Male Breast Reduction Surgery in New Jersey
If we thought about it long enough, nearly every single person in the world could think of some
part of their body that embarrasses them.
But for some, embarrassing parts are more noticeable than others and this can lead to a great
degree of self-consciousness and embarrassment. One such feature that plagues anywhere from 40 to 60 percent of men
is gynecomastia, or female-like breasts.
It is estimated that over 50% of males over 50 and over 70% of males over 70 have some form of
Gynecomastia is usually created by one of two things: excess breast tissue or excess glandular
tissue. Some men can also experience it from excess fatty tissue and this is called pseudogynecomastia. In most men
gynecomastia consists of both - breast tissue and fat.
Regardless of what it is called, it can cause many men social and psychological
Men who suffer from Gynecomastia can opt to have male breast reduction surgery where the
gland or excess fatty tissue is removed, giving their chest a flatter, more masculine appearance. A male breast
reduction is a much simpler version of a female breast reduction and it is less expensive and requires less time to
Some patients, and unfortunately physicians, might feel that gynecomastia surgery is a very
simple procedure. It is not complicated, however, it is not simple. As we gain more experience in
gynecomastia surgery, the understanding of a good result changes from just reducing the volume to the shaping of the
chest wall. We have to look beyond just a volume issue, we need to consider the other anatomic structures for
the best results.
When I assess a gynecomastia patient, I consider 5 main
1. Amount of excessive breast
2. Location of breast tissue an amount of fatty tissue
3. Amount of excess
4. Size, shape, position, and symmetry of the
5. Size, shape, and symmetry of the nipple itself
Most surgeons perform liposuction alone. For many patients it may work well but in my
mind, it may not be enough for a good result.
If you have more questions about gynecomastia surgery, please contact our practice.
So, what causes gynecomastia? Here are my
thoughts about gynecomastia:
Common causes include obesity, subtle hormonal or metabolic imbalances, and liver disease (which can cause
hormonal imbalance). Some medicines and supplements can cause it as well, especially steroid abuse and street
These days you cannot turn on the TV without seeing some form of ED or testosterone
remedy. With a significant increase in testosterone supplementation in this country, I expect the gynecomastia
rates to increase accordingly. In a sense, we are at the beginning of a gynecomastia
I am a proponent of safe testosterone supplementation, but I feel that currently promoted
non-supervised use of it is not appropriate. In many males testosterone will convert to estrogen and create
side effects, like gynecomastia, for example.
As mentioned above, gynecomastia can appear as excess breast or fatty tissue, as excess
glandular tissue, or both. The type of gynecomastia may dictate the appropriate remedy: removal of excess tissue
with liposuction, excision, or a combination of both. Depending on nipple and areola size and shape,
additional procedures may be needed.
My guidelines for the gyncomastia procedure:
When I evaluate my gynecomastia patient, I choose my surgical procedure to better address the patients
If there is a high volume of fatty tissue: To remove an excessive volume
of fatty tissue in a gynecomastia patient we can use a variety of techniques: liposuction, power liposuction, tickle
liposuction, laser liposuction (aka Smart Lipo), and Vaser liposelection. Please note, that none of these
techniques can remove glandular breast tissues.
Liposuction: If the gynecomastia is created
from excess fatty tissue, liposuction can be the preferred first method of removal. The excess tissue is removed
through an incision placed in the armpit or around the nipple, or underneath the fold. The important part is
to remove the fat not only from the lower part of the chest wall but also from the lateral chest and outer aspect of
the muscle, otherwise, indentation may occur.
Power liposuction: Power liposuction for
gynecomastia is similar to traditional liposuction, however the cannula oscillates back and forth during
liposuction process. The principle is the same but the removal process is a bit more gentle then traditional
liposuction and it allows more precise removal of fatty tisssue.
MicroLiposuction: Microliposuction is similar to
liposuction. The surgeon uses a cannula that is a size or two smaller than the usual cannula. The idea is
that the smaller cannula requires more passes but creates more even appearance. I am not sure how
significant this would be in larger gynecomastia cases but for smaller cases, this is important.
Laser Assisted Liposuction. The option I
prefer is SMARTLIPO. The laser vaporizes fat tissues and removes the excess volume. The benefit is that it is
more gentle in removing fat cells and it also allows ADDITIONAL SKIN TIGHTENING compared to other methods. The
downside with laser technologies is the swelling may stay a bit longer.
VASER Assisted Liposelection. First of all,
it is different from liposuction. The Vaser literally liquifies fat cells. The Vaser loosens up fat cells from
surrounding connective tissues and they turn into "buttremilk type liquid" in front of our eyes. We still use
liposuction to remove this liquid but it is much more gentle and Vaser also allows ADDITIONAL SKIN
If there is breast or glandular tissues: The breast or glandular
tissue in gynecomastia patients is too tough to be removed with liposuction or laser or
Vaser. There are only two techniques to address this; traditional excision and endoscopic
Traditional Excision: If the gynecomastia is
created from excess glandular tissue, the tissue may need to be excised. An incision is made along the edge of the
areola (the dark part of the nipple). The gland is then removed and the sutures are placed along the
Endoscopic Excision, aka Scarless Gynecomastia Surgery: This is an
elegant way of using orthopedic technology in gynecomastia surgery. A small oscillating loop blade, that is usually
used to shave excessive cartilage in the knee, is used to shave off the excessive glandular tissues which
achieves the same result as the traditional method without an incision underneath the areola.
If there is excessive skin in gynecomastia surgery. There are three ways
to decrease or tighten the stretched out skin:
- Let it shrink on its own,
- Tighten it with laser, Vaser, ultrasound or Fadiofrequency
- Excise it with surgery
Most of the time we do not have to cut extra skin any more, except in more extreme cases. My preference
is to use a combination of Laser and Vaser to allow both fatty tissue removal and skin tightening. Occasionally
other non invasive methods can be used to further tighten the skin after surgery.
Shape and size of the areola: In many gynecomastia patients, areolas are rarely
discussed. Most patients with unilateral gynecomastia have areola enlargement only on one side. When we
perform unilateral gynecomastia or male breast reduction surgery the nipple of larger side needs to be brought to
symmetry with the normal side. Sometimes it can be quite challenging, especially of the patient chooses to have a
scarless method. If the patient has gynecomastia on both sides, then both sides need to be treated.
There are several ways to treat stretched out areolas. One is to allow tissues shrink naturally. In many
mild cases, this is enough.
If the desired size cannot be achieved with skin relaxation alone, then the following two techniques can be
- Closed purse string
- Formal incision around areola
The incision around areola is known as mastopexy and depending on shape of removed skin, the
incision can be called crescent or doughnut.
Shape and size of the nipple: This is, perhaps, one of the most
under-appreciated areas of gynecomastia or male breast reduction surgery. As the result of a male breast
reduction, the tissue volume and sometimes the nipple muscle is removed. As the result the nipple loses its
shape and ability to function. I call it 'splayed nipple'.
It is important to recognize that for many patients the shape and size of nipple are very
important also. As a part of gynecomastia surgery, I commonly preserve the muscle and then restore the
youthful appearance of the nipple itself by rebuilding its volume. If the patient is concerned with the final
nipple shape and volume, the open approach, or open excision of glandular tissue is needed to achieve excellent
results and restore the volume and projection of the nipple.
VASER chest wall sculpting is the next step in gynecomastia surgical
techniques. The final shape and definition of the chest can be further improved with Vaser
Liposelection. If you have read about Vaser Hi Def procedure on the web, I perform a similar procedure focused
on the chest wall and further improved definition of the chest wall. This is a technique of selective fat
sculpting. Traditional liposuction usually removes excessive fatty tissues from the chest wall but it DOES NOT
artfully define the chest wall. With liposuction most surgeons just remove the excessive volume of fatty
tissues. In most cases, the surgeon is trying to leave an even thickness layer of skin and fatty tissues on
top of the muscle.
Chest wall sculpting is a bit different. With Vaser liposelection, some areas of the
chest wall are left a bit fuller or thinned out more on purpose, in order to create or truly sculpt a chest wall
that the patient could rarely get on his own.
There is a significant difference in Vaser chest wall sculpting versus traditional liposuction
or even traditional Vaser assisted liposuction.
Potential Risks and Complications
As with all surgical procedures, there is the possibility of some risks. While they don't
happen often, some of the risks include excessive bleeding, bruising, hematoma, asymmetry and scarring. Following
your physician's pre- and post-op instructions will help you heal and minimize any other complications.
However, in most cases a combination of liposuction and excision are used, especially if there
is excess of both fatty and glandular tissue. Dr. Volshteyn also uses a special reconstruction technique to preserve
the shape and elevation of the nipple.If you would like more information on our gynecomastia
procedures or to schedule a consultation, please call our office today at 732-641-3350. We look forward to
speaking with you.