Gynecomastia is a common problem affecting the self confidence and self esteem of many men.
estimated incidence of gynecomastia in young men
2. What is Gynecomastia?
It is the appearance of female breast characteristics on a man's chest.
a younger man with bilateral gynecomastia more prominent on the left
3. Man Boob Anatomy
Gynecomastia Glands - Puffy Nipples
Nipple "puffiness" is caused by gynecomastia glands directly behind the nipple pushing it outwards. The size of the gynecomastia glands stretches out the areola making it appear lighter. After gynecomastia removal surgery, the skin retracts and the areolar becomes darker
notice how the nipple areola complex shrinks and darkens once the glands are gone
The gynecomastia glands themselves are made up of a tough fibrous tissue that cannot be removed with liposuction. They must be surgically removed.
gynecomastia glands - gross specimen. Notice the difference in color and quality in these glands versus the image above.
Pseudo-Gynecomastia
stubborn fat deposits on the lower/side chest
When it's mostly superficial chest fat causing a breast like appearance, we call it pseudo-gynecomastia.
Quick Facts - Pseudo gynecomastia
Diet and exercise are the 1st line treatment option.
men with normal BMI and good muscle tone can still have stubborn fat deposits at the lower and lateral chest area
A Combination of Both
surgically removed large gynecomastia gland with some anatomic labels. on close inspection one can see some yellow fat globules surrounding the glandular tissue.
4. Conidence and Self Esteem
The Ideal Male Chest
Usually described as: broad shouldered, symmetric, minimal fat, well developed muscles, proportional nipple-areola complexes.
5. Diagnosing Gynecomastia
Physical Exam - What are some signs that you may have gynecomastia?
a mass you can feel behind the nipple(s)
pointed/puffy nipple(s)
lower chest volume
persistent gynecomastia despite significant weight loss and good muscle tone
Imaging - CT, MRI and Ultrasound
Depending on the quality of the fibrous tissue, we can see it really well on CTs and MRIs.
CT of the chest with gynecomastia glands labeled
MRI of the chest with gynecomastia glands, superficial chest fat, pectoralis muscles and the heart labeled
CT
MRI
Ultrasound
6. Causes
What causes gynecomastia? most cases have no identifiable cause because gynecomastia is a naturally occurring phenomena
Genetics - Nature vs Nurture
Most cases of gynecomastia are caused by our natural genetics and physiology. A quarter of cases are associated with medical problems and about one in five are cause by medications/drugs.
the balance of testosterone and estrogen is determined by our genetics and our environment. These hormones have a big impact on our physical appearance
Physiologic Gynecomastia
Gynecomastia is a naturally occuring phenomena. It ebbs and flows in man's lifetime. It peaks during 3 periods of life. Infancy, during puberty and in our senior years. Prevalence rates as reported by Johnson et al:
transient neonatal gynecomastia: 60-90%
transient pubertal gynecomastia: 50-60%
age related gynecomastia: up to 70%
spontaneous regression of gynecomastia from age 14 (a) to age 15.5 (b)
Pathologic Gynecomastia
Gynecomastia can also be caused by medical problems such as:
testicular dysfunction (gonadal failure)
kidney dysfunction (renal insufficiency)
liver dysfunction (cirrhosis)
thyroid dysfunction
hormone secreting tumors
obesity - more likely to cause pseudo-gynecomastia
other - cystic fibrosis, ulcerative colitis, etc
Medication/Drug Induced Gynecomastia
Although drugs are responsible for less than 20% of all cases of gynecomastia, there is a long list of medications that have been identified as potential causes of this condition.
medications implicated in causing gynecomastia
7. Non-Surgical Treatment:
Diet & Exercise
Maintaining a low body fat percentage with high muscle mass is the best chance one has at minimizing the appearance of their gynecomastia.
This makes a bigger difference for pseudo-gynecomastia than glandular gynecomastia
Medications:
Tamoxifen 10mg. Brand name: Nolvadex
the primary medication used to treat gynecomastia is Tamoxifen
the main indication for Tamoxifen is breast pain in gynecomastia smaller than 4cm.
unfortunately Tamoxifen can have a variety of side effects including: blood clots, loss of libido, bone pain, mental fog, leg cramps
8. Surgical Gynecomastia Treatment
Overview
We use a 4 step approach
Anesthesia - the patient receives sedative medications to relax them, then we pump in a large volume of anesthetic into the superficial chest
VASER - we liquify the fat surrounding the gynecomastia glands and liquify surrounding chest wall fat as needed
Liposuction - we suction out the liquified fat
Surgical gland removal - we carefully resect the gland(s) with a scalpel, scissors, electrocautery or via blunt dissection.
Cost of Gynecomastia Surgery
our TOTAL price is $4,000-$6,000
Financing Options
Does Insurance Cover Gynecomastia Surgery?
credit card and cash payments online at this time
Payment Plans for Gynecomastia Surgery at 2 Palms Medical Center
Payment Plans for Gynecomastia Surgery at 2 Palms Medical Center
Getting Surgery at 2 Palms Medical Center
Are you a candidate for gynecomastia surgery?
Yes IF:
If you've had gynecomastia for more than 2 years despite a healthy lifestyle
are relatively healthy (no serious medical problems)
you are NOT obese (BMI less than 32 unless you are very muscular or have made a lot of progress in your weight loss journey).
Contact us for a FREE video consultation with Dr. Hersi
Text 956-315-2851 to schedule a free phone or video call with Dr. Hersi.
If you are a candidate, then we will schedule you an in-person consultation.
Requirements for Surgery
Why do we request require blood work?
A few reasons:
to make sure you're not anemic
have no organ problems
no bleeding problems
to get a baseline in case we need to compare future labs results should you have any complications
How much does blood work usually cost?
there are multiple facilities in the RGV that charge less than $40 for 3 labs we require (cbc, cmp, pt/ptt/INR).
In Person Consultation
How long will the appointment last
50 minutes
What will we go through?
goals of the surgery
pre operative photos (you will receive a copy) and
check your vital signs (blood pressure, heart rate, etc)
Deposit: ½ the price of surgery
payments can be made by either credit card or cash.
Required to schedule surgical date
Prescriptions
prescriptions called into your local pharmacy of choice
Prescriptions will be sent to you pharmacy of choice
Direct number to Dr. Hersi.
Day of Male Breast Reduction Surgery
Arriving at the office
what to expect when arriving to the office the morning of surgery
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