Are there different kinds of gynecomastia? How can you figure out “what’s in there?” And how does what’s under the skin determine the best surgical strategy for your man boobs?
Greater Miami patients have these questions among many others on their minds when they come in to see us for a consultation. Most have done at least some research. Some may suspect what triggered the unwanted breast growth: steroid use, medication, age, or other factors. What patients often can’t envision is how the content of their moobs will impact the surgical approach.
Let’s start this discussion with the general types of gynecomastia we’ve found in decades of experience with man boob surgery, and how they influence our techniques.

Common Gynecomastia

Most often, we encounter solid breast gland tissue under the nipple/areola complex that thins and spreads out into the rest of the breast. In technical terms, doctors refer to this pattern as “dendritic,” or branch-like. These cases usually require a combination of liposuction and gland excision. We can often accomplish both through tiny incisions near the armpit; occasionally we make additional incisions at the rim of the areola. We show guys the possibilities in the consultation room and assure them that either way, scars will heal to be nearly undetectable.
One common mistake gynecomastia patients make is to choose a cosmetic surgeon who proposes liposuction only or gland excision only. When an enlarged breast gland is left behind by the cannula, irregular contours tend to result. We perform many revision gynecomastia surgeries on patients like these–delicate procedures that smooth out the chest.

Lumps and Bumps

Another typical form of gynecomastia results from steroid or supplement use. This type is solid, dense breast gland that may feel lumpy or disc-like under the nipples. Stopping when it hits fascia and muscle, the gland sometimes spreads out across the chest.
Our approach is to remove the enlarged breast gland entirely. Since this measure can leave a depression known as a “crater,” we look for that well before we complete the operation. If warranted, we rotate small fat flaps into the crater, leaving them attached to the surrounding tissue to ensure survival. We also gently loosen the skin and re-drape it. The result? A smooth, flat, masculine appearance.

Fat/Gland Layers

Older guys may present with a third type of gynecomastia called “diffuse.” This means layers of fat and breast gland intermingled under the skin. It’s hard to know what triggers this pattern in most patients; it could be adolescent gynecomastia that has persisted over the years, or it could result from hormone changes with aging.
We use instruments of our own design for almost all our patients, including those with diffuse gynecomastia. Our patented cannula with a sharp tip enables us to excise gland tissue, suction away fat deposits, and smooth the skin from underneath. The flexibility it gives us enables us to treat these cases (and others) successfully. The only additional consideration may relate to excess skin. If we believe saggy skin may mar post-surgical results, we have in-depth conversations with our patients about the best way to handle it. There are options.

What if it’s not Gynecomastia?

What are the chances a given patient has enlarged breasts that are not due to gynecomastia? In South Florida, we see very few patients with something else going on. Very occasionally, we encounter a guy with one of these conditions:

  • Lipomas: Benign fat lumps called lipomas sometimes develop between skin and muscle tissue. We most often detect them on patients’ torsos, but they can also develop in the breasts.
  • Tumors: Men can develop breast tumors just like women do. Some are benign, and some can be cancerous. The Susan G. Komen organization notes that about 1% of breast cancers occur in men. After decades of performing gynecomastia surgery, we’re experienced at spotting a suspicious case. We refer patients with possible cases of male breast cancer to a specialist.
  • Cysts: Cysts are not too unusual in women, and they’re thought to occur when breast glands get blocked. Sacs of fluid develop, and they can feel soft or hard. Cysts are rare in men but not unheard of according to Johns Hopkins.
  • Inflammation: Inflammation is usually pretty easy to distinguish from other conditions, as it causes tissue to feel hot, swollen, and painful. It occurs in women much more often than in men, but it can result from pierced nipples or injury.

The Age Old Gland/Fat Debate

Long ago we lost track of how many times we’ve been asked whether a patient has gland or
fat causing his man boobs. Miami guys are like many other men across the country who seem to have a burning desire to know. Some would like to think they can diet and exercise their way to a flatter chest (they can’t). Many just shudder at the thought of having “female” attributes.
If you are one of these guys, hear this: it really doesn’t matter “what’s in there.” While it’s true that some guys have lots of fat while some patients have hardly any, surgery is still the answer. The ratio of fat to gland is not the issue.
What does matter is that your gynecomastia surgeon has years of experience producing satisfying results for thousands of patients with man boobs. This means he or she will be able to deal with whatever is under the skin, from large fat pockets that need skillful resculpting to big knobs of breast gland that could leave craters if not handled correctly.
We invite you to arrange a consultation with us. We are ready for anything!

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