What are the treatment options for gynecomastia?

    Correction of enlarged male breasts is one of the most common plastic surgeries for men. For a good result, the selection of the right surgical technique is crucial. On this page you will find all the information about the surgical treatment of gynecomastia. If you would like to learn more about the causes of the condition (medications, hormonal causes, etc.), the symptoms as well as alternative forms of treatment, please also visit the page Gynecomastia .

    There are different forms of gynecomastia. To learn what is behind the term pseudo-gynecomastia (lipomastia) and what the difference is, visit our corresponding parallel page, which covers this topic.

    As a rule, a combination of several surgical procedures is useful. Liposuction is best performed using the vibration method (SAFELipo technique). The enlarged solid glandular body of the male can be removed by the specialist in plastic-aesthetic surgery through an inconspicuous, small incision at the lower edge of the areola. If there is very little breast – glandular tissue, you can try to avoid the incision at the edge of the male areola. Experience shows that in true gynecomastia, the combination of removal of the enlarged mammary gland and liposuction provides harmonious and very satisfactory results, so that the breasts no longer look feminine. After liposuction with the vibration method, the skin shrinks afterward, in the months following gynecomastia surgery. The extent to which the skin recedes depends on the following factors, among others: Age, prolonged exposure to sunlight, tobacco smoking, predisposition, concomitant diseases, certain medications and the extent of the enlarged breast. In young healthy men, an attempt can be made to do without the additional scar of the tightening. If you still suffer from an annoying excess of skin after six months, a moderate tightening can be performed in an uncomplicated way, on an outpatient basis and under local anaesthesia. Also a partial regression of the skin, offers the advantage that a smaller skin incision is sufficient for correction. There are various techniques for removing excess skin, depending on the severity. Some excess skin can be removed from around the male areola. In the case of a drooping and large breast, which may look feminine, a relocation or transplantation of the nipple is necessary.

    Are there scars after gynecomastia surgery?

    Scar after gynecomastia surgery

    The scars that a correction of the man’s breast leaves afterwards are usually very inconspicuous. As part of liposuction, a three millimeter short skin incision on the side of the chest is required to remove excess fatty tissue. Access is slightly offset to the right and left. Even small and barely visible scars do not give the impression of a planned operation. The tissue of the male mammary gland is removed through an arched skin incision on the edge of the areola. The scar between the areola and the breast skin is usually barely visible. If the skin is moderately tightened, a circular scar will remain around the areola. Removing sagging and sagging skin after significant weight loss requires nipple relocation or grafting. Here, the aesthetic units of the male breast and the skin tension lines must be taken into account. The transverse scars fade after six to nine months.

    What Are The Eight Benefits Of Gynecomastia Correction?

    1. Correcting gynecomastia can restore a normal body image to affected men, so that they can then do without wearing extra wide clothing such as oversized T-shirts.
    2. The correction of gynecomastia usually leaves hardly any scars afterwards.
    3. Removing the mammary gland will improve or eliminate the chest pain.
    4. Correcting gynecomastia can significantly improve the general quality of life (Davanco RA, et al. 2009, Aesthet Plast Surg).
    5. Correction of gynecomastia delivers faster, more effective and aesthetically better results than drug treatment (Zavlin D, et al. 2017. Aesthetic Plast Surg).
    6. Most male breast reductions are performed on an outpatient basis.
    7. Gynecomastia surgery is associated with a small absence from training or work.
    8. There is no risk of the man’s breast coming back, so the suffering can be effectively put to an end. An effective and sustainable before-and-after change.

    What does gynecomastia removal cost?

    Male contours of the breast can be restored by an experienced specialist in a surgical procedure. You can get a first cost estimate on our cost page. . The techniques and the effort required vary according to the degree of gynecomastia, the type of excess tissue (tissue of the mammary gland, fatty tissue, skin) and the state of health of the man to be treated. We will be happy to give you an exact price following a consultation. Whether health insurance will pay for gynecomastia treatment through plastic surgery depends on the individual case. To get more information on the topic of gynecomastia and , you can view the following page. There you will also be able to find out whether costs can be expected to be covered in your case.

    How can I prepare for gynecomastia surgery?

    The correction of gynecomastia is an elective procedure and should be carried out under the best possible conditions, i.e. without avoidable risks, in order to keep the swelling low and to ensure optimal healing. Frequent questions are answered in the run-up to the aesthetic plastic surgery in the case of an established breast enlargement (female breast). In addition to answering questions asked, a good doctor also provides comprehensive information and preparation for the plastic-surgical correction by the aesthetic surgeon.

    • To clarify the causes, a blood test and a presentation to a specialist in endocrinology as well as an ultrasound examination of the breast and testicles are recommended.
    • Uncertainties about possible complications before the surgery should be cleared up in advance during the consultation. Of course, all alternative forms of treatment will be presented to you.
    • The cosmetic surgery for gynecomastia takes place on an outpatient basis in the practice. An inpatient stay in a clinic is not necessary.
    • In smokers, wound healing is delayed and the cosmetic results can be significantly worse. Therefore, if possible, refrain from smoking two weeks before to four weeks after the planned breast reduction surgery.
    • Blood-thinning medications (for example Thomapyrin®, ASS) must be discontinued at least 10 days before the surgical procedure. This must be done after consultation with your attending physician.
    • The discontinuation of vitamin preparations (A, E) as well as food supplements (St. John’s wort preparations, omega-3 fatty acids, etc.) must take place at least 4 weeks before the operation.
    • Before performing aesthetic surgery, you should take out follow-up insurance.
    • You can help to keep the surgical risk of inflammation low by cleaning your breast on the day of the surgery with a disinfecting soap (for example HiBiScrub® Plus from Mölnlycke, Octenisan® Wash Lotion from Schülke, Prontoderm® Shower Gel B. Braun).
    • Operations limit the ability to travel by air. You should therefore not plan any air travel, either professionally or privately, in the six weeks after the operation.

    What is the procedure of a gynecomastia operation?

    Every operation is prepared with the greatest care by the plastic surgeon. This means that several security checks are routinely carried out to ensure that the surgical breast reduction in men takes place under the best possible conditions. The surgeon will double-check that all of your questions have been answered. On the undressed upper body, the doctor marks the area of ​​skin to be treated with a waterproof pen. The marked operation plan is used for control and better orientation during the operation in order to restore the planned natural shape. You will then be taken to the operating room. There, the team consisting of your plastic surgeon, a surgical assistant, the anesthetist, an operating room nurse and a technical assistant will take care of your well-being. Care is taken to ensure that you are lying comfortably on a specially padded operating table. A bit of background music can take away your fear and reduce the feeling of pain. You will be given medication that will put you into light or deep sleep (general anesthesia). During general anesthesia, the operating area is thoroughly disinfected several times. Sterile, pathogen-proof drapes are stuck to the skin in order to protect the surgical field extensively on all sides. So that you do not feel any physical pain after the procedure, the specialist anesthetist will administer a long-lasting anesthetic to you. The water solution that is injected into the subcutaneous tissue contains adrenaline. This will reduce blood loss and prevent bruising. Excess fatty tissue is suctioned off with very fine cannulas. The firm glandular tissue of the male breast is removed through an arched skin incision on the edge of the areola. Small vessels are deserted. If necessary, the excess skin is removed. The wounds are sutured with self-dissolving skin threads. The specialist in aesthetic surgery then critically checks again whether the result is beautiful and symmetrical. Finally, after the plastic treatment, a sterile bandage is applied and the compression girdle is adjusted. The duration of the operation for the surgical breast reduction is one and a half to two and a half hours, depending on the severity of the real gynecomastia. You will then be taken to a relaxation room where your wellbeing will be continuously monitored. If you are fine, you can have a drink or a bite to eat. As a rule, you can be picked up four to six hours after the operation. The doctor gives the approval for this after control. Before you are brought home, there will be a personal conversation: The surgeon will tell you how the operation to reduce the size of the enlarged breast went in detail. You will also be given a detailed report. The behavioral measures are listed in detail and the dates of the check-ups are noted. The report also contains the personal telephone number of the aesthetic surgery specialist, who is available to you around the clock. In the evening after the operation, the surgeon will contact you to find out how you are and to rule out any unusual swelling or pain.

    Schematic representation of the male breast from the front and the side

    1 Regions of contouring in HD liposculpture 2 Intercostal nerve and vessels
    1 Large pectoral muscle (Musculus pectoralis major) 2 Third rib 3 Subcutaneous fatty tissue 4 Intercostal nerve and vessels 5 Dense glandular tissue 6 Pleura

    A man’s breast is usually caused by both increased mammary gland tissue and increased subcutaneous fat tissue. Vibration liposuction is a very gentle and safe procedure for removing excess fatty tissue. From a palpable enlargement of the breast tissue of two centimeters in diameter, one speaks of a gynecomastia. The glandular tissue of the male is very firm and therefore cannot be suctioned. It contains no glandular lobes but glandular ducts that open into the nipple. The mammary gland tissue is removed through a small skin incision at the lower edge of the areola. Only in special cases should the removed tissue be examined for fine tissue (familial incidence of breast cancer, congenital chromosomal disorder, unilateral gynecomastia). The procedure can be performed very gently with targeted anesthesia of the intercostal nerves. Thanks to the so-called Rapid Recovery procedure, you will be back home a few hours after the procedure and will recover better and faster.

    What are the risks of gynecomastia surgery?

    Surgical correction of the male breast is a safe method of treatment. However, there is no surgical gynecomastia treatment without the risks that may arise. In the first 30 days after surgical correction, the complication rate is 2.1 percent. The most common complications include inflammation in 1.3 percent, divergence of the wound edges in 0.3 percent, or bleeding that requires a blood transfer in 0.1 percent of cases. Diabetes, diseases of the heart or the liver increase the risk of complications (Zavlin D et al., 2017, Aesthetic Plast Surg). In general, smokers, overweight, or the elderly are at higher risk for surgery than non-smokers, normal-weight, or younger men.

    Afterwards, every wound represents a possible entry point for germs. An inflammation can require medical or surgical treatment. Cigarette smoking, even if it is stopped four weeks before surgery, has been shown to be linked to a higher risk of inflammation.

    In order to minimize the risk of secondary bleeding, the doctor discusses the use of blood-thinning medication, vitamins and food supplements in detail and asks about the status. Surgical gynecomastia treatment is possible if blood-thinning agents can be temporarily stopped. Normal laboratory coagulation values ​​do not rule out a bleeding tendency. To reduce the risk of bruising, adrenaline is injected into the surgical area. Fluctuations in blood pressure can cause bruises to develop in the first few days or several days after the breast operation. Physical exertion should therefore be avoided for the first fourteen days.

    In the form of gentle surgical and suturing techniques, the surgeon can help the tissue to heal quickly and well. Other factors such as old age, cigarette smoking, obesity, chronic diabetes, vascular calcification, medication (cortisone, Marcumar), shear forces and the effects of pressure can promote wound healing disorders. If there are serious illnesses, we advise against male breast surgery.

    The aim of a good skin suture is the precise, tension-free and gentle closure of the wound. The formation of new structural proteins as well as the alignment and cross-linking of the fiber scaffold takes up to one year. In the first few weeks, scars are slightly indurated, red, possibly painful or itchy, and sometimes slightly raised above the level of the skin. As a rule, after a year scars become pale, soft, painless and flat.

    Correcting the man’s chest may cause irritation of skin nerves. This affects the nerves of the nipple and the cutaneous nerves of the breast skin. This can cause temporary numbness.

    Despite all precautionary measures, side differences and contour irregularities cannot be ruled out. Pre-existing inequalities, pronounced skin tightening or breast reduction make it difficult to produce results on both sides. A loss of elasticity in the skin and individually different scar healing processes can lead to an asymmetry of the scar. A correction is usually possible after the scar has matured. After the correction of a man’s breast, there may be an increased excess volume on the abdomen. Your goals will be discussed in detail in advance in order to create an individual treatment plan that takes your body into account holistically.

    With sufficient elasticity, the skin shrinks and adapts to the new body contours. If the natural shrinkage is insufficient for sagging skin, excess skin folds can result. Skin tightening procedures can remove these wrinkles by reducing the size of the skin.

    What should you do after gynecomastia surgery?

    Optimal follow-up treatment is required for a perfect result.

    • Immediately after the surgical procedure, which is performed on an outpatient basis in a special operating room of the practice, the attending physician will schedule regular appointments to monitor your well-being. In addition, the surgical result is always checked.
    • Elevation of the upper body by about 30 degrees for 5 days is very beneficial for decongestion and wound healing. The elevated position should also be maintained during sleep.
    • Previously adapted compression girdles (compression vests) should be worn continuously three to six weeks after the operation.
    • Showering is possible from the third postoperative day and should be done immediately before the wound check.
    • As a rule, you can go back to your usual daily activities after five to seven days.
    • Scar care (scar massage, sun protection, silicone pad) from the third postoperative week helps to create inconspicuous scars.
    • Sports activities, saunas, swimming, hard work and sunbathing should be avoided for at least three weeks.
    • From the third postoperative week, massage the scar several times a day for a few minutes. Use an oily cream, such as Bepanthen® ointment or Linola® fat. Pay attention to circular movements as well as lengthways and crossways to the scar. These measures help to create an inconspicuous scar that can only be seen by looking closely at the part of the body.
    • Smoking increases the risk of inflammation and thrombosis. Avoid tobacco smoking and e-cigarettes after surgery.

    How long should you not do sports after gynecomastia surgery?

    Cardio training and muscle building should not be resumed until after three to six weeks at the earliest. Short walks stimulate the circulation and are therefore quite helpful. In rare cases, pain medication may still be required after the third day of surgery. You can find out more by talking to the doctor. Since the external wounds are very inconspicuous, the temptation can be great to resume the usual strength training after a few days. The body needs at least two weeks of rest. Depending on the state of swelling, a longer period of rest may be necessary.

    Gynecomastia surgery experience at Centerplast

    Patients today place a lot of importance on reviews of other patients’ experiences and look at the average rating of a doctor to select him or her for their surgery. If you would like to see how satisfied our patients are and read more about their experiences with gynecomastia surgery with our cosmetic surgeons, visit our testimonials pagenow.

    Gynecomastia before after pictures

    In addition to testimonials, men who are interested in gynecomastia surgery also place a lot of value on before and after photos. In Germany, such images may not be shown on the Internet. However, this is possible within the framework of a personal consultation. This is of course done in compliance with the data protection guidelines. To learn more about the possibilities of an illustrated before and after comparison, you can view the following page.

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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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