Gynecomastia

Conveniently located to serve the areas of San Diego, CA

The goal of gynecomastia treatment, also known as male breast reduction, is to reduce breast size in men who are embarrassed by overly large breasts. Reduction methods include liposuction, cutting out excess glandular tissue or using a combination of liposuction and excision. Dr. Alexander can effectively and safely improve or correct your concerns.

For more information about our San Diego Gynecomastia procedure, please contact us online or call us at 888-463-9532. We look forward to helping you look your best.

Understanding the San Diego Gynecomastia Procedure

When to Consider Gynecomastia Treatment

  • If you are reluctant to remove your shirt in public, to swim, to participate in sports or to exercise at a gym.
  • If you want to improve your overall body proportions.
  • If you experience psychological discomfort associated with large breasts.
  • If you want to increase your social confidence.

ASK DR. ALEXANDER

Before You Decide…

Choosing Your Surgeon

There are several important factors to choosing a surgeon, including recommendations from friends, personality, physician training and board certification, and experience.

Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure. This is often a good first step in making a decision. However, not all patients know someone who has had surgery. Most of our patients are referred by satisfied friends who have been our patients.

Personality: It is important to develop a good relationship with a surgeon, where communication is easy and trust can be developed. A patient needs to feel intuitively that they are in good hands with someone they can trust. Bedside manner is important.

Training and Certification: In years past, only plastic surgeons performed cosmetic plastic surgery. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including ear, nose, and throat doctors (also known as otolaryngologists and facial plastic surgeons), dermatologists, ophthalmologists, and gynecologists. Only a surgeon who has completed residency training in an accredited training program can become certified by the American Board of Plastic Surgery. There are many boards, and it is easy for patients to become confused or assume that when a doctor says they are “board certified,” it all means the same thing. BE CAREFUL!

Experience: Finally, consider the physician’s experience, the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.

If the doctor is recommending a specific procedure, how many has he performed? How often does the surgeon perform this procedure?

While board certifications and training are important, a surgeon’s experience with the procedure itself is more important. Don’t hesitate to ask pointed questions about recommended procedures.

The Consultation

To ensure the most natural-looking results, it’s imperative for a surgeon to recommend the procedure that most appropriately matches your needs and offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your gynecomastia procedure.

A good surgeon will go through a series of examinations and observations that are individual and dependent upon your specific situation and goals. Also factored into this process are the doctor’s expertise, training, and experience. If a surgeon specializes in a particular type of procedure, don’t be surprised if it is recommended over other options. Be wary of the “one-size-fits-all” approach.

This is particularly important because, as medicine continues to advance, patients have more options made available to them.  

The success of your procedure depends very much on your complete candidness during your consultation. We will ask you questions about your health, desires, and lifestyle.

Be prepared to discuss:

  • Why you want the surgery, your expectations, and desired outcome
  • The options available to you for gynecomastia surgery
  • Medical conditions, drug allergies, and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco, and drugs
  • Previous surgeries

We may also:

  • Examine and measure your chest.
  • Take digital photographs for computer imaging
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of the procedure and any risks or potential complications
  • Discuss the anesthesia options available

Questions to Ask

  • Are you certified by the American Board of Plastic Surgery?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure?
  • Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency?
  • Am I a good candidate for gynecomastia surgery?
  • What will be expected of me to get the best results?
  • Where and how will you perform my surgery?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How are complications handled?
  • How can I expect my chest to look over time?
  • What are my options if I am dissatisfied with the cosmetic outcome of my procedure?
  • Do you have before-and-after photos I can look at, and which of these results are reasonable for me to expect?

Who is a good candidate?

The following are some common reasons why you may want to consider gynecomastia treatment:

  • You are unhappy with the size or appearance of your breasts.
  • You experience physical discomfort because of your breasts.
  • You have good skin elasticity. Successful gynecomastia surgery involves adequate skin contraction after your excess skin is surgically removed. Your skin may lack the necessary elasticity for good contraction if you are age fifty or older, have significant sun damage, have breasts with a lot of stretch marks or have undergone gastric bypass surgery.
  • You have first tried diet and exercise to reduce your breast size.
  • You are not significantly overweight. Although surgery will help this patient population, the results will not be as good. For this reason, you should try to get within thirty to forty pounds of your ideal body weight before surgery.
  • You do not use marijuana, steroids or drink alcoholic beverages excessively (it is theorized that these substances may cause gynecomastia).

If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

What does it cost?

A quote will be provided to you after your consult with Dr. Alexander. Cost is always a consideration in elective surgery, but remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery. We offer patient financing plans, so be sure to ask.

Costs include:

  • Surgeon’s fee
  • Operating Room and Supplies
  • Anesthesia fees
  • Prescriptions for medication
  • Post-surgery garments, and
  • Medical tests

To learn more about our partner in payment plans, please visit CareCredit.

The Gynecomastia Procedure

Prior to surgery, we will have you:

  • Take certain medications or adjust your current medications
  • Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
  • Stop smoking well in advance of surgery

During a preoperative appointment, usually 1-2 weeks before surgery, we will:

  • Get lab testing or a medical evaluation
  • Tell you what to do on the night before and morning of surgery
  • Discuss the use of anesthesia during your procedure
  • Explain post-operative care and follow-up, and what help you will need after the procedure

Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. We will recommend the best choice for you based on your personality, your desires, and the complexity of your procedure.

How We Do It

The goal of gynecomastia surgery is to restore a normal male breast contour and to correct deformities of the breast, nipple or areola. Surgical options include liposuction, excision (surgical removal of tissue) or a combination of both approaches. Glandular breast tissue is denser than fatty tissue and is not appropriate for liposuction.

  • The choice of surgical technique depends on the likelihood of skin redundancy after surgery. Skin shrinkage is greater in younger than older patients.
  • The most common approach is the intra-areolar incision, which extends along the circumference of the bottom half of the areola in the pigmented portion.
  • The length of your incision will be based on your anatomy.
  • In severe gynecomastia, skin resection (surgical removal of part of an organ or structure) and moving the nipple (nipple transposition) may be necessary.
  • Liposuction has improved the results of gynecomastia correction. In liposuction-assisted breast reduction, there is less compromise of blood supply, nipple distortion and areola slough. In addition, postoperative complications are fewer with this technique than with open surgical resection; however, liposuction-assisted breast reduction is not effective for correcting glandular gynecomastia. The fatty and glandular components of your breast must be assessed before surgery. Few patients can be sufficiently treated with liposuction only.

What will my gynecomastia incisions and scars be like?

Scars resulting from gynecomastia surgery vary, depending on the amount of breast tissue you have and the elasticity of your skin. Even those who have larger breasts and tend to get larger scars are usually quite satisfied with the results.

  • If you have small breasts that are only fat, then your scars will be tiny (just large enough to admit a liposuction cannula).
  • If you have large female-like breasts, then the scars may extend across each side of your chest, but your surgeon will attempt to hide them in a crease.
  • With firm breast tissue, there is usually a scar under the areola.
  • If the areolas are large and need reduction also, then the scar goes all the way around the areola.

Informed Consent

Pain from the nose surgery is usually minimal. Pain pills are provided, but are usually not required after a couple of days. Significant pain is extremely rare and may be the sign of a serious complication, so your physician should be notified.

The decision to have nose surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

The risks include:

  • Nose asymmetry
  • Rupture of small surface vessels of the nose
  • Infection
  • Poor wound healing
  • Bleeding (hematoma)
  • Change in skin sensation (numbness)
  • Nasal airway alterations may occur after a rhinoplasty or septoplasty that may interfere with normal passage of air through the nose
  • Nasal septal perforation (a hole in the nasal septum) may develop but is rare; this is usually associated with septal surgery only
  • Pain, which may persist
  • Unfavorable scarring
  • Skin contour irregularities
  • Skin discoloration and swelling
  • Possibility of revisional surgery
  • Anesthesia risks

Important Terms to Know

Anesthesia—General: The patient is asleep, requiring that the airway be protected, either by a standard breathing tube, or by a laryngeal mask (LMA), an inflatable mask that goes in the back of the throat but doesn’t go down the trachea. Through the airway, an anesthesiologist gives gases to put the patient asleep. Drugs may also be given through the IV.

Anesthesia—Local: The surgical area is numbed up with an injection, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.

Anesthesia— Sedation (Twilight): The patient is made sleepy with medications given through an IV. The level of sedation can be adjusted, from barely sleepy to very sleepy. Sometimes sedation is given by the surgeon, but most of the time it is administered by an M.D. anesthesiologist.

Cartilage: Connective tissue that forms the structure of the nose.

Columella: The narrow strip of tissue that separates the nostrils.

Deviated septum: Cartilage that separates the nostrils is misaligned which may cause partial nasal airway obstruction.

Hematoma: Blood pooling beneath the skin.

Rhinoplasty: Surgery to reshape the nose.

Recovery

Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery. If you experience shortness of breath, chest pains, or unusual heart beats, call Dr. Alexander immediately.

You will be given specific instructions that include:

  • How to care for the surgical site
  • Medications to apply or take orally to aid healing and reduce the potential for infection
  • Specific concerns to look for at the surgical site or in overall health
  • When to return to the office

The Specifics

Generally, you can expect to be bandaged, wearing a compression garment, and you may have a surgical drain.

The first three postoperative days are critical in your recovery. You must be at full rest at home, but not necessarily in bed; sitting and watching TV or having meals in the kitchen or living room is permissible.

Movements of the waist and elbow are acceptable, but you should curtail vigorous shoulder movement for the first few days. Lateral arm movements are generally permitted but do not lift your arms up vertically. There are many variables; consult your plastic surgeon for more details.

Recovery time after surgery for gynecomastia depends on how severe your condition is and what was performed for you. The average patient, treated with a combination of liposuction and breast gland tissue excision, will likely be back to work after a week. Gynecomastia surgery usually has a relatively gentle recovery period.

It is important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

Results

Gynecomastia surgical results are permanent, assuming your weight is stable. If your condition arose from the use of medication or anabolic steroids, further use could lead to recurrence.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Small revisions are occasionally necessary. In general, our patients are very pleased with their gynecomastia procedure. Our goal is to provide a result that is pleasing, balanced, and in proportion with your other facial features and your ethnicity. Others should not be able to tell you have had surgery.