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Gynecomastia (enlargement of the male breast, puffy male nipples) is surprisingly common. It frequently begins during puberty but may also occur later. The cause of gynecomastia is unknown in most patients, though it has been linked to hormonal imbalance, excessive body weight, and certain drugs, such as anabolic steroids. Many teens and adults with enlarged breasts complain of self-consciousness and conceal the breasts with baggy clothing or multiple T-shirts. Most feel uncomfortable taking off their shirts in public.
Gynecomastia may include one or more of the following:
Male breast reduction is a surgical procedure performed to reduce the size of the breasts and/or the prominence of the nipple-areolae. In most patients, our Plano plastic surgeon, Dr. Friedman recommends liposuction of the breasts, which is performed through a single incision that is less than a quarter-inch in length. In men with prominent areolae or lumps beneath the areolae, he will also remove the excessive tissues through a short (less-than-an-inch) incision along the lower border of the areola.
Dr. Friedman attempts to minimize scarring by avoiding external stitches and making smaller incisions than those used by many surgeons. He generally blends the boundary of tissue removal through liposuction, minimizing the risk of a demarcation between the operated and unoperated areas of the chest.
In men who have isolated enlargement of the nipples (rather than puffiness or enlargement of the areolae), Dr. Friedman may perform nipple reduction under local anesthesia.
Dr. Friedman performs male breast reduction for gynecomastia under general anesthesia on an outpatient basis. The procedure is performed in his AAAASF-accredited surgical facility, the West Plano Plastic Surgery Center, which is located on the campus of Texas Health Presbyterian Hospital of Plano. He strictly uses physicians—not nurses or technicians—to administer your anesthesia.
Pain medication is necessary for about a week following surgery. Most patients return to light activities within 3 to 5 days, depending on the areas treated. A compression garment must be worn over the surgical sites continuously for one month and intermittently for a second month to maximize the surgical result.
When you visit our Plano, Texas office, Dr. Friedman will discuss your specific concerns. He will give you a realistic idea of what you can expect from surgery. We will also show you a variety of before and after photos of male breast reductions performed by Dr. Friedman. If you wish to speak to other patients who have undergone these procedures, we will be happy to provide phone numbers.
Watch Video: Dr. Friedman explains liposuction.Back To Top
Most cases of male breast enlargement are of unknown cause. Certain drugs (anabolic steroids, marijuana, spironolactone), hormonal conditions (excessive estrogen, deficient testosterone), and hereditary conditions may be associated with gynecomastia. Some men choose to see an endocrinologist for evaluation of potential causes, though the work-up is usually negative. Being overweight may also cause male breast enlargement.
The goal of male breast reduction surgery is to allow you to go out in a light T-shirt (or go out to the pool without a shirt) without feeling self-conscious about the appearance of your chest. This requires reduction of excessive breast tissue through small, carefully placed incisions. Ideally, your chest should not look “operated,” as this may detract from the surgical results.
Any surgery involves scars. However, Dr. Friedman makes an effort to use the smallest possible incisions. When he does liposuction of the breasts, he uses a single less-than-a-quarter inch incision. When he does direct tissue removal, he generally limits the incision to less than an inch along the lower part of the areola (unlike many surgeons who utilize an incision along the entire lower half of the areola.
This is simply another, more localized form of gynecomastia. Typically this is addressed through a small incision along the lower part of the areola. Removal of excessive tissue that pushes the nipple-areolae forward will reduce the prominence of the nipples.
Many teens considering male breast reduction worry about postoperative pain. While all surgeries involve pain, male breast reduction is generally well tolerated. Pain is usually moderate for a few days and then becomes much milder. Dr. Friedman will prescribe pain medication, which is usually necessary for about 5 to 7 days after surgery.
One week before surgery
The evening before surgery
Day of surgery: before you leave home
Day of surgery: at the facility before surgery
Day of surgery: at the facility after surgery
At home after surgery
Instructions for your first postoperative visit (about one week after surgery)
1 week after surgery: you may resume casual walking but must not engage in vigorous exercise that increases your blood pressure or heart rate. You may resume driving once you are off of your pain medication. Avoid freeways until you are comfortable with city driving.
4 weeks after surgery: you may gradually resume exercise activity. You should wear your compression garment while you are exercising.
Please sleep on your back (flat or elevated) or part way over (pillow under your shoulder and hip). Do not sleep on your side until about 3 weeks after surgery. Unless otherwise instructed by Dr. Friedman, do not sleep on your stomach until about 8 weeks after surgery.
After your butterfly tapes and/or surgical glue peel off (about 2 weeks after surgery), begin scar massage with Mederma twice daily. Mederma is available at our front desk or over-the-counter at your pharmacy. If you prefer, you may use Vitamin E or Aloe Vera. Continue scar massage for about 3 months.
You should begin massage to the chest one week after surgery. This will help smooth any irregularities and areas of firmness. You may apply lotion to your hand to massage and/or you may use a vibrating massager. If you would like, we will provide you the phone number of a licensed massage therapist.
You may begin light showers 3 days after surgery. You should avoid scrubbing your incisions. Avoid the pool, lake, and ocean for 4 weeks.
One week after surgery, you may resume use of any medications or supplements that you discontinued prior to surgery. However, for at least 3 weeks, you should avoid Motrin, aspirin, and any other product that may thin your blood.
Do not smoke for at least one month (and preferably much longer) after surgery. Smoking may increase your risk of infection, lung problems following anesthesia, and wound healing problems.
You may tan whenever you like. However, you should use a high-SPF sunscreen (30 or greater) over your incisions for at least 6 months. Premature tanning of the incisions may cause them to darken permanently.
Adult males may resume intercourse about 3 weeks after surgery. You may not bear weight on your chest for at least 6 weeks.
Wear the compression garment all day and all night (except for showers and massage) during the first month. You may gradually taper your use of the compression garment over the second month.
Please feel free to ask Dr. Friedman or his staff about any additional questions or concerns.Back To Top
Ronald M. Friedman, M.D. is a board-certified plastic surgeon with offices in Plano and Flower Mound. He specializes in breast and body contouring surgery, including the treatment of gynecomastia. Gynecomastia (enlarged male breasts and/or puffy male nipples) is exceedingly common, occurring in up to 30% of teen boys and 15% of male adults. Gynecomastia (gyne=female, mastia=breast) is often related to hormonal imbalances, but the cause is usually unclear. Less common causes of gynecomastia include liver disorders, chronic alcohol use, pituitary tumors, and certain medications.
Diagnosis of gynecomastia is usually made by history and physical examination. If a suspicious breast mass is found on exam, then mammogram/sonogram and possible biopsy may be recommended. If an underlying medical cause is suspected, then endocrinology evaluation may be appropriate.
Large male nipples may be addressed by male breast reduction. Men with large areolae will note reduction in areolar puffiness and diameter with reduction mammoplasty. It is not necessary to live with “man boobs,” as they can effectively be reduced by surgery.
Dr. Friedman is experienced in the treatment of male breast enlargement, having practiced plastic surgery since 1995. Please see the before and after gynecomastia photos, all of whom represent Dr. Friedman’s actual patients and surgical results. Not only does male breast reduction address the gynecomastia, it generally addresses the self-consciousness and embarrassment that come with having enlarged male breasts.Back To Top