Gynecomastia FAQs

How can I tell if a particular plastic surgeon is experienced with gynecomastia surgery?

Your potential surgeon should display confidence during the initial consultation. Ask to see before and after photos of previous gynecomastia patients. The surgeon may be able to put you in contact with previous male breast reduction patients to hear their experiences and testimonials. Most importantly, ask the surgeon how frequently he/she performs male breast reduction surgery each year. The more frequent their exposure to this procedure and satisfaction rate of their patients, the better off you are.

Will my insurance company pay for male breast reduction?

Unfortunately in most cases, they will not cover this procedure. We have had only one insurance company agree to cover a case.

What if my insurance company denies my claim? What are my options? Do patients ever win appeals?

If your insurance company denies your initial request for coverage, you can always file an appeal. Most appeals are not won, however, there have been a few cases that have prevailed.

What is the best way to approach my insurance company?

When requesting coverage for gynecomastia surgery, it is most important to inform them that you have a congenital condition and that you experience breast tenderness if this is the case for you. If you are overweight, it would be a good idea to get as close to your ideal weight prior to making a claim, as this can have an effect on their decision.

How much does male breast reduction surgery cost?

In the USA, the average total cost of gynecomastia surgery is around $6,000 to $7,500, broken down as follows:

• Surgeon’s fee: $3,000 to $5,000
• Certified Operating Facility fee: $1,500 to $1,800
• Anesthesia fee: $275/hr. (Board Certified Anesthesiologist)
• Miscellaneous costs: compression vest, lab tests, pathology, and prescriptions

What blood tests should be done before surgery?

A “CBC,” or complete blood count, is required of all our surgical patients. For male breast reduction patients, a “PT/PTT” may possibly be requested if you have been using any type of aspirin-containing medications or certain types of vitamins/supplements. This test measures your “clotting mechanism.”

Who should do the testing and evaluation of blood tests?

You can have the testing done at any lab convenient for you. The results should be sent to your surgeon and anesthesiologist for evaluation before surgery.

Does it matter what causes Gynecomastia?

Yes. Gynecomastia can be drug-induced (i.e. steroids, excessive marijuana use, or alcohol use). Medications such as Propecia (prescribed for hair loss) can also cause gynecomastia. It is highly advisable to discontinue the use of these substances prior to surgery.

Is there a minimum age requirement for patients interested in gynecomastia surgery?

There is no minimum age requirement for gynecomastia surgery, however, many surgeons prefer to wait until the person has completely finished puberty (18-20 years old). The reason for this is that for many teens who are still in their pubescent period, the gynecomastia they’re experiencing can, and usually will, go away on its own. The surgeon will use their clinical judgment if the case is severe and causing severe social/psychological issues. This may encourage surgery or other treatment for excess breast tissue at a younger age.

Is there a maximum age limit for patients interested in male breast reduction?

There is no age limit for male breast reduction, however, if you have any medical conditions that could compromise your health during surgery, your surgeon may be hesitant to proceed or decline to perform the surgery altogether.

What medical conditions would prevent me from having surgery?

It is very rare for a patient to be turned down for surgery, however, there are some serious medical conditions that can cause concern. Severe heart disease, malignant hyperthermia, or severe bleeding disorders would be reasons for a surgeon to deny service.

Will there be scarring to treat gynecomastia?

If the surgeon removes glandular tissue, they will make a small peri-areolar incision; a half-circle incision around the lower half of the areola. In most cases, the surgeon will also perform liposuction to sculpt the chest into the best contour/shape possible. Whichever technique your surgeon uses, there will be scarring afterward. However, within 6 months to a year, most scars fade to the point where you cannot distinguish them from your normal skin.

What is the most common technique for male breast reduction?

The most common technique for gynecomastia is for the surgeon to make a peri-areolar incision to remove glandular tissue and then perform liposuction of the area for definition. Some surgeons only use liposuction, but in most cases, this is a mistake unless it is diagnosed as pseudo-gynecomastia (all fat content). This is most often due to only using liposuction. This leaves the excess glandular tissue behind.

I understand that there are two types of liposuction, tumescent and ultrasonic. Is one better than the other?

The tumescent technique is the gold standard for liposuction. Basically, the surgeon enlarges the area to be suctioned with a large amount of sterile fluid combined with a vaso-constrictive agent such as epinephrine to reduce bleeding. The excess fat and the fluid are then suctioned out.

Ultrasonic liposuction uses sound waves to break up fat which is then suctioned out. In our opinion, there is no advantage to this technique which is why we prefer tumescent. In some surgeons’ hands, however, it works very well.

I am 30 pounds overweight. How will this impact my surgery?

True gynecomastia does not react to either weight loss or gain. Enlarged breasts in men are composed of breast glands and fatty tissue. The change in body weight can affect the fat content of the chest. The breast gland will increase in size due to hormones or other drugs, like steroids. After a certain point, weight gain will lead to additional conditions needing treatment, such as excess skin. However, genetic or other idiopathic conditions that cause gynecomastia result in proportional growth of breast tissue along with weight gain.

What do I need to do in preparation for surgery?

It is absolutely necessary to quit smoking starting at least 2 weeks prior and continuing until four weeks after your surgery. Do not take any aspirin-containing products, such as Advil/ibuprofen or any other drugs that promote excessive bleeding. Herbal remedies such as St. John’s Wort, Ginkgo Biloba, Fish Oil, Flax Seed Oil and excessive amounts of Vitamin E can cause excessive bleeding. Bottom line is that it is best to avoid all medications/ vitamins/ supplements such as these for two weeks prior to and two weeks after your procedure. In our practice, we supply the patient with a comprehensive booklet of pre-operative instructions before the surgery, clearly outlining these recommendations.

What is the recovery time following gynecomastia surgery?

The initial recovery period is 7 to 10 days. If drains are used, they will typically remain in for about three days after which they will be removed at your first post-op appointment. Total recovery time can vary from patient to patient. Most patients can expect to be fully healed by 3-6 months. At this point, most or all of the bruising and swelling should have dissipated and the scars should have begun to shrink and fade. Sometimes, it may take as long as a year to completely heal to the point where the scars are no longer visible.

For the first 4 to 6 weeks after surgery, it is necessary to avoid all strenuous activities, especially those involving the upper body, such as lifting weights or intense workouts at the gym. In addition, we advise my patients to wear a compression garment for 6 weeks post-operatively.

What do I tell my employer, family, and friends?

All medical conditions and patient records are confidential. At my practice, we gladly provide any letters/paperwork necessary to excuse you from work. We can provide such medical excuses without giving any details to your employer by simply stating it is for a medical condition. Your employer does not have the right to know what your surgery is for. Your medical information is between you and your doctor, exclusively.

As for family and friends, you can tell them exactly what your surgery is for or you could tell them that you are having “benign lumps” removed from your chest. Saying that you are having benign lumps removed is not lying and, hopefully, they will not pressure you into divulging any more information than that.

Gynecomastia is a very common procedure, and yet, we have many patients that don’t want to tell anyone that they are having surgery to correct it. It is completely normal to not want to share the details of your surgery with anyone, and it is at your discretion to do so if and when you feel the time is appropriate.

How long will I be in the hospital? Will I have to stay overnight?

This is a same-day outpatient surgical procedure. The actual surgery takes about 2 to 3 hours. After your surgery, you will be taken into recovery for at least one to one and a half hours to be observed and attended to by a nurse. Once your surgeon feels you are in a stable enough condition, you are released to return home. It is necessary to have a family member or close friend escort you home and stay with you for at least the first 24 hours.

How much pain will I be in post-surgery and for how long?

A long-acting local anesthesia will last at the surgical site for about 24 hours. When this wears off, you may begin to experience moderate discomfort for about another 24 hours. After that, most patients only experience minimal discomfort and most never complain of any severe pain, only soreness of the area. Regardless of your pain level after surgery, we always prescribe pain medication for you to have on hand should you need it.

What kind of stitches do you use externally? How long will they be there?

We use very thin 6-0 nylon sutures that are removed 7 to 10 days after surgery.

Do I need to avoid exposing my scars to the sun after my procedure?

Early sun exposure to your incisions after surgery is not advisable. To avoid scar pigmentation, you should use sunblock on your scars for 3 to 6 months following surgery. We also recommend silicone sheeting to be placed directly on the incisions for 2 months after surgery. We find that silicone gel sheeting improves the appearance of the scars by flattening them and decreasing the pigment.

Will I need to have more than one surgery?

Within the first year, a redo or touch-up procedure is covered by the patient’s initial surgical fee. However, it is important to remember that one must have realistic expectations for the outcome of any type of cosmetic surgery. That being said, we want all of our patients to be happy and we will always do what we can to achieve that.

Do I need to wear a compression vest? What is it for? How long do I have to wear it?

It is necessary to wear a compression vest for about four to six weeks following the procedure. After the gland is excised and liposuction is performed, a large open space exists. The compression garment helps the tissue come together and close properly. The placement of the drains helps as well. Another function of the garment is to help reduce the initial swelling and contract the skin over the surgical site.

When can I return to work?

Usually, patients are able to return to work 5 to 7 days after surgery, depending on what type of work they do. If they work in an office environment that does not require much physical activity, then it is easy to return shortly after the procedure. If you do physical labor, it is recommended to wait at least 10 to 14 days or whenever you feel you are ready. Listen to your body! It will tell you when it is ready to return to your normal activities.

Are there any post-operative complications that I should be aware of?

Excessive fluid can accumulate underneath the skin. If a drain is not used, the fluid would have to be aspirated with a needle. Also, if you have extreme pain after 24-48 hours which is not helped with your pain medication, this could indicate a problem. One potential complication is a hematoma. A hematoma is a collection of blood underneath the skin, made noticeable by excessive bruising, swelling, and pain, typically of only one side of the chest. If this happens it is imperative to contact your surgeon immediately.

Other Online Sources of Information

Below is a shortlist of some of the best resources for gynecomastia information and advice on the web:

• Mayo Clinic
• National Institutes of Health
• American Society of Plastic Surgeons
• MedicineNet.com (part of WebMD)

Frequently Asked Question