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    What are the causes of lipomastia?

    Lipomastia, also known as pseudogynecomastia, describes the increase in fatty tissue that leads to the formation of a man’s breast. In contrast, it is a “real gynecomastia” when there is excessive glandular tissue. In both cases there is the same problem, which can lead to psychological stress. Many men hide their feminine breasts under a wide T-shirt in order to look “normal” and to hide the enlargement.

    One of the well-known and most common causes of pseudo-gynecomastia is obesity, i.e. a high percentage of body fat. After significant weight loss, the skin’s elasticity is limited and excess skin can remain. The sagging skin can give the impression of a female breast. Therefore, the term lipomastia or pseudogynecomastia is also used in these cases of enlarged breasts. In order to restore a male upper body contour, the skin on the chest and the lateral torso of the man must also be tightened.

    A man’s breast can, however, also develop without being overweight or severely overweight (obesity). Most often, men’s breasts are caused by both an increase in fat (adipose tissue) and an increase in mammary gland tissue. In this case, one speaks of lipo-gynecomastia.

    It is a myth that gynecomastia can be related to a large pectoral muscle (Musculus pectoralis major). In addition, the wrong, widespread opinion must be denied that gynecomastia can always be trained away by changing the diet and doing adequate chest training (sport): As mentioned, in not infrequent cases the cause is not overweight.

    The tissue proliferation of the male mammary gland can rather be caused by drugs or e.g. changes in the hormonal balance (physiological gynecomastia). A disturbed balance between the hormone testosterone (male hormones) and the hormone estrogen (female sex hormone) is associated with the enlarged mammary glands. In many cases, however, there is often no clear and precise cause.

    For more causes and even more detailed information on the triggers (causes) of an enlarged male breast, see the main page on gynecomastia. There, the male and female hormones and their interaction are also discussed in more detail. In addition, the site provides a detailed list of medications that have been associated with the occurrence of the various forms of gynecomastia.

    Gynecomastia or pseudogynecomastia? What is the exact difference?

    A man boob is caused by excess fatty tissue and an enlarged mammary gland. The disease can also develop as early as puberty. If excess fatty tissue predominates, this is called pseudogynecomastia. However, it has been shown that for optimal results, it is usually necessary to treat both the glandular tissue and the tissue consisting of fat. The distinction between gynecomastia and pseudogynecomastia therefore has little practical relevance with regard to gynecomastia surgery in men.

    The combination of liposuction and mammary gland removal for the treatment of gynecomastia was first described in 1983 (Teimourian B., et al., 1983, Aesthetic Plast Surg.). The advantage of using both techniques simultaneously is a pleasing contour of the breast with fewer irregularities and greater patient satisfaction than either technique alone can achieve. For low-grade gynecomastia in young normal-weight patients (body mass index: 18.5-21.5 kg/m2) between the ages of 18 and 43, 5 to 80 grams of breast tissue can be removed from each side of the body and approximately 100 to 200 milliliters of adipose tissue can be aspirated (Cigna E., et al., 2011, Aesthetic Plast Surg). Vibratory liposuction for the treatment of gynecomastia was first used in 1999 (Fodor P.B., et al., 1999, Aesthetic Plast Surg). The fine deflections of the vibrating suction cannula remove fat from a larger area. The assistance of vibration is particularly helpful in the treatment of fibrous dense tissue (Scuderi N., et al., 2005, Aesthetic Plast Surg). In addition, after vibration liposuction, there is a tendency for the skin to shrink, which has a positive effect on the aesthetic result. Patients are therefore ultimately more satisfied with the shape of their body.

    How do I recognize lipomastia?

    This is one of the most frequently asked questions in this context. Usually, a man’s breast is caused by both increased glandular tissue and excess fat. The excess glandular tissue can usually be easily palpated under the nipple. It feels harder than the surrounding fatty tissue. In an ultrasound examination, the doctor can assess and measure the mammary gland tissue.

    Is there an increased risk of breast cancer with lipomastia?

    The risk of breast cancer in men is very low compared to women. Lipomastia is not associated with increased breast cancer. You can find detailed information on this topic on the main page on gynecomastia .

    What to do about lipomastia?

    The main page on gynecomastia provides particularly detailed information on the known methods used for the non-surgical treatment of a man’s female-looking breast. You will find out to what degree they are actually medically effective against male breasts in comparison to the plastic surgery approach. Gynecomastia surgery performed by a cosmetic surgery specialist is the most effective method of reducing the size of the affected man’s chest. Nevertheless, a brief comparison is also made here so that you can learn to what extent the suffering of the affected men can be reduced by these measures.

    With exercise and diet or a healthy diet (low calorie, low fat and balanced), the body fat percentage can be reduced. Fat in the form of pads is reduced faster in some areas of the body than in others. Lipomastia, however, as mentioned above, can also be present without being overweight, so this solution to the same problem is not possible. Depending on the changes in your upper body, the goals cannot be achieved by weight loss. Depots of fat can be reduced to a small extent by the technique of cryolipolysis (targeted, temporary cooling of the affected area of the body). Cryolipolysis can reduce fat in the treated regions of the man to a very limited extent after at least three treatments. However, cryolipolysis as well as fat way injections are not serious indicated or common alternatives to gynecomastia treatment. The success of a therapy with drugs (danazol, tamoxifen or aromatase inhibitors) is doubtful and has – if at all – only in the first months after the occurrence of gynecomastia in puberty prospect of success (www.awmf.de).

    The following goals can be achieved by surgery in the affected individual:

    • The creation of a flat and masculine breast
    • The elimination of an underbust crease
    • The correction of the size and position of the areola
    • The reduction of the nipple
    • Removal of excess skin
    • Removal of excessive fat by liposuction
    • The equalization of the size and shape of both breasts

    What is the procedure of lipomastia surgery?

    On the main page for gynecomastia surgery you will find detailed information about the breast surgery procedure. There you will also find answers to frequently asked questions on topics such as the duration of the operation, pain, swelling and whether anaesthesia or general anaesthesia or local anaesthesia (local anaesthesia). The risks of aesthetic plastic surgery and possible complications are also discussed at this point. You will find written information on the preparation for gynecomastia surgery and aftercare, i.e. what must be observed before and a short time or a longer period after lipomastia surgery for a good result and which behaviors are not allowed at all in the first weeks. The question of when sporting activities can be resumed after male breast surgery is also answered.

    What are the techniques of skin tightening for lipomastia?

    With the technique of vibratory liposuction (SAFE-Lipo) as part of the procedure, some shrinkage of the skin is observed over the months. The extent to which the skin shrinks after liposuction of the fat breast varies from individual to individual and cannot be calculated. The goal of skin tightening is to remove excess skin and correct the size and position of the nipples. In cases of moderate excess skin, a scar-saving technique leaves a scar around the male areola. This so-called O-shaped tightening may be accompanied by a shift and reduction in the size of the areola. Careful consideration is necessary in advance, as scars on the front of the upper body cannot be hidden during the procedure. Despite all caution, the formation of bulging and reddened scars must be considered if the patient is predisposed to them. If the affected person has a lot of excess skin after heavy weight loss, which leads to a skin fold under the breast, a tightening of the entire chest may be necessary. Removal of the sagging skin may require an incision from the lateral chest under the upper arm to the man’s sternum.

    What are the costs of surgery to correct lipomastia?

    Our cost page gives an idea of the cost of lipomastia surgery. If you are unable to determine the lipomastia surgery costs or if you are not sure which form of the disease is present in your case of the man boobs, you have the possibility to have a physical examination performed by the attending physician. This takes place within the framework of the personal consultation. The plastic surgery specialist can analyze the symptoms and make a definite diagnosis. Since many different surgical techniques are used, an exact price can only be given after a consultation and examination by the plastic surgeon. Within the framework of the above-mentioned consultation, you will receive an individual offer with a transparent cost overview.

    Is the cost of pseudogynecomastia treatment covered by health insurance?

    The assumption of costs depends on several factors. In any case, health insurance will only pay for gynecomastia treatment, or the procedure, if there is a medical necessity. If you would like to find out in advance whether the costs of gynecomastia surgery for the reduction of large breasts in men will be reimbursed or covered by health insurance, please visit our informative page on the obligation of health insurance companies to pay benefits.

    Before and after pictures of lipomastia

    A comprehensive consultation is of utmost importance for a successful treatment. Through the consultation, your plastic aesthetic surgeon will get a clear understanding of your goals and you will get an idea of the possible treatment results. Before and after pictures can be very helpful to illustrate the possibilities and limitations of the respective techniques. Since not every technique is suitable for every man, it requires certain prior knowledge to be able to evaluate the images. Surgical techniques differ in terms of results, effort and therefore risks. Treatment is only appropriate if the expected results outweigh the possible risks. The legislator has decided that the presentation of before and after pictures is not permissible outside of the educational discussion. Because we attach great importance to providing you with the best possible information, we are happy to show you before and after pictures during a consultation. For more information on the subject, visit our before and after pictures page.

    Testimonials for lipomastia treatment

    Before undergoing pseudogynecomastia surgery, most patients usually search the World Wide Web for testimonials to get an idea of the treatment and find a suitable, specialized surgeon. On our testimonials page, you will find numerous patient testimonials and reviews about lipomastia treatment.

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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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