Gynecomastia Surgery: The Lateral Pull Through Technique

by Miguel Delgado, MD | May 10, 2016 | Surgery

Have you ever heard of the term “man boobs”? Many people who use this term are not aware that there is often a real medical condition connected to it. Gynecomastia is a fairly common condition that causes males to experience excess breast tissue. It can affect males of all ages and can occur in one or both breasts. While some may notice their gynecomastia symptoms resolve on their own during adolescence, some men live with this condition into adulthood. In these cases, male breast reduction surgery is often required to achieve the masculine chest contours that are desired. Gynecomastia surgery is an effective treatment for those who wish to eliminate their excess breast tissue.

What is Gynecomastia Surgery?

Gynecomastia surgery, also known as male breast reduction surgery, is an effective solution to male breast enlargement due to gynecomastia. For the majority of males, this procedure is performed under light general anesthesia. During this procedure, excess glandular tissue is excised and liposuction employed to eliminate excess fat and excess breast tissue from the chest area for a more masculine chest appearance. However, there are an array of techniques that can be employed during this procedure depending on the patient and desired outcomes. As an outpatient procedure in most cases, patients are free to return home during the healing process. This surgical procedure should be performed by a board-certified plastic surgeon for optimal results.

The Lateral Pull Through Technique

The Lateral Pull Through technique is an alternative to treatment of the large majority of patients with gynecomastia. In Dr. Delgado’s experience, it routinely includes traditional liposuction, ultrasonic-assisted liposuction, and direct excision all through a 4-millimeter opening along the lateral areola placed on the side of the chest. It avoids the use of a lower peri-areolar scar. (Not that there is anything wrong with a peri-areolar scar, for in fact the vast majority of surgeons still use them today.) He believes the advantage is that there is a smaller scar with the lateral pull-through because there is less direct cutting.

While peri-areolar scars generally heal very well, the scars that sometimes show near the nipple could make the patient feel a little self-conscious if visible. 

Also similar to peri-areolar techniques, the Lateral Pull-through technique has a quick and relatively easy recovery. In the end, the technique that the surgeon is most comfortable with, and can deliver consistent, predictable results is the one that should be used.

Schedule a Consultation in the San Francisco Bay Area

If you are interested in learning more about gynecomastia surgery and if it is right for you, please contact Dr. Delgado in San Francisco or Novato today. During your one-on-one consultation, Dr. Delgado will discuss your medical history and perform a physical exam to determine the best surgical technique for your case.

Gynecomastia Surgery San Francisco FAQs

What are some of the most common causes of gynecomastia?

There is not just one cause of gynecomastia. Hormonal imbalance, anabolic steroids, certain drugs, and some medications can all lead to the formation of gynecomastia. Moderate breast enlargement in males can occur at any age.

What is false gynecomastia?

False gynecomastia, also called pseudogynecomastia, is characterized by enlarged male breasts due to excess fatty tissue in the chest. This is common in males who are overweight or have experienced significant weight gain. Weight loss is often an effective solution. An initial consultation with Dr. Delgado can help determine if you have false gynecomastia and what your treatment options are.

What is a compression garment?

Following surgical correction of gynecomastia, patients will need to wear a compression garment to reduce swelling in the treatment area. It is imperative that you wear this garment as instructed by your surgeon for optimal results.

Is gynecomastia surgery safe?

As with any plastic surgery procedure, there are some risks involved with gynecomastia surgery. However, when performed by a skilled board-certified plastic surgeon, these risks are diminished. Some risks may include visible scarring, breast shape and contour irregularities, bleeding, and more.

Minimally Invasive Male Breast Reduction

by Miguel Delgado, MD | Jun 12, 2013 | Surgery

Minimally Invasive Male Breast Reduction

Each case of gynecomastia is unique, while most men have what is considered “true gynecomastia” there are some men with a milder form that offers some options. Men that have “true gynecomastia” usually require both liposuction of fat and surgical excision of the breast gland. This is generally a three to four hour surgical procedure and requires the placing of drains which stay in place for about four days.

Men who have what is referred to as puffy nipples and/or a smaller breast mound of an A or B cup and have good quality skin could potentially be candidates for a less invasive surgery that I refer to as the “light pull through procedure”. It is not a new procedure it has been around for almost twenty years, but it has been perfected through the years with outstanding results.

This procedure differs with traditional gynecomastia surgery in that an endoscope is used. An endoscope is an instrument that is inserted into the body through a small incision of about two to three millimeters at the lateral edge of the areola.  The endoscope allows the surgeon to see inside the body via optical fibers that send a picture to a computer monitor. First, fat is removed by liposuction with a cannula through the same small incision. Then, through the same incision the connecting fibers are freed up with a medical instrument that resembles a pickle fork, allowing the glandular tissue to be pulled gently through the incision thus the name “light pull through procedure”.

For my traditional gynecomastia patients, a three millimeter incision is made in the arm pit to remove fat from the chest by liposuction. Then I make an incision around the lower half of the areola to have access to breast tissue for excision. With the incision around the areola where the skin color naturally changes, the scar heals very nicely and usually is not detectable. Once fat and tissue have been removed from the chest a pocket of space is left where fluid can collect, this is referred to as a seroma, different than a hematoma which is a collection of blood from a small artery or vein. To prevent the accumulation of fluid in the pocket I use drains.  The drains create a negative pressure encouraging the cavity to close down. In addition, I have my patients wear a compression vest for six weeks. There are several reasons for the vest, for one thing it helps close the pocket of space, reduces swelling and helps the skin to retract.

Contrary to a popular belief that liposuction alone may reduce the male breast, removal of breast tissue is also necessary for a well sculpted outcome. Whether it is by the traditional surgical excision or for those with a minor case who are treated by the “light pull through procedure”, breast tissue must be excised as it is too dense to be removed through the cannula by liposuction. The exception to this would be the patient that has what is known as pseudogynecomastia (which is caused by fat alone).

Since the “light pull through procedure” is so much less invasive, my patients do not require drains. In addition to not needing drains, the other advantages are; the surgical time is less and the recovery time is faster, and with the smaller incision the resulting scar heals to almost invisible.