excess skin present.

At the end of the procedure, a drain is placed through the liposuction incision to create negative pressure in the open space and remove the fluid that naturally accumulates. This prevents the formation of a seroma, a buildup of bodily fluid underneath the skin. Should this occur, the fluid will need to be removed through needle aspiration. Special dressings and a compression garment are placed around the chest after the drains are in place, and the patient is taken into recovery.

This technique can be used to treat 75 percent to 80 percent of gynecomastia patients. The more severe cases may need a minor lift during the first procedure, or a secondary procedure to excise redundant skin through a peri-areolar lift.

The minor lift excises a crescent or half-doughnut-shaped piece of skin above the areola. This will lift the skin upward to reduce sagging below the nipple-areola complex. This is an excellent technique for a patient who does not have much sagging skin. One disadvantage is a slightly more visible scar, on the top of the areola rather than at the bottom.

The peri-areolar lift is a more aggressive procedure, removing more skin and tightening up the chest. With this technique, a doughnut of skin is excised around the areola. The scar is confined to the peri-areolar incision and it blends in very well over time. This secondary procedure is done three to four months after the first stage and is only used in severe cases. For such cases, I will rarely perform a single-stage mastectomy, a technique that leaves a quite obvious scar going across the chest.

To see samples of male breast reduction patients, feel free to view gynecomastia surgery before and after photos. You may also watch some of the featured male breast reduction videos on his website.

Contact Us For A Consultation

Dr. Delgado is board certified by the American Board of Plastic Surgery (ABPS). He is also a member of the American Society of Plastic Surgeons (ASPS), the California Society of Plastic Surgeons (CSPS), and the American Society for Aesthetic Plastic Surgery (ASAPS). Featured on BBC and Discovery Australia, Dr. Delgado is reputable for providing satisfactory gynecomastia treatment results.

To schedule a consultation with Dr. Delgado, you can call his Novato office at (415) 898-4161 or his San Francisco office at (415) 989-2221. You may also send your gynecomastia questions via our quick contact form or send an e-mail to info@dr-delgado.com.

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All men with enlarged breasts are candidates but the more extreme cases of gynecomastia will require more extensive surgery and possibly skin excision. It is important for the patient to be healthy and emotionally stable. Men whose gynecomastia is exacerbated by drugs should take this into consideration prior to surgery.

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