Page Content : Gynecomastia or Male Breast Definition, Causes of Gynecomastia, Synonyms & Types of Gynecomastia, Gynecomastia Treatment Options, Details of Classical & "Minimally Invasive Total Chest Reshaping Gynecomastia Surgery" - (Our Own Development ),Gynecomastia Surgery Video, Gynecomastia surgery Before After Pictures of different types & Faqs regarding Gynecomastia Surgery, Recovery & potential side effects. Before After Pictures and Link of our videos below in appropriate sections. Both English and Hindi Versions. You may also go to our gynecomastia Surgery Videos Play list on you tube by clicking here - Gynecomastia Surgery Delhi Male Breast Reduction India Videos by Dr Prabhash .

Gynecomastia or Enlarged Male Breast

Gynecomastia Definition - Gynecomastia, as its name suggests, is development of female like breast in males.
Synonyms : Male Breast, Gynecomastia, Man Breast, Male Chest Fat or Moobs

Composition of Male Breast tissue & What Causes Gynecomastia : Breast is there in both males and females. Main components of breasts , both in male & female are glands and fat. Glands are active milk secreting tissue & fat provides cushion to these gland. So every breast will be having both, glands and fat, however one component may predominate. besides glands and fat, there are nerves, blood vessels, fibrous tissue, musculo-cuteneous ligaments etc.
In male and in children below pubertal age, breast tissue is limited to the area beneath nipple and areola like a thin disc. On puberty, under influence of hormones it grows fully in females while less amount of estrogen or female hormone fails to promote growth of breast in male. Please mind, both males & females are having hormones of both sexes.
In some males, deficiency of male hormone (testosterone ) or excess of female hormone (estrogen) or both promotes development of Breast similar to those in females.
In most of cases, its exaggeration of normal physiology (i.e. idiopathic - when no recognized reason is found), while in some it may be due to obesity (leading to peripheral conversion of male hormone into female), Deficiency of testosterone & thyroid hormones, Some liver and kidney diseases leading to hormone imbalance, some Congenital defect in hormone production, Thyroid hormone deficiency, chromosomal abnormality (like Klinfelter syndrome ) some drugs or medicines and very rarely estrogen secreting tumor. In some cases, other parts of body may also be affected , specially primary & secondary sexual characters.
Global warming, altered food and sleep habits and increasing stress of work may be the most common factor today in reducing testosterone level in males and also altered hormone balance in females leading to PCOD. It seems reduction in potency & fertility of males will be the most common health issue in coming era if we don't change our lifestyle and don't take care of environment.
So, first , we need to see case, record complete medical history and some laboratory tests to diagnose identifiable cause of gynecomastia, if any.

Types Of Gynecomastia or Male Breast: this section includes description & different types or grades of gynecomastia along with Gynecomastia Before After Pictures : Three usual types:- (a) Neonatal Gynecomastia or male breast (Man Breast) (in new born babies irrespective of gender - under influence of maternal sex hormone) (b) Adolescent Gynecomastia or male breast (Man Breast) enlargement, (at puberty), should regress after one to two years normally. If hormonal imbalance is there, it will continue growing. This represents most of gynecomastia cases, means they actually arise in adolescent age and get recognized later. (c) In old age or Senile Gynecomastia or male breast (Man Breast) enlargement, (Our circulating male hormone testosterone level starts declining after 30 yrs of age, and with reduced testosterone level , female hormone starts predominating) (d) other reasons may be pathological or drug induced Gynecomastia or male breast enlargement.
Depending upon involvement of breast on one side or both it may be Unilateral Gynecomastia (i.e. one side only)
   
or Bilateral Gynecomastia (i.e. both sides). Please mind, even if gynecomastia is predominantly visible on one side, some enlargement is almost always there on other side , so if you correct only on one side, other side will look awkward after some time. Actual incidence of purely unilateral gynecomastia is dubious. In most of cases, even in bilateral gynecomastia, one side will be little bigger than the other side (usually left side). Human body is almost never symmetrical i.e. left and right sides are almost never identical. see our video on  Gynecomastia surgery - Unilateral or Bilateral explained by Dr Prabhash (Delhi, India)
Depending upon predominance of tissue types, gynecomastia may be mainly fatty or florid (mainly glands) or mixed. Please mind both glands and fat will always be there, however one may predominate.
Besides, glands and fat, nipple and areola size is also considered while planning for surgery. in most cases, nipple and areola will shrink in size after removal of underneath glands, very rarely, nipple and / or areola reduction may be required.
Depending upon size of gynecomastia - it can be 1 ) so called puffy Nipple - it seems there is no gynecomastia, only the nipple portion is little protruding. Actually , nipple cant protrude without well formed gynecomastia or male breast tissue beneath. Areola is usually tubular in such cases and need complete removal of breast tissue including glands and fat.
Mild or Grade I (Minimal Gynecomastia),
Grade II (Moderate Gynecomastia with No skin excess),
Grade III (Severe Gynecomastia with or without skin excess (III A or III B).
These grades are based on fact that whether skin excision will be required or not. These classifications are useless with Minimally invasive total chest reshaping, as no skin excision is required in our cases. Skin contraction is superb & we get flat chest without skin excision in almost all cases. (see examples below)

Gynecomastia Treatments or Male Breast Treatments : Glands in Gynecomastia or Male breast are active tissue and fat provides cushion. Glands in Gynecomastia once developed, don't have any method to go back to its prepubertal size, so it cant recede back and Fat in Male Breast or Gynecomastia is cushion providing fat and not energy store, so this fat usually doesn't disappear even with vigorous exercise. However, some reduction in fat can be noticed with exercise.
So, finally, Unfortunately , Surgery is the only option for cure of gynecomastia right now.

Drug Treatment for Gynecomastia Medicine or Drug Treatments for Gynecomastia or Male breast (Man Breast) :-Can be tried after consulting some endocrinologist but invariably they fail to reduce size surgery is ultimately required. Gynecomastia is a hormone induced problem and treatment will be anti hormone, which affects other functions too. Side effects are usually intolerable. Most important, Glands once grown don't revert back. There are many so called "Chest Fat Reduction Pills" or Chest Fat Removal Medicines being advertised, we advice you to any medicine only after consulting endocrinologist. Some chest fat reduction pills companies have hacked our video in past and put their advertisement on that, we declare that we don't have any association with any of them.

Gynecomastia Surgery

Various Types for Gynecomastia Surgery (Man Breast Surgery or Male Breast Reduction Surgery) :-

Open Gynecomastia surgery or Male Breast Reduction Surgery :-

Peri-areolar or Circum-areolar Incision:- In open approach & En-bloc or In toto removal , Half circumference usually lower half or smile incision) incision is made either at areola skin junction or just inside , gland is dissected through the same opening and entire gland is delivered out. Excess skin, if there is also excised causing a permanent big scar. This is classical surgery for gynecomastia with En-bloc removal technique which removes gynecomastia tissue as well as nerves, blood vessels and skin (when required), not recommendable now. With our modification (see below), nerve and blood vessels are preserved and skin contraction is very good to excellent. We never needed to remove skin, so no long permanent scar, skin turns flat in almost every case.

Infra-mammary approach :- Actual incision is planned below the breast in breast fold to primarily extra skin along with gynecomastia tissue. this surgery may turn obligatory in some cases where skin sagging is too much or breast is very large & saggy ,otherwise its best avoided, as it leaves an ugly scar in visible area. till now, we never needed to perform it even in bigger Gynecomastia cases.

Minimally Invasive Surgery (MIS) :-

Minimally Invasive (Scar less) Surgery (MIS) :- Minimally Invasive Gynecomastia Surgery or Male Breast Reduction includes Liposuction & Gland removal, both through tiny incisions. Liposuction is done through remote tiny incisions ( 3-4 mm) for removal of Fat, followed by removal of glands with cannulas. Almost entire fat and most of glandular tissue is out with this maneuver, Residual glands are removed through a very small incision near areola margin.
Scars of liposuction heal in 5-6 days and color match takes around 2-3 months, incision line at areola is almost invisible in almost every case, so making this surgery virtually scar-less.

Minimally Invasive Total Chest Reshaping (MIS - TCR) :- Males who have Gynecomastia or male breast enlargement also have fat distribution and shape of upper body more like females. In such cases only removal of Gynecomastia tissue from beneath the nipple is not sufficient. In such patients we are doing total chest reshaping with Liposuction, including front and sides of chest along with Gynecomastia removal so that their feminine appearance changes to normal regular masculine shape. We developed this technique in 2010 and named it "Minimally Invasive Total Chest Reshaping". After refining our technique, studying all its pros & cons, limitations, our first video of minimally invasive total chest reshaping was published on you tube on 12 March 2011. It turned to be a landmark video in field of gynecomastia treatment. Many people tried to copy our technique and publish it with different names like pinhole surgery, keyhole surgery etc.
Watch 1st Minimally Invasive Total Chest Reshaping Gynecomastia Surgery Video on you tube - Gynecomastia : Minimally Invasive total Chest Reshaping Surgery.
Please mind, This minimally invasive technique is not simply Liposuction & Gland removal (what people think). Any surgical design is based on some principle. This particular Male breast reduction surgery designed has been developed specially to remove gland and fat through tiny invisible incisions, so practically scar less, plus main target is maximum preservation of nerves and blood vessels (so better preservation of sensation) and induction of skin contraction, so that skin turn flat on muscle after surgery (no skin cutting so no scar). You need to plan for every case, where to put entry point for liposuction, up to what extent liposuction should be done, suction pressure in machine, how to handle central area and where to put incision for gland removal for scar less result. its all based on experience and there is no fixed rule .
Currently, we are doing male breast reduction through minimally invasive surgery in almost all cases, its not only scar less but time saving also, entire surgery takes 60-80 minutes only in average case. Best part of this surgery procedure is that its almost scar less, best possible preservation of nerves and blood vessels (so negligible loss of sensation ), & best possible skin contraction so no need to cut skin, skin turns flat on muscle. No extra skin removal ,  so no added scar. (see our oldest video & description below).

Why not Liposuction through areola or Gland Removal Through Nipple : Nipple and Areola are specialized tissues and their color is relatively darker. Anywhere in body, if there is trauma there will be hyper pigmentation or color will turn little dark. This is normal response of body. Gradually its turn light and finally little lighter than surrounding normal skin. In nipple and areola, it turns light and scar becomes prominent due to color difference. Movement of cannulas during liposuction produces heat and it may cause discoloration of nipple & areola. in males, Nipple is very small and removal of entire glands will tear the incision & make margin ragged, scar and hypo pigmentation possibility would be high. We avoid doing this but we have seen such deformity during revision surgery in cases primarily operated somewhere else. Example below.

 

                                                 So, Liposuction through Nipple & Areola is best avoided. We developed, breast gland removal (not liposuction ) through nipple in FTM Top Surgery or Female to Male Breast removal in 2012 as an extension of Minimally Invasive Total Chest Reshaping in female breasts. Its good for female breasts as Nipple size is bigger, more stretchable and nipple needs reduction after FTM top surgery. During nipple reduction, fresh tissue is repaired leading to well healed small nipple. (will load video soon).
Moreover, Puncture point made for liposuction in our surgery heals well in 3-5 days, little darker for 2-3 weeks and unnoticeable after that. Incision nears areola margin , where we take advantage of color transition is almost never visible. So, Liposuction through nipple or areola is best avoided & gland removal through nipple is suitable only in FTM Breast Removal or FTM Top Surgery.

Male Breast Reduction Gynecomastia Surgery : Videos & Before & After Pictures

Our First & oldest Minimally invasive total chest reshaping video - must watch to understand the procedure -
Gynecomastia Surgery video by Dr Prabhash (Delhi, India) - English
Gynecomastia Surgery in Delhi by Dr Prabhash - Hindi

Minimally Invasive Total Chest Reshaping Video including results of Female to male (FTM) Breast Removal, we are using this surgery for FTM ( Female to Male gender reassignment surgery or sex change) with excellent results. Skin contraction is remarkable and no skin excision required in any case, so no long permanent scar. This the charm of our modification.
Watch this video on You tube - Gynecomastia Surgery Delhi Scarless "Minimally Invasive Total Chest Reshaping" India

Gynecomastia Surgery - Picture showing Instrument entry points (two) , each 3-4 millimeters punctures in skin only away from breast area, (some blood visible there). Appearance of nipple areola just after surgery, practically invisible cut, Correction of entire breast area along with side bulges.

Gynecomastia Surgery or Male Breast Reduction Before After Pictures : -

Mild to moderate gynecomastia surgery or male breast before after -

Before After Picture Scar less Gynecomastia Surgery / Male Breast Reduction Correction

Small to moderate gynecomastia with hanging breasts.

Moderate & diffuse gynecomastia surgery before after

Moderate & formed breasts (acquiring feminine shape) Gynecomastia surgery before after picture

Large & diffuse with poor skin elasticity - as is seen after weight loss

Large & formed breast (but not hanging) - case of testicular failure -

Large , well formed & hanging breasts - Gynecomastia Before After .

Minimally Invasive Total Chest Reshaping works well even in Largest size Gynecomastia. Most impressive is skin contraction after Gynecomastia treatment.

Male Breast Reduction Surgery during operation and Gynecomastia Surgery before after picture- Comparison of Breast Mass before and after scar less removal.

Gynecomastia or Male Breast : Before after Picture scar less removal, Skin contracts well no skin removal required.

Male Breast Reduction : Revision Gynecomastia Surgery

Gynecomastia Revision Surgery : Most of Gynecomastia revision cases are for either residual Gynecomastia or breast gland tissue there due to incomplete removal or unacceptable scar or due to deposition of fibrous protein tissue deposited there due to improper use of compression garment in post operative period. It can happen in any surgery with any surgeon and patient. You should have faith in your surgeon as it can be corrected. Fortunately, we needed to do only one revision for our case in last seven years, most of gynecomastia revision we are doing were operated somewhere else.  Revision surgery ideally should be done 6 months to one year after primary surgery, once the skin there becomes soft and supple. Revision surgery too soon may lead to failure.

Male Breast Reduction or Gynecomastia Surgery Treatment procedure & Gynecomastia Surgery Recovery Time

Male breast reduction or gynecomastia surgery treatment course, duration & recovery - Consultation with thorough discussion about problem & procedure followed by some blood tests & hormone tests (as per requirement) if found fit you may book date for surgery (please mind our dates are booked in advance & we are unable to entertain sudden appearance for surgery) On the day of surgery - Nil by Mouth (means empty stomach - 6 hours before surgery
Under anesthesia - 5 -10 minutes before surgery
Average Gynecomastia surgery duration- 60-90 minutes.( may be little more in larger cases)
recovery from anesthesia - almost immediate after surgery,
Surgery & Post operative period almost painless, rest- 3 hours, Usual smooth activity & liquids followed by normal diet allowed after 5-6 hours,
discharge from hospital after male breast reduction surgery- after 6-7 hours.
mild discomfort - 2-3 days (similar to stiffness after exercise), mild swelling 1-2 weeks (almost invisible),

Rest from work advisable for 3-4 days
return to exercise schedule after gynecomastia surgery - after 3-4 weeks. this is routine after male breast gynecomastia surgery - there may be minor variation from case to case.

Other Surgeries Combined with Gynecomastia : Usually we prefer to do one surgery at a time, but if needed other surgeries can be combined with male breast reduction. Most common surgery combined with male breast are abdomen or stomach liposuction, Mons pubis liposuction and penile girth enlargement surgeries. Males with Gynecomastia, if having low lwvwl of testosterone hormone, feminine distribution of fat, bulky mons pubis hiding penile length and poor development of penile organ is not very uncommon. Abdominal liposuction or penile enlargement is combined if cumulative magnitude of all procedures is within acceptable limit and its common. if fat volume very high then, it can be better done in stages, we don't recommend combining surgeries with undue risk. please see liposuction and penile surgery page on our main website for details.

 
Gynecomastia Surgery & Abdomen Liposuction - Total Torso Reshaping

              
                    

Female to Male Breast Reduction (FTM Top Surgery) : Minimally invasive total chest reshaping is useful not only in male breast reduction but for female to male breast reduction or FTM Top surgery too. In cases of gender reassignment or sex change surgery, we take out entire breast through same small punctures and small incisions. Skin contracts well and turns flat over chest. So, even in female to male breast reduction you get a good masculine shape without any added scar. usually a big permanent scar is there due to removal of excess skin after surgery, we dont do that surgery. Minimally invasive total chest reshaping is good enough for FTM cases too.

         FTM Top Surgery by Dr Prabhash (Delhi, India)

         for FTM top surgery before after please see our  surgery videos on you tube.
Female to Male Breast Reduction or FTM Top Surgery Before After. Minimally invasive total chest reshaping for a complete flat masculine chest without any added scar. Commonly excess skin is removed in such cases leading to a long permanent scar below nipple area at junction of chest and abdomen, we can avoid scat with minimally invasive FTM breast Reduction.

Q :- Is there any chance of regression without surgery?

Ans:- yes, regression can be seen within one year of development of Gynecomastia. After one year chances of regression are less and persistence of male breast or Gynecomastia beyond two years is clear indication for surgery.

Q : What about awake Tumescent Gynecomastia Surgery?

Ans : Tumescent anesthesia and analgesia is used in every case of liposuction everywhere in body , so it doesn't need special mention. We are doing tumescent liposuction for fat removal, chest reshaping and use gland cutting cannulas for gland removal . Its because of tumescent infiltration, both Gynecomastia removal as well as total chest reshaping has become possible with minimally invasive technique. Use of isolated tumescent anesthesia for small gynecomastia cases is okay, but total chest reshaping should be best avoided in isolated tumescent anesthesia, as either local anesthesia will pass in toxic dosage, or patient will feel uncomfortable and there will be half hearted job. Many patients we are seeing for revision, first done under local anesthesia somewhere else.

Q:- is Gynecomastia surgery a big surgery?

Ans:- No, its moderate level Day Care surgery. You may go back to home 5-6 hours after gynecomastia surgery.

Q:- How much rest required?

Ans :- If you are office worker with no much physical activity you may resume work in 2-3 days , if more physical work is there should delay for 4-5 days then resume gradually. Strenuous work and heavy weight lifting should be avoided for at least three weeks.

Q :- Any complication possible and what is incidence?

Ans:- Almost all complication related to other surgeries including infection, bleeding, persistent pain, persistent numbness, unsatisfactory result may happen in Gynecomastia surgery also. Till Now we have not seen any major complication. We take proper precaution right for very beginning and getting good result. Patient cooperation is also very important in avoiding haematoma & seroma. As such these don't affect healing and final result much but certainly spoil your time and delay recovery. Without patient cooperation, its almost impossible to get good result in any plastic & cosmetic surgery. we are thankful to our patients .

Q :- Any Chance of breast cancer in Gynecomastia?

Ans:- Male breast cancer are rare but yes rarely some cases may develop cancer. Chances are remote. Rather tumors of testis and hormone secreting glands are more common.

Q :- Any systemic disorder which may be associated with Gynecomastia ?

Ans :- Yes, a vast majority of abnormal hormonal disorders, Impaired Thyroid, kidney & liver function may be associated with Gynecomastia but in a few percentage of cases. majority of Gynecomastia are idiopathic . Most common tumor association are hormone secreting tumors, usually found in testis, in adrenal gland, or Para vertebral lymph nodes.

Contact Us
Dr. Prabhash's Cosmetic Surgery Clinic
B-20, B Block Shopping Centre, (Behind Post Office) Tagore Garden
(Near Tagore Garden Metro Station)
New Delhi, Delhi, India
For Appointment :- Mob: +91-08826795869, 08130600960,  09311614424, 09350948285
Ph: +91-11- 45019453, 011-25191051
E-mail : dr_prabhash@yahoo.co.in
Fax: +91-11-45019453; (Thursday Closed)