What Is the Best Treatment for Gynecomastia?

Gynecomastia (sometimes colloquially referred to as “man boobs”) is a common condition many men experience around the age of puberty. In fact, some studies say 10 percent of men experience some degree of this condition at puberty. Adolescents to middle-age men often can experience gynecomastia after usage of anabolic steroids or certain medications. In some cases the condition is just idiopathic and we don’t really know the causality. Some men may experience an enlarged breast appearance as their testosterone declines in middle age, and they can ultimately be bothered by their appearance in shirts and other types of clothing. The good news is that surgery for gynecomastia can improve the appearance of the chest, whatever the cause.

The physical and emotional discomfort that accompanies gynecomastia can be overwhelming and can have a significant impact on one’s self-esteem. Fortunately, effective treatments are available to help men suffering from either gynecomastia (excess glandular or breast tissue), which usually consists of a subset of cases referred to as “puffy nipple” cases (glandular buds of breast tissue below the nipple that stick out in shirts, even in very slender males) and “classic gynecomastia” cases, which involve some glandular breast tissue and some fatty tissue in combination. Dr. Boynton sometimes also refers to these cases as “mixed gynecomastia” because they include fatty tissue and glandular breast tissue. Finally, some cases are referred to as pseudogynecomastia (excess fatty tissue) which Dr. Boynton also refers to as fatty gynecomastia because the dominant tissue causing the fullness is fatty tissue rather than glandular breast tissue. In all cases and subtypes or classifications of gynecomastia, Dr. Boynton strives to tailor a surgical plan to best help each patient achieve the flattest chest possible. Sometimes, patients have extra skin and droopiness to the chest itself (usually after massive weight loss), and in those cases, skin excision is usually incorporated into the surgical plan in addition to removal of the glandular and fatty tissues.

Excision of gynecomastia with chest wall lipo-contouring is a treatment designed to remove excess glandular or breast tissue in patients with true gynecomastia and improve the appearance and contours of the chest, including flattening “puffy” nipples. Power-assisted lipo-contouring of the chest and breast roll (armpit area) with excision of glandular gynecomastia: Dr. Boynton utilizes a minimal incision approach that is hidden at the border of the lower areola. In some cases he can even remove a slight bit of extra skin through this incision when indicated.

Dr. Boynton truly believes that liposuction alone does not completely flatten the male chest because most patients who think they may just have extra fat in the breasts also have a component of glandular breast tissue under the “blanket” of fat that will not resolve with liposuction alone. Dr. Boynton also thinks that “male breast reduction” is a term he can use for all patients because the treatment he performs is really a subcutaneous mastectomy through a small incision.

In less than five percent of patients—usually patients who have had massive weight loss—glandular excision with chest wall contouring is not enough, and a full chest lift with skin excision and free nipple graft is indicated to get the flattest chest wall. Dr. Boynton has performed pedicled chest lifts over the years but now finds that FNG (free nipple grafts) give a better and flatter shape in most cases compared to pedicled chest lifts. Dr. Boynton says: “Not every patient wants this procedure, even when it is indicated. Some patients want the flattest chest possible and are not worried about incisions, while others want to take their shirt off at the beach and would prefer the ‘less invasive’ technique advocated first in most cases. Sometimes, even when patients technically ‘need’ the bigger procedure with skin excision, they opt for the lesser procedure first, and only a small fraction of patients who are bothered by skin excess will pursue the ‘part two’, or second bigger procedure.”

Dr. Boynton notes that some patients also separately complain of “the headlights always being on” when their nipples show through in tight shirts or golf shirts. Nipple reduction is a procedure that corrects large or over-projecting nipples (projecting in the center of the areola, which sometimes shows through shirts, and many men do not like that). The treatment involves a simple, in-office procedure that can often be performed under local anesthesia in approximately 20-30 minutes.

Our board-certified plastic surgeon is one of the preeminent providers of gynecomastia surgery in the Houston area and has many years of experience performing the latest surgical techniques for both forms of gynecomastia. He is committed to helping patients look and feel their best using the most advanced procedures and customized treatment plans designed to meet individual goals with minimal scarring. Contact our office today for additional information, or to schedule a consultation with Dr. Boynton.