#21: Movember & Male Breast Reduction (Gynecomastia)

This week Dr. Barrett delivers another amazing solo episode that focuses on Gynecomastia Surgery / Male Breast reduction. It’s a real thing that happens to real people more often than most people would think. Join us for this informative episode and learn all about it.

Questions Covered in this episode:

• Can men get breast reductions/gynecomastia?
• Why do some men form breasts and others don’t?
• Who is a good candidate for gynecomastia?
• What are the steps that someone who is considering getting gynecomastia should take?
• In your opinion, are more men getting gynecomastia surgery? Is this surgery becoming more common and why?
• How is gynecomastia surgery performed?
• How long does the procedure typically take?
• What is scarless gynecomastia?
• How do I prepare for gynecomastia surgery?
• How long does it take to recover from gynecomastia?
• How does someone prepare for gynecomastia surgery?
• What would you recommend that someone who is considering this surgery should do?

On this episode of The Natural Plastic Surgeon…

Dr.B: This is a surgery that I actually had myself, when I was younger, I was in college. It was a very insecure, kind of, thing I was going through when I was in college. It was like, you know, it was unilateral for me. It never went away. It started in puberty.

A potential plastic surgeon that specializes in this procedure, look at their websites. Do they have any before and afters? Can they do this scarless technique? I tell you, unfortunately, there's not too many people that are doing this right now.

And he developed male glandular tissue later on in life when he was 40 years old. And that's a problem. That's unusual, right? So if you have glandular tissue that's developing in later, past puberty, there's something that's contributing to that and you need to go see your doctor to get that checked out. Okay, so this particular patient, I said, Look, you may have a pituitary tumor.

You are listening to The Natural Plastic Surgeon Podcast. I'm Dr. Daniel Barrett, Board-Certified Plastic and Reconstructive Surgeon located right here in Beverly Hills. I specialize in cosmetic surgery of the face, nose, breast and body. This podcast is dedicated to those deciding if plastic surgery is right for them and revealing all the latest beauty secrets. Let’s get started.

01:05 NOVEMBER IS MEN’S HEALTH MONTH

Hey, everyone, it’s Dr. Barrett and it is officially Movember. So we're raising awareness for a lot of men's health-related issues and some of the things that we can do plastic surgery-wise. Also in November is the New York Marathon which I just came back from doing. So I've got this big, shiny little medal, shaped like an apple because of the Big Apple. What an incredible experience. I literally just ran the thing yesterday. I felt like my nipples fell off, which is a great segue to this topic about male gynecomastia and male breast reduction Okay? So you can either run a marathon until your nipples fall off or you can see a plastic surgeon.

Okay, so I want to dive into this and I'm going to, I'm going to make this chock full of information about male gynecomastia and male breast reduction.

01:50 WHAT IS MALE GYNECOMASTIA

And I think it's really important to understand some things, some basics first, okay? So what, what is male gynecomastia? Male gynecomastia is male breast growth. And it can be glandular tissue or it can be fatty tissue. That's an important distinction because male gynecomastia, traditional male, or, or classical male glyne, gynecomastia, develops from puberty and never gets better in life. Because there's actually hard, firm glandular tissue. So if you think this might be you, if you reach and you grab your, your, the excess tissue that you have, if it feels hard and firm, like, kind of, like a rubber eraser, that is the more traditional gynecomastia of glandular tissue. And that's an important distinction that we're going to get into.

Now, if you're on in your 30s and 35, 35-years-old and you gained a bunch of weight, and you have excess fullness of your breasts, that you didn't have when you were younger because you were less weight, that's just fatty tissue. And that will get better with weight loss.

02:50 THE TWO TYPES OF GYNECOMASTIA REQUIRE DIFFERENT TREATMENT METHODS

Now the first situation where you have the actual glandular tissue is, requires a different type of removal method. So you can't weight loss alone, you could be as skinny as possible, and that's how you know you have gynecomastia. I have patients that come in They're like, I lost a bunch of weight. And this glandular tissue just doesn't go away. So they could be skinny, bone-thin skinny, but that glandular tissue is still there. So that requires a surgical procedure to remove it, and it's called male gynecomastia surgery. And so we deal here, in my practice, with the full spectrum.

03:20 DR. BARRETT HAD GYNECOMASTIA

And, and this takes a special consideration for me because, I, this is a surgery that I actually had myself, when I was younger, I was in college. It was a very, it was a ver, kind of, a very insecure, kind of, thing I was going through when I was in college. It was like, you know, it was unilateral for me. It never went away. It started in puberty. And it was noticeable in t-shirts. And it was super obnoxious, super annoying.

And it was like, I don't even, like, this is embarrassing. I don't even want to talk about it. I didn’t even know anything about it, because obviously I wasn't a doctor back then. And so I did some research online. I was like, oh my god, I have breast cancer. I don't even know what I have. Now, I think there's so many more resources for men that are going through this, especially at the puberty level, that they can, kind of, get a better sense for it.

But back then and went to the doctor. Went to a general surgeon who was, like, you should maybe get a plastic surgeon. But we didn't have the resources where we lived to get a plastic surgeon. So I had the traditional technique of removing that glandular tissue with this big incision along the areola and extended beyond there, believe it or not, to remove that glandular tissue to make it relatively flat. And I think he did a pretty good job. But there's a noticeable scar. There's a noticeable contour irregularity, which are the typical consequences for the traditional male gynecomastia surgery.

04:30 SURGICAL TECHNIQUE

You can make the incision smaller, you can keep it on the border of the areola. But the technique that I've further developed, there's, there's a group in Texas that actually came up with this technique where it is done scarlessly, okay.

So you don't need that big scar along the areola. Because if someone notices, you know, a male chest, we're not wearing a bikini top, right? It's completely open. You're supposed to wear your shirt off. So any scarring on the chest is going to immediately draw attention unless you're extremely hairy, which I am not. For those of you that are really hairy, big scars doesn't really matter. But for the average male out there, we want to try to avoid scars. So I developed, kind of, further developed this technique using a scarless, scarless approach, where I use a, a combination of liposuction to remove excess fat, some of the glandular tissue, with a special cannula that is designed to, kind of, break up that glandular tissue.

And then I follow that up with a endoscopic microdebridement removal. Okay, so basically, it's a specialized device. It's actually designed for endoscopic nasal surgery where it goes in and actually bores out...so imagine a big tunnel digging, you know, device that's going in and just, kind of, digging out the tissue and a very small cannul, a very small, very small tubule. And then that jet, delicately removes that tissue and cores it out. But it's extremely sharp, but it just in that tiny little tube, and if you do lots of little passes from that microdebrider, you can get a gentle reduction all from an access site that’s the size of the top of this pen.

Okay, so that's a big difference from a, of a standard incision which is like four to five centimeters, and much less noticeable for a male patient's chest, especially when the shirt’s off.

06:20 CONTOUR IRREGULARITY

Furthermore, the contour regularity--that little sharkbite consequence that you can get if you take out too much glandular tissue--is resolved because you're, you're actually, you're, kind of, doing a cross-hatching, a feathering down of the glandular tissues. You're still leaving some of it. You don't want to take all of it. And you're able to do that more precisely with this microdebridement technique.
Lastly, I go through and I cauterize all of the glandular tissue, all of the, the fatty tissue and the skin, just underneath the skin, to tighten up that skin. Because yes, once you remove the glandular tissue and the fatty tissue, you get a reduction of the volume but if the skin doesn't go back, you're going to get a looseness of the skin. That can be even more noticeable and even more problematic.

Okay, so that's, that's, kind of, my procedure in a nutshell. Now, there's other categories of male breast reduction.

07:05 LARGE BREASTS AND LOOSE SKIN

If you have very large breasts and a lot of skin, you're going to need a skin excision technique. And that's different for female breast reduction techniques that are designed to keep some breast tissue. For men, we want to get all of that breast tissue, all that fatty tissue and all that skin flat, and a more masculine type of environment or a masculine type of look.

07:30 HORMONE LEVELS AND PROLACTIN

So let's just, let's just dive into some of these questions. So why do some men form breasts and others don't?

Well, we really don't understand that completely, but it has a lot to do with hormonal levels. I did have a patient one time come see me. And he developed male glandular tissue later on in life when he was 40 years old. And that's a problem. That's unusual, right? So if you have glandular tissue that's developing in later, past puberty, there's something that's contributing to that and you need to go see your doctor to get that checked out.

Okay, so this particular patient, I said, look, you may have a pituitary tumor called a prolactinoma that is actually creating male breast growth later in life. And sure enough, he did. He had to actually have a surgery to remove the tumor in his brain that was creating the prolactin. So if this is something that's happening to you later in life and it's glandular tissue, you need to see your doctor to get it figured out why that's happening.

Now, if this is something from puberty, we don't need a whole hormonal workup and so forth. But a quick test for that tumor is called a prolactin level. You can get that done at your standard primary care office to rule that out if that's something that's happening to you.

08:30 WHY DOES IT AFFECT SOME MEN AND NOT OTHERS

So why do some men form it? Well, you know, again, it, it's a lot of genetic, hormonal, environmental, but typically around puberty is, is the standard time. Now, when people, when men get just pure fatty breast growth, that's generally just from weight gain. And some, some men gain more weight in their chest than they do in other places.

08:50 GOOD CANDIDATE FOR SURGERY AND WHERE TO START

So who's a good candidate for gynecomastia surgery?

Pretty much anybody that's a normally good surgical candidate. Someone who's healthy, doesn't have any heart issues. You want to check for labs, make sure there's any, no abnormalities, any bleeding issues.

What are some steps that someone who's considering getting gynecomastia should take?
Well, basically, you, you call your primary doctor. Go over just basic stuff, I think is a great way to start. Make sure there's no hormonal abnormalities, and then consult with a plastic surgeon that does this type of procedure, like myself. This is something I specialize in so that I'm pretty familiar with ways and techniques to reduce the area in the most cosmetically pleasing way as possible.

So in my opinion, are more men getting gynecomastia surgery than the past?
I think so. I think it's becoming more recognized. So when I was 15 years, or whenever, I was 16-years-old, I can't remember how old I was. It was, it was unheard of. There was no internet resources. Now I think the internet's great. People can look this up, they can find out pretty accurate information, like on Medline and all these other things, to learn more information that I think is really good, helpful start.

09:55 SURGERY CAN LAST UP TO 3 HOURS

Okay, so we talked about how gynecomastia is performed. The procedure that I like to do generally takes about one and a half to three hours, depending on the severity of the, of the gynecomastia. And, you, you know, I, I prepare patients for this pretty, pretty carefully prior to the operation. Because it doesn't look great right away.

All right, there's a, a lot of numbness that's involved right after the surgery. But you're going to get a lot of swelling. So after procedures done, we put all of our patients in compression so that they don't get a whole lot of swelling right after the operation. And that has to be worn for at least two weeks. Standard downtime for this type of procedure is probably, for average desktop, about three days. But to be on the safe side, most people can take a week off, and they would be, that should be more than enough time.

Most results, they're not typically seen until at least six weeks. A lot of my patients see the results right away. But that full result can take up to six months to fully settle down and to heal.

11:00 RESEARCH PRIOR TO SURGERY

So if you're interested, if, if you're someone who's considering undergoing this procedure, you know, do your research. Check out, check out a potential plastic surgeon that specializes in this procedure. Look at their websites. Do they have any before and afters? Can they do this scarless technique? I tell you, unfortunately, there's not too many people that are doing this right now. Which is unfortunate because I really hate scars. I really try to minimize it and I think this procedure is a game changer for a lot of men. And it's something I wish I had when I was younger. Would have saved me from a big scar myself.

And, you know, again, do your research on the doctor, make sure they are board-certified, make sure this is something that they do. The American Board of Plastic Surgery has a website, you can check out people and see if they're on there.
So in summary for this solo episode, you guys, on gynecomastia. I just think, as a patient myself, I think it's really important to find someone who specializes in this and gets that, that minimally invasive option if you have the glandular tissue. If you have larger breast tissue with lots of skin, again, you might need a more complex skin excision approach. But that can be handled easily by, by me here in this office or someone who specializes in this.

So if you have more questions about male gynecomastia surgery, check out my website, DrDanielBarrett.com. I've got a whole page on male breast reduction, okay? So check that out. I've got videos there of men who've had this procedure done. I can go into detail about all the different, you can see me going into detail about all the different steps that I do for the reduction procedure. and we have a whole list of further information there to answer any further questions you have.

Thank you for tuning into our podcast. If you liked today's podcast, don't forget to share, rate, review and subscribe. Also, find out if plastic surgery is right for you by using our virtual consultation at DrDanielBarrett.com/virtual-consultation. See you soon.

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