While facelifts, breast augmentation, and tummy tucks get a lot of recognition, there is a lot more to plastic surgery. St. Louis’ West County Plastic Surgeons of Washington University, for instance, frequently sees men interested in surgically addressing gynecomastia—a condition better known as the development of male breasts.

The appearance of breasts in males is typically associated with hormone fluctuations. Adolescent boys going through puberty are a common demographic to experience this problem, since shifting body chemistry can trigger physical changes. These often resolve on their own as estrogen and testosterone levels find their appropriate balance, though the resolution can take a couple of years.

If breasts develop in older boys or men, they are less likely to go away on their own. In these cases, plastic surgery can be a valuable resource. Note that these cases should also prompt a visit with a primary care physician who will work to determine the cause, since certain potentially serious medical conditions, such as masses on the pituitary gland or testicles, can be a catalyst.

Certain medications and drugs can also alter a man’s hormone levels, leading to the development of breast tissue. In certain situations, gynecomastia can be resolved by an endocrinologist treating the underlying cause itself. This may lead to a reduction in breasts. If not, plastic surgery may be called for.

Before undergoing gynecomastia surgery to address the cosmetic aspects of the problem, a man dealing with the development of breasts must first meet with a plastic surgeon for an initial consultation. The doctor can determine the makeup of the breasts, which will be some combination of fibrous breast tissue and fat. The type and amount of tissue, as well as its positioning, will guide the surgeon’s decision on what techniques to use.

Patients with a mild to moderate amount of fat and fibrous breast tissue, good skin quality, and a nipple in its typical position can benefit from ultrasonic liposuction, which involves the introduction of a sterile solution to make the targeted tissue firm, to constrict blood flow, and to reduce sensation in the area. The surgeon then uses ultrasonic energy delivered by a metal tube called a cannula to rupture fat cells so they can be suctioned out, also through a cannula. The end result is reduced breast tissue, with the added benefit of tightened skin—also an effect of the ultrasonic energy. The incision scar is hidden in natural folds on the chest.

Ultrasonic-assisted lipoplasty is employed for a variety of reasons, including the fact that it can allow for greater fat extraction than liposuction techniques calling for manual disruption of fat cells. It also minimizes patient discomfort throughout the procedure and reduces recovery times. Since it is especially effective on localized fat that sits in small- to medium-sized pockets, it is particularly effective when used in male breast reduction surgery.

Men who have a moderate amount of tissue along with a “disk” of skin that sits beneath the areola can undergo a procedure that includes the ultrasonic liposuction, as well as excision of the excess skin causing the slight sagging at the nipple. The scars resulting from this surgery are hidden in creases in the chest, as well as in the areola itself, at the line of where lighter skin transitions to darker skin.

A case of significant extra skin and fat that creates the look of sagging breasts on a male chest involves the surgeon removing excess skin above the nipple in what is known as a “boomerang” pattern. The remaining skin is pulled up and sutured into place, creating a flatter chest and lifting the nipple higher into a more typically masculine position.

To learn more about gynecomastia and related plastic surgery, contact St. Louis’ West County Plastic Surgeons of Washington University. Call 314.996.8800 or send a message via the practice’s online contact form.