It can be difficult to know if plastic surgery is the right option for gynecomastia symptoms and the type of procedure that is most appropriate. In this article, Dr. Miguel Delgado discusses why gynecomastia surgery is the most popular solution for men who want to banish man boobs permanently.
Gynecomastia Types
Before deciding if gynecomastia surgery is the most appropriate option it is essential to know the type of gynecomastia type that needs to be treated.
True Gynecomastia — This type of gynecomastia is defined by the presence of excess breast (glandular) tissue. The symptoms of true gynecomastia will depend on the grade of gynecomastia.
Pseudogynecomastia — This type of gynecomastia is categorised as “false” gynecomastia as it is not due to the presence of glandular tissue. The appearance of man boobs with pseudogynecomastia is caused by the presence of breast fat tissue.
Gynecomastia Grades Explained
There are four gynecomastia grades as per the gynecomastia scale developed by McKinney and Simon, Hoffman, and Kohn which are used by the American Society of Plastic Surgeons (ASPS). The grades are determined by the degree of excess glandular tissue, the amount of breast fat, and how much skin needs to be removed. By classifying gynecomastia into grades it is simpler for surgeons to advise on the treatments and surgical options available. Below are the four grades of gynecomastia explained according to symptoms.
Grade 1 — Symptoms are slight swelling of the chest with puffy nipples that are slightly enlarged. There is a small degree of glandular tissue and there may be breast fat.
Grade 2 — Symptoms are more noticeable, with a more feminine appearance due to a greater degree of glandular tissue. There will be a small amount of excess skin and the presence of breast fat is also normally found with grade 2 gynecomastia.
Grade 3 — This grade gives a femine appearance with medium-sized man breasts that will have a slight sag and breast crease. Excess skin is present, glandular tissue is greater, and there will be some breast fat.
Grade 4 — The most severe gynecomastia grade with significant excess skin, creating the appearance of medium to large man breasts with significant sagging and defined breast crease.
Gynecomastia Treatment
Gynecomastia surgery is the only guaranteed way to get rid of true gynecomastia symptoms. Pseudogynecomastia can be reduced by diet and exercise, although with grade 3 and 4 there may be a need for removal of skin which may not contract after weight loss.
Gynecomastia treatment options for true gynecomastia include medications that can balance hormones. Clinical studies have shown a percentage of men find that once medication is stopped gynecomastia symptoms return. Another concern with medications is the possibility of unpleasant side effects which include erectile dysfunction, fatigue, and hot flashes.
Gynecomastia Surgery Options
The best type of gynecomastia surgery will depend on different aspects which include:
- Gynecomastia grade – This is the main factor that will limit the surgical options.
- Age – Age will impact the elastin and collagen in skin. In most cases the patients age will limit how much their skin will contract.
- Gynecomastia type – Grade 1 and 2 pseudogynecomastia may not need gynecomastia surgery, and can generally be rectified with liposuction or liposculpture.
- Patient preference – This will impact the degree of scarring that is acceptable for the individual.
A specialist plastic surgeon who regularly performs gynecomastia surgery will be in the best position to advise. During a consultation it is usually viable to diagnose the type and grade of gynecomastia, following a physical examination. The most popular gynecomastia surgeries performed most often are:
- The “pull through technique” — a relatively new procedure offered for grade 1 and sometimes grade 2 gynecomastia. Only one small incision is required which is usually made at the outer edge of the areola, although it can be made towards the outer edge of the chest. Glandular tissue is pulled through the excision and removed. Liposculture may be combined with this technique to contour the chest for a more even result.
- Areola excision technique (Webster method) — the most common type of gynecomastia surgery. This procedure involves making an excision around the bottom part of the areola to remove excess glandular tissue. The scar will be slightly larger than with the “pull through technique”, running along the bottom crescent shape of the areola. Again liposculture or liposuction may be used to remove excess localized fat to create a better result.
- Peri-areola lift or the “Donut technique” — a procedure that may be done following a Webster lift when there is a greater amount of excess skin causing a breast crease. The procedure involves making an incision all the way around the outer edge of the areola. Another larger circle is then made to remove excess skin, creating a donut shape. The skin is excised between the areola edge and the large circle and stitched back together to create a chest with smooth tight skin.
- Double incision mastectomy — the technique most suitable for grade 3 and 4 gynecomastia. The procedure involves an incision in the crease of the breast through which glandular tissue and fat is removed. Excess skin is excised and the incision is stiched together to create a masculine chest. This procedure is less popular for grade 2 gynecomastia, as it leaves a scar extending across the chest and towards the armpit.
Why Gynecomastia Surgery Is Popular
The number of men choosing to have plastic surgery procedures is increasing year on year. Social media platforms like Instagram and plastic surgery channels on YouTube, alongside television programmes such as Extreme Makeover, have brought male plastic surgery into the spotlight. The rise in men having plastic surgery is also due in part to ongoing reports of celebrities having plastic surgery, such as Dwayne Johnson. Furthermore, male influencers are jumping on the PR bandwagon and often use their own plastic surgery journeys to promote themselves and increase their reach.
With the rise in popularity, many men are getting a new insight and opinion of plastic surgery. This may be part of the reason why gynecomastia surgery is fast becoming one of the top plastic surgery procedures for men. This trend looks to keep growing and the more mainstream male plastic surgery becomes, the more it is accepted and considered an option. Alongside the influence of the media, cosmetic surgery procedures have become more affordable, in line with an increase in disposable income.
Plastic surgery procedures such as rhinoplasty and body sculpting are increasing in popularity, as men want to enhance how they look to increase their sense of wellbeing. Advancements in procedures such as gynecomastia surgery now offer men more options than ever before, with less risks and minimal downtime.
