Gynecomastia (Male Breast Reduction) Surgery By Jim Lowe, MD on September 12, 2017


Do I need a male breast reduction?

Patients whose weight is stable and have a persistent breast mound and skin may be candidates for gynecomastia surgery (male breast reduction).  The question for male patients considering surgery is, are the risks and the resulting scars worth it? In most cases the need for male breast reduction is obvious, but in other cases it may not be clear.  Most patients who are candidates for breast reduction are typically concerned about the constant need to cover the chest due to the size and shape of the breast. Young male patients with breast smaller than a B cup can undergo liposuction alone. Other men with significant skin redundancy will require a surgical reduction or complete mastectomy. Surgical incisions cannot be avoided in men with a C cup breast or bigger. Patients with significant droopiness (ptosis), particularly patient with larger breasts require longer incisions and free nipple grafting. A frank discussion with a board certified plastic surgeon helps patients make the right decision regarding surgery. 

Is gynecomastia surgery covered by health insurance?

Male breast reduction is considered cosmetic and is not covered by insurance in most cases. Males with breast tumors are not the same as gynecomastia. Breast biopsy in men is covered by most insurance, but general enlargement or redundancy of the male breast is not.  Male patients with breast enlargement should undergo a medical workup prior to consulting with a plastic surgeon. Many patients undergoing male breast reductions will need breast tissue as well as skin removed to obtain symmetry and shape. Breast tissue is usually sent for evaluation to pathology.  Patients are encouraged to look at photos of gynecomastia patients online or in our office before scheduling surgery.  

How is a male breast reduction performed?

Male breast reduction surgery requires aggressively removing soft tissue and skin around the breast mound. The skin is tightened or re-draped after the breast is reduced or removed.  The length and position of incisions is determined by the amount of skin and tissue.  Sometimes the surgical scars are small, and other times they are big. Male breast reduction scars may be prominent due to the tension required on the skin.  Most plastic surgeons use liposuction in combination with mastectomy to fully remove the breast. Dr. Lowe is well trained in all current male gynecomastia techniques utilizing both surgical and nonsurgical techniques.  He individualizes surgery to best meet each patient’s needs, and he will do his very best to obtain the best results while limiting scars and recovery. 

I am not sure about what surgery I should choose.

One of the biggest concerns for patients considering gynecomastia surgery is deciding if they can live with how they look and feel now.  Most patients seeking surgery have been self-conscious and even ridiculed for years.  Many patients are told they would outgrow the problem or it would go away if they lost weight.  In most cases gynecomastia does not get better it gets worse with age. Most patients are not fully satisfied until all the fullness in the breast has been removed.  Patients who undergo aggressive mastectomy surgery may regret that they did too much while others undergoing limited treatment may regret they did too little.   Patients with particularly large breast benefit a great deal if they lose weight prior to surgery.  Patients who are unsure of which treatment is best are encouraged to do less, limit the scars, and compromise. It is always best to avoid an unsightly scar on the male breast when possible in patients who want to go shirtless in the future.  Most men just want to look good in a dress shirt without wearing 1-2 undershirts.  

What is the best technique for gynecomastia surgery?

The best approach can usually be determined in consultation with your board certified Plastic Surgeon.  Although Dr. Lowe will make specific clinical recommendations, each patient should make clear their wishes and expectations regarding size and shape. Most male breast reductions for severe deformities involve an aggressive removal of skin and breast tissue placed in a linear fashion across the chest. Female reduction incisions placed around the nipple and in the fold only accentuate the breast shape and should be strictly avoided.  Male breast reduction surgery is completely different. The exact surgery depends on the patient’s anatomy, personal preference, and the type and size of the breast.  When considering different approaches, patients should be aware that it is best to remove as much skin and tissue as possible while limiting the scar.   Pictures always help to clarify patient expectations. Go to www.drjlowecom to look at photographs of patients who have undergone different types of gynecomastia surgery.

Does male gynecomastia surgery cost more than liposuction alone?

The cost for male breast reduction or mastectomy is dependent on time and complexity.  Chest liposuction alone does not take much time and avoids lengthy incisions.  Male breast reduction with mastectomy requires greater surgeon skill and patient care resulting in increased cost.  In patients undergoing male breast reduction or removal breast tissue must be sent to pathology adding to cost. In rare cases staged surgery is required requiring more than one surgery.  It is best for patients to choose the operation that is right for them and ensures the most predictable outcome to limit costs. 

What about patient safety concerns related to gynecomastia surgery?

There are a variety of safety concerns with gynecomastia surgery.  Many of these concerns relate to the surgery itself: nipple or skin compromise, skin stretch, persistent breast mound, and scaring.  The risk of anesthesia is the biggest concern.  In most cases the safety of male breast surgery is most dependent on the surgeon and surgical facility.  Gynecomastia surgery is an elective operation reserved for patients in good health in an outpatient setting.   Dr. Lowe is a real plastic surgeon, who performs real surgery, in a real surgical center.  As a member of the American Society of Plastic Surgeons (ASPS) he is required to follow safety guidelines designed to ensure the best patient safety and outcomes.  Dr. Lowe proudly performs surgery only in accredited hospitals and surgical facilities.

Should I wait and think about my options?

Gynecomastia surgery is an important lifelong decision.  The surgical procedure carries significant risks and benefits.  Patients require a limited period of recovery, scar treatment, compression, and wound care.  Good candidates are male patients who hate having female breast and accept the risk of surgery. Patient should choose a board certified surgeon that they feel comfortable, takes time, reviews risks, puts safety first, and trust.  One of the most important issues is patient care and follow-up.  When possible, patients should talk about their plans with family members and significant others. Patients should have realistic expectations regarding the surgery, recovery, long term care, costs, and results. Gynecomastia surgery is a life changing operation that is often the right thing for the right person.

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James B. Lowe, MD, FACS

Lowe Plastic Surgery

Dr. Lowe is a triple board-certified surgeon with over 20 years of experience providing comprehensive cosmetic and reconstructive care. He is affiliated with several prestigious organizations:

  • American Society of Plastic Surgeons 
  • American Society for Aesthetic Plastic Surgery
  • American Board of Plastic Surgery
  • Fellow, American Association of Plastic Surgeons
  • Fellow, American College of Surgeons 
  • American Society for Surgery of the Hand 

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