On average, I perform male breast reduction to treat gynecomastia about five times a month, as it is a very popular procedure at my practice. The technique I utilize is best defined as chest wall sculpting with a “pull-through” or “mini-strip” excision of the “fibrous” gynecomastia tissue. Essentially, this approach is a very detailed and focused liposuction of the chest during which specialized cannulas (surgical liposuction instruments) are used to extract breast tissue and fatty tissue through two tiny (3 mm) puncture incisions. Then, remaining fibrous tissue – which is unresponsive to any version of liposuction due to its density – is removed via the same small puncture incisions using specialized instruments that remove the tissue in “strips.”
Patients cannot get this “flat” and sculpted with just liposuction alone, or even with laser or ultrasonic techniques. Over the years, I’ve tried it, and it doesn’t work. This technique is the best of both worlds because it includes a component of excision (almost micro incision) and contouring similar to liposuction. Traditional techniques still use a crescentic or half-moon incision, or sometimes one even larger, to excise the tissue out in one large incision. Patients don’t often like that type of incision.
What my technique effectively does, is it shapes and sculpts the chest, as well as removes the stubborn “bud,” “bump,” or “mass” of tissue below the areola that often causes nipples to protrude (“puffy nipples,” in layman’s terms). The bonus is, the diameter of the areola will often “shrink,” in many cases, which is something that traditionally has required a full periareolar incision (an incision all the way around the areola) to achieve. Furthermore, whereas other traditional techniques employ liposuction and then a larger “half moon” incision halfway around the nipple to fully excise tissue (which often results in a more visible scar), my technique encompasses both features through the most minimal access incision.
Overall, this male breast reduction technique is something that works great when not much skin excess is present; only fullness. However, I have applied this technique in many cases of medium skin excess, and I’m happy to say my patients have been very pleased. Should there be any residual loose skin for these particular patients, we can always come back and excise the excess skin at a later date and avoid a big surgery with a large incision.
It is important to note that for patients who have undergone massive weight loss (typically about 100 pounds or more), the traditional excisional techniques to remove the “loose skin” will usually still be necessary. When I do perform this more extensive surgery, I prefer a pedicle technique to the nipple as compared to a free nipple skin graft.
— James F. Boynton, MD, FACS
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