George H. Sanders, M.D., APC

Gynecomastia is an embarrassing condition for the average American male. Our culture teaches us to view it as a sign of feminization and the unfortunate man with gynecomastia sees himself and is perceived by others as less than completely masculine. For a few thousand dollars, a man can rid himself of the enlarged breasts with a simple operation which is virtually painless, has minimal scars and few complications, and from which he can return to work within a day or two. Never again will he need to be embarrassed by his chest appearance.

The treatment of Gynecomastia depends upon individual patient factors such as the amount of excess fat, the degree of laxity of the skin, the amount of excess breast tissue, and patient preferences concerning the scar location. Most patients have a combination of excess breast tissue and excess fat of the breast and chest, although some have only excess breast tissue and others have only excess fat. The general principle is that fat is removed by liposuction and breast tissue is surgically excised, all during the same procedure.

For the patient with excess fat around the breast as well as on the sides of the chest, liposuction is used. Dr. Sanders employs various methods of liposuction including Power Assisted Liposuction (PAL), ultrasonic liposuction (UAL), and microliposuction that involves tiny suction tubes and equally tiny incisions. Each of these techniques has its particular advantages and disadvantages. In consultation with the patient, a decision will be made as to which to use. 

For the patient with excess breast tissue, removal is usually done by means of direct excision through a small incision beneath the areola that almost always heals with a minimal scar. A newer technique involves the use of a miniaturized shaving device that trims away the breast tissue that is located directly beneath the nipple and areola. The device is inserted through the small liposuction incision on the side of the chest, thus avoiding a scar around the areola. This technique does not work as well as direct excision in very slender men in whom virtually total removal of the breast gland is desired. In most other patients, it is becoming the technique of choice because it allows one to avoid drains after surgery and because of the lesser degree of scarring.

In those cases where excess skin is present due to factors such as patient age or a history of significant weight change, it may be necessary to remove skin from the breast to give an excellent result. In many cases, the skin will shrink down following liposuction and removal of the breast tissue. If it does not shrink down after surgery or if it is obvious before surgery that excess skin is present, the skin is removed. This can be done at the time of the initial surgery for gynecomastia excision. The skin removal usually takes the shape of a circular strip of skin around the areola. This leaves a final scar that encircles the areola and which is usually very well accepted by patients.