Male breast enlargement (hypertrophy) is common with aging, weight gain, stress, certain medications, and other factors. This can become a significant esthetic concern for men if it becomes disproportionate. Treatment may involve liposuction of the chest, surgical removal of the underlying breast tissue, removal of excess skin, lifting of the breast, or a combination of these procedures. Different patients require different combinations of these procedures to achieve the ideal result. A thorough evaluation with Dr. Goldman's team at consultation can help determine what the best option is for you.

Gynecomastia (male breast enlargement) can affect one or both breasts. It is common in young men going through puberty, but will generally resolve over time. Medical evaluation is performed in all patients. Certain medications (including THC and Propecia) can cause male breast enlargement. Specific hormonal imbalances and other medical problems can also cause gynecomastia. Further workup is therefore appropriate in some patients.

Men do have breast tissue, which is a combination of fatty tissue and actual breast tissue, although less tissue than is typically present in women. Physical exam alone can give a general idea of the proportion of fat versus breast tissue, but the degree to which gynecomastia is caused by increased amounts of breast tissue can ultimately only be determined at surgery. Radiologic workup is not necessary in most cases unless a mass is present. In such cases, the mass must be evaluated prior to gynecomastia repair.

In younger men for whom gynecomastia persists or in older men who develop breast enlargement, surgery may be an appropriate option. A spectrum of options exist. Patients with more severe gynecomastia will require more involved procedures.

• Liposuction: For patients with gynecomastia that is predominantly fatty and for whom gynecomastia is mild, liposuction alone may suffice. Patients with excess skin and hanging breast tissue are generally not a candidate for liposuction alone.
  
  Liposuction involves using a small incision to remove the fatty component of the enlarged breast using a thin tube (cannula) attached to suction. Dr. Goldman prefers power assisted liposuction (which oscillates to help remove fat) and sometimes uses ultrasonic liposuction in patients with more dense fat. Liposuction does not require drains and has fewer postoperative restrictions than procedures that use open incisions to remove breast tissue.
  
  
• Open excision (male mastectomy): In cases where there's significant glandular tissue or dense tissue that cannot be removed with liposuction alone, Dr. Goldman may recommend using an incision to remove (excise) the breast tissue. This is a form of simple mastectomy (removal of the breast).
  
  For patients who do not have significant skin excess or hanging breast tissue, an incision around the areola can be used. This is well hidden. Patient's generally comfortable with their shirt off in public after this procedure. Dr. Goldman typically combines open removal with liposuction to optimize contours and facilitate tissue removal.
  
  Open removal of breast tissue leaves a pocket or space where the breast used to be, therefore a suction drain (a thin plastic tube connected to a bulb) is left in place, generally for 3 to 4 days after surgery, to help the wound heal.
  
  
• Chest panniculectomy and breast lift. For patients who have larger male breasts, especially if the breast hangs over the fold at the bottom of the breast (the inframammary fold) removal of skin is necessary. Simply removing the underlying breast tissue would leave loose, hanging skin. Most commonly, a wedge of skin is removed along the inframammary fold.
  
  Removal of this wedge is referred to as a chest panniculectomy. Chest panniculectomy may also require moving the nipple and areola to a higher position, which in men is commonly performed as a skin graft (free nipple graft). Many men do feel that the scar the results at the inframammary fold is visible to others when shirtless. If patients with larger male breasts are unwilling to have this scar, they may not be candidates for gynecomastia repair.

Nipple reduction surgery is a cosmetic procedure designed to reduce the size of large or protruding nipples. This procedure is commonly performed for both men and women. Nipple reduction can address size or asymmetry, and may be performed just on one side. 

By itself, nipple reduction is typically performed under local anesthesia in the office setting. Dr. Goldman makes small incisions on the nipple to remove excess tissue and reshape the nipple in a natural way. Stitches are dissolvable and do not have to be removed.