Before male breast reduction surgery

After male breast reduction surgery

Before breast reduction surgery

After breast reduction surgery

Many young men start to develop gynecomastia at age 12 and some even younger. Puberty is an emotional time for boys anyway with their hormone levels changing. Adding to that the development of gynecomastia breasts and/or “puffy nipples” can make for an extremely traumatic and stressful time for maturing boys. Many young boys of San Jose and all of the Bay Area find themselves pleading with their parents for corrective surgery and find when they see the pediatrician or plastic surgeon they are told they must wait.

This can cause a lot of anger and frustration for the young man, affecting his relationship with his parents and other people. But the doctors want to delay because in most cases the male breast will resolve on its own as the boy matures and doctors are hesitant to perform unnecessary surgery.

If gynecomastia has not resolved after two years, then chances are it will not, so depending on the maturity of the boy, surgery can be contemplated.

There is not a magic number as to what age is allowable. Each patient needs to be evaluated considering many factors. It is not unheard for a boy of 13 to have gynecomastia surgery.

When Los Angeles and San Francisco Bay Area men discover that no amount of dieting and time at the gym will reduce their “moobs” or “man boobs” loss of self confidence is generally the result.

For men who find the right surgeon and proceed with male breast reduction surgery, the impact on self confidence is life altering.

Some inspiring comments heard from men after their gynecomastia surgery:

• “I now have the confidence to approach women without feeling the need to fold my arms across my chest”

• “Choices in clothes are unlimited, what a difference to wear what I want and not just shirts that hide my chest”

• “The ability to go to the beach with friends and not be fearful of teasing or cruel remarks is a freedom I can’t describe, I feel normal”

• “My personality has changed for the better; I am so much more outgoing and confident. I am enjoying my life in so many ways that I never thought possible.”

• For the first time in my life I have a serious relationship and am looking forward to starting a family. If I have a son and he develops gynecomastia, I know how to help him and won’t let him suffer like I did.

What can be more encouraging than hearing comments like these from men who have had successful results? These men obviously did their homework in researching for a Board Certified Plastic Surgeon who specializes in gynecomastia surgery. This cannot be emphasized enough; there are many men that have disappointing results when they do not choose a surgeon with vast experience. If your surgeon tells you that liposuction alone will get rid of your gynecomastia breast, get another opinion or even two. “Pseudo-gynecomastia” is caused by fat alone and is the only condition that can get a good result from just liposuction. Only a very small percentage of men have gynecomastia caused by fat only. True gynecomastia needs to have a combination of liposuction and surgical removal of breast tissue.

Dr. Delgado has heard back from hundreds of patients who share their life altering stories after their gynecomastia surgery and finds his ability to help men change their lives is one of the biggest rewards in his practice.

It is important to see a Board Certified Plastic Surgeon who specializes in male breast reduction surgery to evaluate a patient’s condition, in some cases a referral to an endocrinologist may be advised. In a previous blog dated, June 21, 2011 various drugs are discussed that may be possible causes for the gynecomastia breast. If the use of marijuana or steroids or even some prescription drugs continue there is a small chance some regrowth may occur. If gynecomastia surgery is done on the adolescent boy of 13 or 14 years of age, there can be reoccurrence of the male breast due to the fact that the hormones are still active.  Sometimes the cause of the development of the male breast is unknown.

Gynecomastia will rarely return if enough breast tissue has been removed during surgery. The surgeon’s goal is to remove 80% to 90% of the gland, leaving enough to create a well contoured chest and for survival of the areola. Liposuction is generally done to remove fat but again not all fat is removed, so if the patient gains weight, there can be an increase of fat content of the overall chest and body.

However, recently there has been multiple personal injury lawsuits filed against Merck due to serious side effects claimants have made, including:

• Heightened prostate cancer risk
• Gynecomastia (male breasts)
• Decreased arousal and libido
• Erectile dysfunction
• And more

The FDA made an announcement in June of 2011 requiring Merck to add new drug label warnings to Propecia. The FDA is also advising Healthcare professionals to be aware of the “warnings and precautions” sections of the labels for the 5-Alpha reductase inhibitor class of drugs which includes Propecia.

Interestingly, Merck updated the warnings for the United Kingdom, Sweden and Italy in 2008. Propecia sales are almost a half billion dollars a year and Merck’s patents don’t run out until 2013.

Lawsuits against drug manufacturers are very hard to win unless you can prove “failure to warn”. If you go to Propecia.com, the website is “currently not available” but encourages patients to report negative side effects to the FDA!

For San Francisco Bay Area gynecomastia surgery patients, it is very important to be aware of all drugs you are taking and inform your surgeon who will be trying to discover the cause of your gynecomastia and to determine your gynecomastia treatment.

The vast majority of San Francisco Bay Area gynecomastia patient’s have temporary loss of fine sensation of the nipples and surrounding skin, this is normal. This is referred to as neurapraxia. In neurapraxia, there is no alteration in the structure of the nerve; however conduction of impulse is interrupted due to injury or surgery. This type of injury can be recovered from completely. Blood supply disruption and nerve compression are the effects of such nerve injuries. Nipple sensation usually returns within a few weeks, but for some it can take a long time even 6 to 12 months. Nerves regenerate slowly, how it returns is extremely variable depending on the surgical techniques used and the extent of surgery. Return of sensation is typically preceded by dysesthesia/paresthesia (pins and needles sensations).

Dr. Delgado advises his Marin County cosmetic surgery patients to massage during the recuperation phase which helps reduce hypersensitivity of the skin as sensation returns.

Gynecomastia.org has comments by post surgical patients regarding changes they have experienced with nipple sensation. In order to read posts you need to sign up, but there is no charge to become a member and the site has a tremendous amount of valuable information.

About 35% of my gynecomastia cases are for corrective surgery. One common problematic result is referred to as “crater deformity”. This is where the surgeon has removed too much breast gland underneath the areola without blending in the surrounding tissue smoothly.

Fortunately there are procedures available that can help correct this. Once the patient has fully healed from the first surgery, fat transfer, (also called fat injection or fat grafting) is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. In the fat transfer procedure fat is harvested from one part of the body where an excess exists and then places it in another part of the body.  Another popular technique is a fat flap.  This is fat tissue that is attached to its blood supply and can be rotated into the crater deformity.  The fat flap is a very useful technique. It would be optimal to avoid having to go through this process (avoiding extra surgical costs and down time) by doing your homework and finding the right surgeon the first time.

Click on the links below for a short video on before and after Crater Deformity Correction.

             Crater deformity prior surgery                                       Crater deformity 1 week post op

It is extremely important to be sure your surgeon is an expert in gynecomastia surgery. Dealing with the resulting scars from male breast reduction surgery is secondary to the correct placement and technique of the surgical incisions. By placing the incision at the bottom of the areola most men find it difficult to see any resulting scar after all healing has taken place. However, to ensure the best possible result, Dr. Delgado has his patients use silicone gel sheeting about 10 days after the incisions are completely healed. The silicone helps soften and lighten the color and appearance of the scars.

Directions for using the silicone gel sheeting are as follows:
1. Cleanse and thoroughly dry the scar area.
2. Cut a piece of the silicone sheeting slightly larger than the area of the scar.
3. Apply the adhesive side directly to the area and secure in place with tape or bandage.
4. Clean the silicone sheeting and the scar area on a daily basis using mild, non-oil based soap (Ivory or Neutrogena soaps are recommended). The silicone sheeting may be reapplied to the scar until the patient notices excessive wear or reduced adhesion and then a new strip of silicone sheeting should be administered. Product wear will depend upon the scar location and patient activity level. Typically, the silicone sheeting should be replaced every 10 to 14 days.
5. For best results, the sheeting should be worn 12 to 20 hours per day.
6. The surgeon is responsible for determining the treatment time for the patient. Generally, the minimum duration of treatment is 4 to 12 weeks.

Sun exposure on the healing incision must be avoided for the first few months. The sun can cause the pigment of the skin to darken and the tissue may thicken. Keep the scar covered with clothing or a bandage.

Dr. Delgado has always encouraged his male breast reduction patients to take good quality multiple vitamins before and after surgery as it will greatly enhance the recovery process and so the patient can be at his optimal health for surgery of the gynecomastia breast . It can be a challenge to find a good multi-vitamin that does not have vitamin E, as vitamin E has blood thinning qualities. In most cases if the vitamin has 400 units or less it will be OK, but to find one without any vitamin E is even better.

After a lot of research Dr. Delgado found VitaMedica vitamins and supplements that he found to be of superior quality and now has them available to his patients at his office. The multi-vitamin does not have any vitamin E and an increased level of vitamin C for strengthening of capillaries and veins. Also available is Bromelain and Arnica for swelling and bruise prevention. Dr. Delgado and his patient coordinator will be able to advise patients what supplements would be best for them based on their health history and blood test results. The whole array of supplements can be viewed on Dr. Delgado’s main website at www.sanfranciscocosmetic-surgeon.com under the store tab.

In addition to getting the body as healthy as possible for surgery, the patient should be sure that all medications prescribed have been filled and are ready at home upon return from surgery. Be sure to arrange to have someone pick you up and to stay with you for the first 24 hours. Due to medications and anesthesia you may be in need of assistance for that short period of time. This is a non-negotiable requirement by Dr. Delgado for the safety of his patients.

The word andropause is currently not recognized by the World Health Organization as it is a term of convenience to describe the stage in life when men have symptoms of aging. The concept is more accepted in Australia and parts of Europe. Some clinicians feel the symptoms are not enough to be considered a medical condition and that “andropause” is just low testosterone. But whatever name we give it does not lessen the impact of the symptoms for San Francisco men’s physiological and psychological well being.
A blood test is required to diagnosis low testosterone. One way of treating andropause is with testosterone replacement, but the treatment is controversial as it may increase the risk of prostate cancer as well as other medical issues. The gynecomastia breast is one of the most upsetting symptoms and while testosterone replacement is not an option for many men, male breast reduction surgery is.