San Francisco, California-Men with gynecomastia, also referred to as moobs, are relieved to know that there are support groups available to help them get current information and to help them cope. Our society makes it difficult for men to reach out for support for a very embarrassing and sometimes devastating condition. It is not considered masculine to be sharing personal issues especially over symptoms of  enlarged male breasts which gives them a feminine appearance.

Fortunately in 1999 Merle Yost, a psychologist who suffered with the condition himself, created the website Gynecomastia.org. He collaborated with gynecomastia specialist Dr. Delgado from the onset in what became the world’s best resource for information on gynecomastia. Besides offering valuable information through blogs, press releases and articles posted by member doctors, there is a vast amount of before and after pictures, and a directory of gynecomastia surgeons listed by state.

However, the most popular aspect of the site are the forums. The forums allow members who join (at no cost) to address issues, ask questions of each other and member doctors. Many share stories of how gynecomastia has affected their life and their journey to resolution, in most cases by male breast reduction surgery. They share pros and cons of their experience from beginning to end and many times their opinion of their surgeon. The support men receive from each other is invaluable. They finally have found a place they feel safe in sharing a nightmare they thought they had to face alone.

Having treated men for years with gynecomastia, Dr. Delgado referred many patients to the site for additional support, the positive feedback he got encouraged him to take over the maintenance and ownership of the site in 2010 when Merle Yost stepped down. Knowing the value the site has had through the years, Dr. Delgado wanted to maintain its integrity, and keep the membership at no cost to the forum members. There is a membership fee to the participating surgeons listed in the directory which covers the maintenance of the site and ensures only Board Certified Plastic Surgeons who have a true interest in gynecomastia  are members.

Severe Gynecomastia

6 months After Stage One Surgery

San Francisco, California-

Gynecomastia breasts (also known as moobs) comes in many different forms, from minor to severe. Each case is unique and needs to be evaluated as such.

For the fortunate men that have what is known as “pseudo-gynecomastia”, liposuction alone may be possible, for that condition is caused by fat alone and does not include breast tissue.

Then for the man that has only a mild to moderate case, it is possible for them to have a less invasive procedure known as the “Light Pull-through Procedure”, see details in the blog dated October 27, 2010.

For the moderate to severe cases, it is sometimes recommended that the surgery be done in two separate stages, allowing the patient to heal from the first surgery for approximately 4 to 6 months so that the blood flow can reestablish itself underneath the nipple-areolar complex. At the time of the initial consultation, it will be possible for Dr. Delgado to advise the patient if a second stage, also known as the peri-areolar lift, may be necessary to get optimal results. The second stage is usually done as an office procedure under local anesthesia with a fee of about $2500 to $2800, but as mentioned before each case is individual and the secondary surgery will depend on how much skin and laxity is present.

2 Weeks After Stage Two Surgery

This 55-year-old man suffers from adolescent gynecomastia. He underwent glandular excision and suction-assisted lipectomy of his chest, flanks and abdomen. From the right flank, I removed 1325cc of total fat, 1175cc from the left flank, 2650cc from the abdomen, 475cc from the right side of the chest and 450cc from the left side, bringing the total amount of fat removed to 6075cc.

San Jose patients ask if they can combine more elective surgical procedures to their gynecomastia surgery. Combining procedures is very common, most popular is the addition of more liposuction to the abdomen, love handles or lower armpit area and/or back. Having a secondary surgical procedure saves money and the recovery time will be the same. Adding areas of liposuction to the upper torso gives Dr. Delgado the ability to get a more sculpted result.

Due to busy work schedules, it is not unusual for some San Francisco Bay Area men to ask if unrelated cosmetic plastic surgeries can be done at the same time as their male breast reduction surgery, and the answer is “absolutely!” Today longer procedures are quite common and considered extremely safe due to advances in anesthesia and surgical technique. Marin Cosmetic Surgery Center has all state of the art equipment and a highly trained staff allowing patients to combine such surgeries as eyelid surgery to their moob reduction surgery. Each patient is different, and a personal consultation is necessary to determine how much surgery can be done at one time. In addition to getting an outstanding surgical result, safety is the main concern for each patient. At the time of the initial consultation, Dr. Delgado is happy to discuss all surgical desires of his male breast reduction patients.

Before and After Gynecomastia Surgery

This question is asked frequently by San Francisco Bay Area men, and the answer is; rarely will liposuction alone get rid of man boobs. True gynecomastia is a combination of fat and breast tissue. Liposuction will only effectively remove fat. Breast tissue is too dense to go through a cannula. There are many surgeons who attempt to remove moobs by liposuction alone, they leave behind the breast tissue which now without the surrounding fat may be even more apparent.

I would say that 35% to 40% of my male breast reduction cases are “redo” surgeries where the original surgeon used liposuction alone. This presents a more difficult “redo” surgery because now there is scar tissue making dissection more difficult and the skin may have lost much of its elasticity. This is especially frustrating for the patient who will have to go through another surgery involving more expense and recovery time and maybe not the result that could have been obtained if breast tissue had been excised in the original surgery.

There are instances when liposuction is a great tool, but mostly it should be used for touch up procedures, to extract and/or inject fat. In the rare case where the male breast is caused by fat alone, liposuction may be very effective. This is not considered “true gynecomastia” however; it is referred to as “pseudo-gynecomastia”.  In many cases, pseudo-gynecomastia can be reversed with weight loss if the skin has not been overly stretched.

In order to avoid needing a “redo” surgery, be sure to find a Board Certified Plastic Surgeon that specializes in gynecomastia surgery. Look at the surgeons before and after photos, and ask questions as to the method of surgery to be used.

Gynecomastia Surgery Continues to Rise

Each year the American Society of Plastic Surgeons (ASPS) reports statistics on the amount of plastic surgeries performed for the previous year. They look at the overall cosmetic and reconstructive surgeries and report which procedures have had an increase or decrease. For the year of 2012, it has been reported that things are quite stable.

Cosmetic procedures were up 5%, but there was a 2% drop in cosmetic surgical procedures. A rise of 6% in minimally invasive procedures such as Botox and injectable fillers accounts for the overall increase.

The treatment of male breast development, gynecomastia, also known as moobs, is one of the largest increases in body contouring surgeries for Northern California men as well as across the nation. Gynecomastia surgery had a 5% increase in 2012 over the previous year. Awareness and acceptance of male breast reduction surgery is attributed to this increase.

Scar from drain before new technique

For the San Francisco Bay Area man, in order to remove male breast tissue and fat during male breast reduction surgery, an incision is made at the bottom half of the areola, between the darker and lighter skin. When it heals it is almost invisible. Chest hair can also help in hiding the incision.The healing process can take up to 6 months to a year.

I recommend silicon sheeting about 10 days after the incisions are healed. Silicon sheeting helps soften and lighten the color of the scar. I also do a tiny incision in the armpit for the liposuction cannula and for the drain.

My San Jose patients let me know that the tiny scar left by the drain under the arm was a point of concern, now by a new technique I place it high up in the armpit toward the back, most of my patients have a hard time finding it.

Depending on the severity of the gynecomastia breast determines the incisions, sometimes it can be less, in some cases it can be more if a second stage reduction is needed.

San Francisco

It has been established that many men will choose to travel for their male breast reduction surgery in order to find a gynecomastia specialist. Taking into account that most patients want to be able to return home as soon as possible, Dr. Delgado of San Francisco, California has made special provisions to accommodate them.

In general, it seems to work best if the patient has gynecomastia surgery on a Thursday allowing them to leave for home on the following Tuesday after their post-operative appointment. This is assuming that everything is going according to plan, and there are no complications which is the case in almost all situations. However, safety is the most important consideration, and if there is any indication of a problem, the patient will be required to extend his stay.

For the majority of patients who head home as soon as possible, Dr. Delgado will be closely following the post-operative care by Skype or phone with the patient emailing photos of the surgical area. This is a practice that Dr. Delgado has offered for quite some time with great success.

To help defray costs for the “out of town patient”, Dr. Delgado offers a generous travel package. Dr. Delgado has an office in San Francisco and Marin County in beautiful Northern California. Many patients plan their surgery so that they can vacation prior to surgery enjoying much of what the Bay Area has to offer.

Miguel A. Delgado, Jr., M.D.

Male breast reduction surgery is now the 4th most popular cosmetic surgical procedure for men according to the American Society of Plastic Surgeons. The percentage of cases has been increasing each year as more men become aware that surgery is an option to get rid of their man boobs.

Once the decision is made to pursue surgery, the gynecomastia patient needs to find a cosmetic plastic surgeon that is Board Certified in Plastic Surgery. Look for one that specializes in gynecomastia surgery. The surgeon should be able to present you with many before and after pictures of their patients. Ask how the procedure will be done. Most gynecomastia procedures need to have liposuction and excision of breast tissue in order to get the best result. In some cases liposuction alone can give a good result, but this is for the patient who has what is known as “pseudo-gynecomastia” which means the gynecomastia is caused by fat alone. I would say at least 30% of my gynecomastia surgery cases are “redo” cases where liposuction alone was done leaving behind breast tissue.  Having to redo the surgery is much more difficult for now there is scar tissue to deal with and the skin may have lost some of its elasticity.

Lastly in looking for a surgeon  in San Jose or any San Francisco Bay Area, ask where the procedure will be performed, check to see  if the facility is accredited and if the anesthesiologist is Board Certified.

Before and After Gynecomastia Surgery

A big concern of San Francisco Bay Area men contemplating male breast reduction surgery is what they will look like after surgery. There isn’t a “one size fits all” answer. Each patient is different, depending on the degree of the gynecomastia breast. Age can be a factor, younger men usually have better skin contraction. Men with moderate to severe gynecomastia, may need to have a two stage procedure for the best result.

During the consultation, it is not unusual to hear a man request that his chest be made as flat as possible. This is understandable for the man that has been suffering with man boobs for many years. A totally flat chest does not look normal, it is important that it is sculpted and has somewhat a natural contour. Dr. Delgado shows his patients many before and after pictures; he does his best to accurately describe what the outcome will be for each individual patient.

Severe gynecomastia

Patient after gland excision, liposuction, superior crescent lift and external lift sutures

He is seen six months later

He is seen two weeks after Stage Two Surgery

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