Who is a Good Candidate for Male Breast Reduction

Those who are not affected by having “man boobs” (larger breasts than typically), do not realize how much emotional distress this can cause a man. Most of the men that I see in my office for this reason refuse to take off their shirts in public, even when they are at the pool or beach. I am a sun-loving plastic surgeon, so I can certainly imagine how miserable this could be!

Most of the men that I see for this procedure have fullness in their breast area, but overall their breast shape is good. It is just larger and fuller than they desire. For these men, I can do their male breast reduction in the operating room with just an incision that only goes along the bottom half of their areola. They go home the same day and can usually return to work in 4-5 days. They can shower the very next day. I usually place drains in the area for excess fluid, which will be removed in my office 5-7 days later.

If there is mostly fatty tissue, rather than fibrous tissue, as well as a good shape, I can perform either SculpSure or SmartLipo to decrease the fat in the chest area instead of a traditional gynecomastia procedure. This has the advantage of no incisions with Sculpsure (and only very tiny incisions with SmartLipo) and a return to work either the same day (with SculpSure) or the next day (with SmartLipo).

Men who have lost a great deal of weight sometimes have large hanging breasts, and their surgical repair is more complicated and involves larger incisions.  These are more challenging cases, but the men that feel they need this surgery are usually more than willing to accept the greater scarring involved in order to get a better breast shape.

Ultimately, a good candidate for a male breast reduction is a man who is realistic in his expectations and is troubled by the appearance of his breasts.

Cost of Gynecomastia Surgery

There are a number of considerations that have to be taken into account before we can determine how much your gynecomastia surgery will cost.

Gynecomastia is the condition when a man develops larger than normal breast. Most of the time it will onset with puberty. However, it can occur later in life or after significant weight gain. Not surprisingly, men hate this condition and are very self-conscious about their breasts. They often will not take their shirts off at the pool or beach or when they are outside. Even with their partners, they hate having their shirts off.

The first question to answer in determining the cost is what treatment is required.

I personally find that rarely can liposuction or even Smartlipo (laser lipo) give enough improvement to make the patient happy. Although there can be some reduction with Smartlipo or SculpSure (a good option as there are no incisions) – most of the men, in my experience, are very self conscious and want to be as flat in the breast area as possible.

Therefore to get the maximum reduction, I prefer to take the vast majority of my patients to the operating room and put them totally asleep. Almost always, I can remove the breast and fibrous tissue, through a small peri-areolar incision. There will be 3 charges. There is a surgical fee. Depending on where you are in the country, you should expect to pay a surgical fee of between $5,000-7,000. There will also be a facility fee between $800-1,700 and there will be an anesthesiologist or nurse anesthesiologist fee of between $700-1,200. This surgery will take between 1.5-2.5 hours.

Some men, if they have a lot of loose skin, will need skin excision in addition to the above, which will add both time and expenses to the above charges.

Gynecomastia and Link to Risperdal/Invega Medications

The vast majority of men that come to plastic surgeons for treatment of gynecomastia have what is called “idiopathic” gynecomastia.  This is fancy medical jargon, meaning that we really have no idea why this man developed male breasts that are larger than normal.  A medical literature search will reveal all sorts of strange and rare causes, including specific tumors. But for the average healthy male who develops bilateral gynecomastia, beyond asking about excessive marijuana use, major weight gain, steroid, drug and alcohol use, there is little point in an extensive medical work-up. Conditions such as liver failure will be obvious from their medical history.  In addition, patients with major medical problems don’t usually request cosmetic plastic surgery.  Regardless of the cause, the problem of gynecomastia will not go away without removing the excessive tissue in the breasts.

Not surprisingly, there is a very large range in the degree of breast enlargement in those men who present for treatment.  Some men have very little extra tissue, while others, if they were women, would fill a C or even a D cup bra.  What is common to all of these men is a deep sense of being very self conscious.  Almost all of these men will avoid taking their shirts off at the pool or the beach.  They would never dream of cutting the lawn with their shirts off.  Even around their partners or children they may feel uncomfortable.

In 1993, two medications, Risperdal and Invega, were approved for treatment of adult schizophrenia.  By 2006, the use of these two drugs was expanded.  Today, these medications have been used to treat schizophrenia in adults and children, bipolar, autism, ADHD, insomnia, and depression. It works by blocking dopamine.  Unfortunately, this causes the pituitary gland to produce more prolactin.  This may cause an actual increase in glandular breast tissue in males (not just an increase of fat ,which is the usual case in most other causes of gynecomastia).  It is more common in children and teenagers – sadly, the age when they are much more self conscious about their bodies.  Furthermore, these drugs can cause very enlarged breasts that can also be asymmetrical.  Not surprisingly, there has been an abundant number of lawsuits that have been settled, both in and out of the courts, between Johnson & Johnson and the plaintiffs who have suffered these side effects.

Those who have developed gynecomastia as a result of the above drugs will almost certainly require surgery for correction.  However, the usual small periareolar incision that is normally used for “routine” gynecomastia, may not be adequate.  An “anchor” type of incision, or maybe even a free nipple graft, may be required.

The best advice I can give is to see a board certified plastic surgeon for an assessment.