Boston Cosmetic Surgery Specialist - Dr. Moss
Gynecomastia is a condition where the male breast is enlarged. It is actually far more common than most men realize. A patient with this condition may have it in one breast only (unilateral gynecomastia) or have it in both breasts (bilateral gynecomastia).
Currently there is no clear explanation of why this happens. While there certainly do appear to be some medications and drugs that can cause gynecomastia, there are many men who have not been exposed to these drugs that have gynecomastia. Exposure to steroids, marijuana, excess alcohol, or digitalis, has been known to cause gynecomastia. A patient should stop these items before surgery to see if this alone will correct the condition.
There are two patterns of gynecomastia. The first pattern (true gynecomastia) refers to an excessive amount of firm breast tissue beneath the nipple. The second type (pseudo-gynecomastia) refers to a diffuse amount of fatty tissue throughout the breast. The patient with the first type of gynecomastia tends to be a young male of appropriate body weight. The second type of gynecomastia pattern tends to be an overweight male. These patients tend to be of an older age group (over fifty). However, with today's crisis of obesity, gynecomastia of the second pattern is now being commonly seen in younger men.
The more ideal surgical candidate for the correction of gynecomastia is the younger patient of ideal body weight, who has a small amount of extra breast tissue in one or both breasts. This is because their breast skin has more elasticity and therefore less chance of sag. In addition, this type of enlargement can usually be corrected without a large scar being placed horizontally across the breast. Dr. Moss usually performs the correction of true gynecomastia surgery on this type of patient by making a small incision around the areola and scooping out the excess breast tissue. While there is an incision on the breast, it is at the junction of the areola, and therefore less noticeable. Dr. Moss will utilize liposuction, as well, if he feels that it will provide for a better aesthetic result.
In all situations where the patient is young and close to or at his ideal weight, Dr. Moss will carefully evaluate the patient's medical history. If Dr. Moss feels that the patient needs a consult with an endocrinologist to rule out any hormonal problems or needs to have a mammogram to rule out breast cancer, then he will refer the patient to the appropriate medical provider. Dr. Moss always wants to make sure before he performs any cosmetic surgery on a patient that there is no underlying medical problem that is causing the patient's condition.
The overweight patient, suffering from pseudo-gynecomastia, can be more challenging to treat. Corrective surgery is NOT a replacement for loosing weight. If an overweight male patient has large breasts, a serious attempt should be made by this patient to lose weight before considering this surgery. The chart below was provided to Dr. Moss by Blue Cross Blue Shield. Many times the correction of gynecomastia on an extremely overweight patient will result in a large horizontal scar across each breast because it is necessary to remove excess skin as well as excess fat.
Height - Weight Chart for Men
Height |
Ideal Weight |
| 5'2" | 136 |
| 5'3" | 138 |
| 5'4" | 140 |
| 5'5" | 142.5 |
| 5'6" | 145 |
| 5'7" | 149 |
| 5'8" | 151 |
| 5'9" | 154 |
| 5'10" | 157 |
| 5'11" | 160 |
| 6' | 163.5 |
Obviously, in this situation, the goal of the surgery is not going to be to have a small scar so that a shirt can be removed in public, but rather a flatter breast silhouette under a shirt. In situations where Dr. Moss feels that he might be able to perform the surgery without a horizontal scar, he will do the procedure with the incision around the areola only, with the understanding that if the skin sags excessively, a second procedure will be required to remove the excess sagging skin.
The surgery to correct bilateral gynecomastia takes Dr. Moss about 2.5 hours to complete. A unilateral correction takes him about 1.5 hours. Dr. Moss performs this surgery in a hospital using general anesthesia (you're asleep), and generally all patients are discharged from the hospital on the day of surgery. All patients will have one or two drains (depending on whether the surgery is bilateral or unilateral). These drains are usually removed at around 5 days or when the drainage has fallen below a certain level. Drain removal is done in the office and doesn't hurt.
All gynecomastia patients will wear a surgical vest for three weeks. Dr. Moss will measure you for this vest and he will supply you with two of them (one to wear and one to wash). All patients should plan on being seen the day after discharge, as well as a few other post-operative visits. Dr. Moss always provides them with enough pain medication to make them comfortable post-operatively. Patients will usually transition to Tylenol at 1 to 2 weeks post-operatively.
Patients will need to plan on taking two weeks off from work or school to have this surgery. Patients can resume light exercise such as walking at about two weeks, and be back on their full exercise regime at six weeks. Weight lifting will be allowed closer to the six week period. All patients should discuss their resumption of activities with Dr. Moss to ensure their safety and proper healing. Dr. Moss has found that in his experience, the correction of gynecomastia surgery has a high success rate.
Dr. Moss has seen that over the last ten years, health insurance carriers rarely, if ever, cover surgery to correct gynecomastia. Dr. Moss is no longer a provider for any insurance carrier, and performs correction of gynecomastia on a cosmetic, self-pay basis only. Dr. Moss has extensive experience with the correction of gynecomastia and has performed this surgery for 25 years.
Gynecomastia Photos
Click on the photos below to see additional or larger photos for each patient.
 Gynecomastia Patient 1 click to enlarge |
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